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Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study

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Abstract

Summary

The incidence of atypical femoral fractures (AFFs) was 2.95% among 6644 hip and femoral fractures. Independent risk factors included the use of bisphosphonates (BPs), osteopenia or osteoporosis, rheumatoid arthritis, increased femoral curvatures, and thicker femoral cortices. Patients with AFFs and BP treatment were more likely to have problematic healing than those with typical femoral fractures (TFFs) and no BP treatment.

Introduction

To determine the incidence and risk factors of atypical femoral fractures (AFFs), we performed a multicenter case-control study. We also investigated the effects of bisphosphonates (BPs) on AFF healing.

Methods

We retrospectively reviewed the medical records and radiographs of 6644 hip and femoral fractures of patients from eight tertiary referral hospitals. All the radiographs were reviewed to distinguish AFFs from TFFs. Univariate and multivariate logistic regression analyses were performed to identify risk factors, and interaction analyses were used to investigate the effects of BPs on fracture healing.

Results

The incidence of AFFs among 6644 hip and femoral fractures was 2.95% (90 subtrochanter and 106 femoral shaft fractures). All patients were females with a mean age of 72 years, and 75.5% were exposed to BPs for an average duration of 5.2 years (range, 1–17 years). The use of BPs was significantly associated with AFFs (p < 0.001, odds ratio = 25.65; 95% confidence interval = 10.74–61.28). Other independent risk factors for AFFs included osteopenia or osteoporosis, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex at the shaft level. Interaction analyses showed that patients with AFFs using BPs had a significantly higher risk of problematic fracture healing than those with TFFs and no BP treatment.

Conclusions

The incidence of AFFs among 6644 hip and femoral fractures was 2.95%. Osteopenia or osteoporosis, use of BPs, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex were independent risk factors for the development of AFFs. Patients with AFFs and BP treatment were more likely to have problematic fracture healing than those with TFFs and no BP treatment.

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Acknowledgments

We thank Soohyun Ahn for her assistance with the statistical analyses.

Funding

This work was supported by Takeda Pharmaceuticals Korea Co., Ltd.

Author information

Author notes

  1. Seung-Jae Lim and Ingwon Yeo equally contributed to this work and share first authorship.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea

    S.-J. Lim & Y.-S. Park

  2. Department of Orthopaedic Surgery, Sejong General Hospital, Gyeongi-do, Bucheon-si, South Korea

    I. Yeo

  3. Department Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    P.-W. Yoon

  4. Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

    J.J. Yoo

  5. Department of Orthopaedic Surgery, Kyung Hee Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea

    K.-H. Rhyu

  6. Department of Orthopedics, Korea University Anam Hospital, Korea University College of Medicine, Seongbuk-gu, Seoul, South Korea

    S.-B. Han

  7. Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea

    W.-S. Lee

  8. Department of Orthopaedic Surgery, St. Vincent’s Hospital, The Catholic University of Korea College of Medicine, Suwon, South Korea

    J.-H. Song

  9. Department of Orthopaedic Surgery, Dongsan Medical Center, Kyemyung University College of Medicine, Daegu, South Korea

    B.-W. Min

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  1. S.-J. Lim
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Corresponding author

Correspondence to Y.-S. Park.

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Lim, SJ., Yeo, I., Yoon, PW. et al. Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study. Osteoporos Int 29, 2427–2435 (2018). https://doi.org/10.1007/s00198-018-4640-4

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  • DOI: https://doi.org/10.1007/s00198-018-4640-4

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