Calcified Tissue International

, Volume 104, Issue 3, pp 313–319 | Cite as

Bisphosphonates Use and Risk of Subtrochanteric and Diaphyseal Femur Fractures in Korea: Results from the National Claim Registry

  • Young-Kyun Lee
  • Dong Won ByunEmail author
  • Sung-Mok Jung
  • Hye-Young Kwon
  • Ha-Young Kim
  • Se Hwa Kim
  • Tae-Young KimEmail author
  • Sunmee Jang
  • Yong-Chan Ha
Original Research


Although Asian with bisphosphonate has been considered to have higher risk of subtrochanteric and diaphyseal femur (ST/DF) fractures, the occurrence of those fractures has been still unclear in Asia. The purpose of this study was to investigate the incidence rate of ST/DF fractures among bisphosphonate users from nationwide database in South Korea. Using national health insurance claim database, we only included the bisphosphonate users who took bisphosphonate for the first time in 2008 and evaluated the incidence rate of ST/DF fracture from 2008 to 2013. Non-user controls were matched to bisphosphonate users by propensity score matching with age and gender. Cox regression models were used to calculate hazard ratios of ST/DF fracture with and without adjustment for comorbidity. A total of 682 ST/DF fractures were observed among 348,311 bisphosphonate users. The incidence rate of ST/DF fracture among bisphosphonate users (37.75/100,000 person years, 95% CI 35.02–40.70) was higher compared with non-users (24.41/100,000 person years, 95% CI 22.31–26.71). The risk of ST/DF fracture was greater in bisphosphonate users compared with non-users (hazard ratio 1.541, 1.370–1.734; p < 0.001). The incidence rate of ST/DF fracture after bisphosphonate use could be determined in Korean patients, which can provide basal information for further studies on risk and benefit of continuing bisphosphonate.


Bisphosphonates Atypical femur fracture Incidence rate Korea 



This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Korea (Grant Number: HI13C1522).

Author Contributions

Y-KL, DWB, H-YK, H-YK, SHK, T-YK, SJ, and Y-CH designed the study. Y-KL, DWB, S-MJ, H-YK, H-YK, SHK, T-YK, and SJ contributed to the acquisition, analysis, or interpretation of data. Y-KL, DWB, S-MJ, H-YK, H-YK, T-YK, and Y-CH prepared the first draft of the manuscript. Y-KL, DWB, S-MJ, H-YK, H-YK, SHK, T-YK, SJ, and Y-CH contributed to the critical revision of the manuscript for important intellectual content. Y-KL, DWB, S-MJ, H-YK, H-YK, SHK, SJ, and Y-CH were responsible for statistical analysis of the data. Y-KL, S-MJ, H-YK, SHK, T-YK, SJ, and Y-CH contributed to the administrative, technical, or material support. All authors revised the paper critically for intellectual content and approved the final version. All authors agree to be accountable for the work and to ensure that any questions relating to the accuracy and integrity of the paper are investigated and properly resolved.

Compliance with Ethical Standards

Conflict of interest

Young-Kyun Lee, Dong Won Byun, Sung-Mok Jung, Hye-Young Kwon, Ha-Young Kim, Se Hwa Kim, Tae-Young Kim, Sunmee Jang, and Yong-Chan Ha declare that they have no conflict of interest.

Research Involving Human Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Patient consent was not obtained because patient records/information were anonymized and de-identified prior to analysis.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSeongnamRepublic of Korea
  2. 2.Department of Endocrinology, Internal MedicineSoonchunhyang University HospitalSeoulRepublic of Korea
  3. 3.Graduate School of MedicineHokkaido UniversitySapporoJapan
  4. 4.Department of Biology & Public HealthMokwon UniversityDaejeonRepublic of Korea
  5. 5.Department of Internal MedicineWonkwang University Sanbon HospitalGunpoRepublic of Korea
  6. 6.Department of Internal MedicineCatholic Kwandong University College of Medicine, International St. Mary’s HospitalIncheonRepublic of Korea
  7. 7.Department of Orthopaedic Surgery, School of Medicine, Konkuk University Medical CenterKonkuk UniversitySeoulRepublic of Korea
  8. 8.College of Pharmacy and Gachon Institute of Pharmaceutical SciencesGachon UniversityIncheonRepublic of Korea
  9. 9.Department of Orthopaedic Surgery, School of MedicineChung-Ang UniversitySeoulRepublic of Korea

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