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The clinical characteristics of patients with hip fractures in typical locations and atypical femoral fractures

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Abstract

Summary

The pathophysiology of atypical fractures is unknown. We compared characteristics of patients with atypical femoral fractures and hip fractures in typical locations of the femur. Patients with atypical fracture reported a longer duration of use of bisphosphonates, had higher body mass index, and higher total hip bone mineral density. Further studies are needed.

Introduction

This study aims to describe the characteristics of patients with typical and atypical fractures of the femur assessed in a tertiary care osteoporosis center.

Methods

We abstracted clinical, laboratory, and radiographic data on subjects with a history of a low-impact fracture at the femur and/or hip (confirmed by review of radiograph and/or radiology report) from January 2008 to October 2011. Available radiographs were reviewed and fracture categorized as typical or atypical by a radiologist blinded to the original diagnosis.

Results

Radiology reports were available for 72 subjects: 40 hip fractures in typical locations (typical fracture), 16 atypical femoral fracture (atypical fracture), and 16 were excluded. While both those with typical and atypical fractures reported taking bisphosphonates at the time of fracture, duration of use was longer with atypical fractures (104.2 ± 42.0 months) compared with typical (71.1 ± 62.8 months) (p = 0.04). Body mass index (BMI) was higher in patients with atypical fractures (26.2 ± 3.2 kg/m2) than in those with typical (23.1 ± 4.3 kg/m2) (p = 0.006). Total bone mineral density (BMD) was higher in patients with atypical fracture (0.795 ± 0.102) versus typical (0.686 ± 0.130) (p = 0.003) Previous history of cancer was reported by 7 of 16 patients with atypical and 7 of 40 patients with typical fracture (p = 0.04).

Conclusions

Compared to those with typical fractures, patients with atypical fracture report a longer duration of use of bisphosphonates, higher BMI, and higher total hip BMD. Future studies should examine if these differences contribute to the pathophysiology of atypical fractures.

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References

  1. Nieves JW, Bilezikian JP, Lane JM, Einhorn TA, Wang Y, Steinbuch M, Cosman F (2010) Fragility fractures of the hip and femur: incidence and patients characteristics. Osteoporosis Int 21:399–408

    Article  CAS  Google Scholar 

  2. Abrahamsen B, Eiken P, Eastell R (2009) Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study. J Bone Miner Res 24:1095–1102

    Article  CAS  PubMed  Google Scholar 

  3. Wang Z, Bhattacharyya T (2011) Trends in incidence of subtrochanteric fragility fractures and bisphosphonate use among the US elderly, 1996–2007. J Bone Miner Res 26:553–560

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Girgis CM, Sher D, Seibel M (2010) Atypical femoral fractures and bisphosphonate use. N Engl J Med 362:1848–1849

    Article  CAS  PubMed  Google Scholar 

  5. Neviaser AS, Lane JM, Lenart BA, Edobor-Osula F, Lorich DG (2008) Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma 22:346–350

    Article  PubMed  Google Scholar 

  6. Koh JS, Goh SK, Png MA, Kwek EB, Howe TS (2010) Femoral cortical stress lesions in long-term bisphosphonate therapy: a herald of impending fracture? J Orthop Trauma 24:75–81

    Article  PubMed  Google Scholar 

  7. Park-Wyllie LY, Mamdani MM, Juurlink DN, Hawker GA, Gunraj N, Austin PC, Whelan DB, Weiler PJ, Laupacis A (2011) Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA 305:783–789

    Article  CAS  PubMed  Google Scholar 

  8. Shane E, Burr D, Ebeling PR, Abrahamsen B, Adler RA, Brown TD, Cheung AM, Cosman F, Curtis JR, Dell R, Dempster DW, Einhorn TA, Genant HK, Geusens P, Klaushofer K, Lane JM, McKiernan F, McKinney R, Ng A, Nieves J, O’Keefe R, Papapoulos S, Sen HT, van der Meulen MC, Weinstein RS, Whyte M, American Society for Bone and Mineral Research (2014) Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res May 29(1):1–23

    Article  Google Scholar 

  9. Bessette L, Ste-Marie LG, Jean S, Davison KS, Beaulieu M, Baranci M, Bessant J, Brown JP (2008) The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporosis Int 19:79–86

    Article  CAS  Google Scholar 

  10. Lenart BA, Neviaser AS, Lyman S, Chang CC, Edobor-Osula F, Steele B, Van Der Meulen MCH, Lorich DG, Lane JM (2009) Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study. Osteoporosis Int 20:1353–1362

    Article  CAS  Google Scholar 

  11. Schneider JP, Hinshaw WB, Su C, Solow P (2012) Atypical femur fractures: 81 individual personal histories. J Clin Endocrinol Metab 97:4324–4328

    Article  CAS  PubMed  Google Scholar 

  12. Giusti A, Hamdy N, Dekkers OM, Ramautar SR, Dijkstra S, Papapoulos SE (2011) Atypical fractures and bisphosphonate therapy: a cohort study of patients with femoral fracture with radiographic adjudication of fracture site and features. Bone 48:966–971

    Article  CAS  PubMed  Google Scholar 

  13. Edwards MH, McCrae FC, Young-Min SA (2010) Alendronate-related femoral diaphysis fracture—what should be done to predict and prevent subsequent fracture of the contralateral side? Osteoporosis Int 21:701–703

    Article  CAS  Google Scholar 

  14. Giusti A, Hamdy NA, Papapoulos SE (2010) Atypical fractures of the femur and bisphosphonate therapy: a systematic review of case/case series studies. Bone 47:169–180

    Article  CAS  PubMed  Google Scholar 

  15. Jamal SA, Dion N, Ste-Marie LG (2011) Atypical femoral fractures and bone turnover. N Engl J Med 365:1261–1262

    Article  CAS  PubMed  Google Scholar 

  16. Napoli N, Schwartz AV, Palermo L, Jin JJ, Wustrack R, Cauley JA, Ensrud KE, Kelly M, Black DM (2013) Risk factors for subtrochanteric and diaphyseal fractures: the study of osteoporotic fractures. J Clin Endocrinol Metab 98:659–667

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Ensrud KE, Lipschutz RC, Cauley JA, Seeley D, Nevitt MC, Scott J, Orwoll ES, Genant HK, Cummings SR (1997) Body size and hip fracture risk in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Am J Med 103:274–280

    Article  CAS  PubMed  Google Scholar 

  18. Ensrud KE, Cauley J, Lipschutz R, Cummings SR (1997) Weight change and fractures in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med 157:857–863

    Article  CAS  PubMed  Google Scholar 

  19. Odvina CV, Levy S, Rao S, Zerwekh JE, Rao DS (2010) Unusual mid-shaft fractures during long-term bisphosphonate therapy. Clin Endocrinol 72:161–168

    Article  CAS  Google Scholar 

  20. Kwek EB, Goh SK, Koh JS, Png MA, Howe TS (2008) An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury 39:224–231

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Unidad de Endocrinología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile

    Soledad Velasco

  2. Division of Endocrinology and Metabolism, Women’s College Hospital, University of Toronto, Toronto, ON, Canada

    Sandra Kim & Sophie A. Jamal

  3. Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada

    Robert Bleakney

  4. Women’s College Research Institute, University of Toronto, Toronto, ON, Canada

    Sophie A. Jamal

Authors
  1. Soledad Velasco
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  2. Sandra Kim
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  3. Robert Bleakney
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  4. Sophie A. Jamal
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Correspondence to Sophie A. Jamal.

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Velasco, S., Kim, S., Bleakney, R. et al. The clinical characteristics of patients with hip fractures in typical locations and atypical femoral fractures. Arch Osteoporos 9, 171 (2014). https://doi.org/10.1007/s11657-014-0171-6

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  • DOI: https://doi.org/10.1007/s11657-014-0171-6

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