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Identifying Atypical Femoral Fractures—A Retrospective Review

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Abstract

Subtrochanteric atypical femoral fractures (AFFs) have been reported in patients on osteoporosis therapy (bisphosphonates and denosumab). In 2010, and again in 2013, the ASBMR AFF Task Force developed strict diagnostic criteria for AFFs. This is the first study using these criteria to define the prevalence of AFFs in Canada. This study is a retrospective review of all adult patients (April 2002–March 2013) with an ICD 10 code for hip, femoral or subtrochanteric fracture, from two referral hospitals in Alberta, Canada. All identified as isolated subtrochanteric fractures were further evaluated by chart review, prescription review and examination of radiographs. Of 349 subjects, 79 had isolated subtrochanteric fractures. Of the 70 cases of subtrochanteric fractures that were radiographically assessed (9 films unavailable), 41 fulfilled ASBMR 2013 AFF criteria. The remaining subjects had subtrochanteric fractures but did not meet the ASBMR criteria to qualify as AFFs. There were 11 AFFs in 2012/2013, giving a rate of AFFs of 1.42 per 100,000 50 + year adults, compared to a rate of 103.47 per 100,000 50+ year adults for typical hip fractures. Isolated subtrochanteric fractures are rare. They cannot reliably be identified by ICD coding alone. In this study, only 59 % of all isolated subtrochanteric/femoral shaft fractures fulfilled the ASBMR task force criteria for true AFFs. The rate of typical hip fractures was substantially higher than the rate of AFFs, defined by ASBMR diagnostic criteria.

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Acknowledgments

Grateful thanks to Alberta Health Services Data Integration, Measurement and Reporting, Edmonton Zone Analytic Team who provided the ICD 10 coded data. Research student activity substantially contributed to this paper from Stephanie RJ Davis and David A Jay.

Conflict of Interest

Angela G. Juby, Sean Crowther, and Marilyn Cree declare that they have nothing to disclose. No external funding was obtained for the study, but Summer Student Research funding was provided by the Department of Medicine, University of Alberta, for David A Jay.

Human and Animal Rights and Informed Consent

Ethics approval was obtained for this research from the Health Regional Ethics Board (HREB) at the University of Alberta.

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Authors and Affiliations

  1. Department of Medicine, University of Alberta, 1-108 Clinical Sciences Building, 11350 83rd Avenue, Edmonton, AB, T6G 2P4, Canada

    Angela G. Juby

  2. Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada

    Sean Crowther

  3. Faculty of Nursing, University of Alberta, Edmonton, AB, Canada

    Marilyn Cree

Authors
  1. Angela G. Juby
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  2. Sean Crowther
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  3. Marilyn Cree
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Correspondence to Angela G. Juby.

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Juby, A.G., Crowther, S. & Cree, M. Identifying Atypical Femoral Fractures—A Retrospective Review. Calcif Tissue Int 95, 405–412 (2014). https://doi.org/10.1007/s00223-014-9908-x

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  • DOI: https://doi.org/10.1007/s00223-014-9908-x

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