Abstract
Background
The location of bisphosphonate-related atypical femoral fractures (AFFs) is related to the femoral bow. Other factors that might also be related to the distribution of AFFs are not well studied. In this study, we attempt to define the demographic factors that influence the distribution AFFs in our local population.
Materials and Methods
The medical records of all the patients diagnosed with AFFs treated in our institution between 2008 and 2017 were retrospectively reviewed and divided based on fracture location into subtrochanteric and mid-shaft groups. Demographic data were collected and compared between the two groups. Independent factors affecting the location of AFFs were identified via multivariate analysis.
Results
Seventy-nine AFFs in 71 patients were included. Thirty-two fractures occurred at the subtrochanteric region and 47 occurred at the mid-shaft. Age, bone density, anterior femoral bow and lateral femoral bow were significantly different between the two groups, whereas height, weight, body mass index, presence of prodromal symptoms, type and duration of bisphosphonates were not significantly different. Multivariate analysis showed anterior femoral bow was the only independent factor associated with the location of AFFs.
Conclusions
Anterior femoral bow is the only factor that can predict the location of AFFs. In our population, other demographic factors were not found to be predictive.
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References
Kanis, J. A., Delmas, P., Burckhardt, P., Cooper, C., & Torgerson, D. (1997). On behalf of the European Foundation for Osteoporosis and Bone Disease, Guidelines for diagnosis and management of osteoporosis. Osteoporosis International, 7, 390–406.
Odvina, C. V., Zerwekh, J. E., Rao, D. S., Maalouf, N., Gottschalk, F. A., & Pak, C. Y. (2005). Severely suppressed bone turnover: a potential complication of alendronate therapy. Journal of Clinical Endocrinology and Metabolism, 90, 1294–1301.
Goh, S. K., Yang, K. Y., Koh, J. S., Wong, M. K., Chua, S. Y., Chua, D. T., et al. (2007). Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. Journal of Bone and Joint Surgery. British Volume, 89, 349–353.
Kwek, E. B., Goh, S. K., Koh, J. S., Png, M. A., & Howe, T. S. (2008). An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury, 39, 224–231.
Neviaser, A. S., Lane, J. M., Lenart, B. A., Edobor-Osula, F., & Lorich, D. G. (2008). Low-energy femoral shaft fractures associated with alendronate use. Journal of Orthopaedic Trauma, 22, 346–350.
Mashiba, T., Hirano, T., Turner, C., Forwood, M., Johnston, C., & Burr, D. (2000). Suppressed bone turnover by bisphosphonates increases microdamage accumulation and reduces some biomechanical properties in dog rib. Journal of Bone and Mineral Research, 15, 613–620.
Soh, H. H., Chua, I. T., & Kwek, E. B. (2015). Atypical fractures of the femur: effect of anterolateral bowing of the femur on fracture location. Archives of Orthopaedic and Trauma Surgery, 135, 1485–1490.
Hyodo, K., Nishino, T., Kamada, H., Nozawa, D., Mishima, H., & Yamazaki, M. (2017). Location of fractures and the characteristics of patients with atypical femoral fractures: analyses of 38 Japanese cases. Journal of Bone and Mineral Metabolism, 35, 209–214.
Kim, J. W., Kim, J. J., Byun, Y. S., Shon, O. J., Oh, H. K., Park, K. C., et al. (2017). Factors affecting fracture location in atypical femoral fractures: A cross-sectional study with 147 patients. Injury, 48, 1570–1574.
Shane, E., Burr, D., Abrahamsen, B., Adler, R. A., Brown, T. D., Cheung, A. M., et al. (2014). Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. Journal of Bone and Mineral Research, 29, 1–23.
Schilcher, J., Howe, T. S., Png, M. A., Aspenberg, P., & Koh, J. S. (2015). Atypical fractures are mainly subtrochanteric in Singapore and diaphyseal in Sweden: a cross- sectional study. Journal of Bone and Mineral Research, 30, 2127–2132.
Sasaki, S., Miyakoshi, N., Hongo, M., Kasukawa, Y., & Shimada, Y. (2012). Low-energy diaphyseal femoral fractures associated with bisphosphonate use and severe curved femur: a case series. Journal of Bone and Mineral Metabolism, 30, 561–567.
Oh, Y., Wakabayashi, Y., Kurosa, Y., Fujita, K., & Okawa, A. (2014). Potential pathogenic mechanism for stress fractures of the bowed femoral shaft in the elderly: mechanical analysis by the CT-based finite element method. Injury, 45, 1764–1771.
Kim, J. W., Kim, H., Oh, C. W., Kim, J. W., Shon, O. J., Byun, Y. S., et al. (2017). Surgical outcomes of intramedullary nailing for diaphyseal atypical femur fractures: is it safe to modify a nail entry in bowed femur? Archives of Orthopaedic and Trauma Surgery, 137, 1515–1522.
Park, Y. C., Song, H. K., Zheng, X. L., & Yang, K. H. (2017). Intramedullary Nailing for Atypical Femoral Fracture with Excessive Anterolateral Bowing. Journal of Bone and Joint Surgery. American Volume, 99, 726–735.
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Wei Yuan and Ernest Beng Kee Kwek declare that they don’t receive any financial support or sponsorship.
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Yuan, W., Kwek, E.B.K. The Influence of Demographic Factors on the Location of Bisphosphonate-related Atypical Femoral Fractures. JOIO 54 (Suppl 1), 116–120 (2020). https://doi.org/10.1007/s43465-020-00216-1
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DOI: https://doi.org/10.1007/s43465-020-00216-1