Skip to main content
Log in

The Influence of Demographic Factors on the Location of Bisphosphonate-related Atypical Femoral Fractures

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. 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.

    Article  CAS  Google Scholar 

  2. 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.

    Article  CAS  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. 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.

    Article  CAS  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. 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.

    Article  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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.

    Article  Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    Article  Google Scholar 

Download references

Funding

Wei Yuan and Ernest Beng Kee Kwek declare that they don’t receive any financial support or sponsorship.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ernest B. K. Kwek.

Ethics declarations

Conflicts of interest

Wei Yuan and Ernest Beng Kee Kwek declare that they have no conflict of interest.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Ethical approval

The study was approved by the local Institutional Review Board.

Informed consent

For this type of study, formal consent was not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43465-020-00216-1

Keywords

Navigation