Clinical characteristics, densitometric parameters and outcomes of patients with atypical femoral fractures related to bisphosphonate treatment for osteoporosis.

Publisher: Humana Press Country of Publication: United States NLM ID: 9434444 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1559-0100 (Electronic) Linking ISSN: 1355008X NLM ISO Abbreviation: Endocrine Subsets: MEDLINE

Publication: Feb. 1996- : Totowa, NJ : Humana Press
Original Publication: Houndsmills, Basingstoke, Hants, UK : Macmillan Press, c1994-

Bone Density Conservation Agents*/adverse effects ; Femoral Fractures*/chemically induced ; Femoral Fractures*/diagnostic imaging ; Femoral Fractures*/drug therapy ; Osteoporosis*/drug therapy ; Osteoporosis*/chemically induced ; Hip Fractures* ; Osteoporotic Fractures*/prevention & control; Adult ; Humans ; Diphosphonates/adverse effects ; Retrospective Studies

Purpose: We described the clinical and densitometric characteristics and treatment outcomes of patients who developed atypical femoral fractures (AFF) while on bisphosphonate for osteoporosis.
Methods: We performed a retrospective cohort study including all adults aged ≥50 years who developed AFF while on bisphosphonates between 1 January 2008 and 31 December 2020, and subsequently managed in the Osteoporosis Centre at Queen Mary Hospital in Hong Kong. A control group of patients who developed fragility hip fractures while on bisphosphonates in the same period was included for comparison. We compared the clinical and densitometric characteristics between the two groups, and described the clinical outcomes for the AFF group.
Results: In total, 75 patients were included (AFF: n = 35; fragility hip fracture: n = 40). All were related to oral bisphosphonates. The AFF group was characterised by a longer duration of bisphosphonate use (median of 5 years), higher bone mineral density (BMD) and more acute neck-shaft angle (all p < 0.05). Following AFF, 8 patients (22.9%) did not receive any subsequent bone-active agents: due to refusal to use an injectable, or BMD out of osteoporotic range. Most of those who received bone-active agents were given teriparatide, followed by raloxifene, and achieved stable BMD. However, subsequent fragility risk remained high. Nonetheless, AFF did not confer excess morbidity and mortality.
Conclusion: AFF was characterised by usually long duration of bisphosphonate use, higher BMD and more acute neck-shaft angle. AFF did not confer significant impairment in mobility or mortality. Nonetheless, further research work is necessary to optimise bone health among patients who develop AFF.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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Keywords: Atypical femoral fractures; Bisphosphonates; Bone mineral density; Hip structure analysis; Osteoporosis; Trabecular bone score

0 (Diphosphonates)
0 (Bone Density Conservation Agents)

Date Created: 20231120 Date Completed: 20240404 Latest Revision: 20240404

20240404

10.1007/s12020-023-03608-z

37985574