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Epidemiology and postoperative outcomes of atypical femoral fractures in older adults: A systematic review

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The journal of nutrition, health & aging

Abstract

Objective

To review the literature on epidemiology and postoperative outcomes particularly surgical, functional and quality of life of atypical femoral fractures (AFFs) in the older population (aged ≥65 years) using the first and second American Society of Bone Mineral Research (ASBMR) Task Force consensus definition.

Methods

Electronic search for articles on AFFs and bisphosphonates published in English was performed. Eligible studies were reviewed systematically in relation to (a) the epidemiology of AFFs in older people and (b) postoperative outcomes of AFFs.

Results

Twenty-three studies on AFFs were included: 14 on epidemiology and 11 on treatment outcomes (two articles reported on both aspects). The epidemiological studies showed that the incidence of AFFs is low (3.0-9.8 per 100,000 person-years) but relative risk increased with longer duration of bisphosphonates use, especially after more than three years. Most cases of AFFs occurred in older people aged 65 years and above. However, in six studies, the mean age of patients with bisphosphonate-related AFFs is younger than those with typical proximal femoral fractures (mean age range of 66–75 years versus 75-89 years respectively). Varying postoperative and functional outcomes have been reported but differences in study population, management approaches and endpoints may account for these variations. For incomplete AFFs, prophylactic surgical intervention is potentially beneficial.

Conclusion

The benefits of bisphosphonates in reducing osteoporotic fractures still outweigh the risk of AFFs in view of its low absolute risk, when the ASBMR Task Force criteria for this type of fracture were applied. The risk of AFFs in different age groups is not well defined but tends to affect the younger patients more (aged <65 years) as compared to the older population (aged ≥65 years). Evidence supporting different types of treatment in AFFs such as intramedullary or extramedullary surgical devices and the use of teriparatide, a parathyroid hormone analogue, is not yet well established.

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Authors and Affiliations

  1. Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia

    Kareeann S. F. Khow, P. Shibu, S. C. Y. Yu & R. Visvanathan

  2. Adelaide Geriatrics Training and Research with Aged Care (G-TRAC) Centre, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia

    Kareeann S. F. Khow, P. Shibu, S. C. Y. Yu & R. Visvanathan

  3. Discipline of Orthopaedics and Trauma, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia

    M. J. Chehade

  4. Aged and Extended Care Services, Level 8B Main Building, The Queen Elizabeth Hospital, 21 Woodville Road, Woodville South, SA, 5011, Australia

    Kareeann S. F. Khow

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  1. Kareeann S. F. Khow
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Correspondence to Kareeann S. F. Khow.

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Khow, K.S.F., Shibu, P., Yu, S.C.Y. et al. Epidemiology and postoperative outcomes of atypical femoral fractures in older adults: A systematic review. J Nutr Health Aging 21, 83–91 (2017). https://doi.org/10.1007/s12603-015-0652-3

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  • DOI: https://doi.org/10.1007/s12603-015-0652-3

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