McMaster University, Hamilton, ON, Canada.
Calcif Tissue Int. 2011 Dec;89(6):427-33. doi: 10.1007/s00223-011-9543-8. Epub 2011 Oct 30.
Our purpose was to characterize the risks of osteoporosis-related subtrochanteric fractures in bisphosphonate-naive individuals. Baseline characteristics of patients enrolled in the HORIZON-Recurrent Fracture Trial with a study-qualifying hip fracture were examined, comparing those who sustained incident subtrochanteric fractures with those sustaining other hip fractures. Subjects were bisphosphonate-naive or had a bisphosphonate washout period of 6-24 months and subsequently received an annual infusion of zoledronic acid 5 mg or placebo after low-trauma hip-fracture repair. In total, 2,127 men and women were included. Of the qualifying hip fractures, 5.2% were subtrochanteric, 54.8% femoral neck, 33.0% intertrochanteric, and 7.1% other (generally complex fractures of mixed type). Significant baseline (pre-hip fracture) differences were seen between index hip-fracture types, with the percentage of patients with extreme mobility problems being twofold higher in patients with index subtrochanteric fracture (9.9%) compared to other patients. The distribution of hip-fracture types was similar between the treatment groups at baseline. No patients with index subtrochanteric fractures and six patients with other qualifying hip fractures reported prior bisphosphonate use. Only one further subtrochanteric fracture occurred in each treatment group over an average 2-year patient follow-up. Subtrochanteric fractures are not uncommon in bisphosphonate-naive patients. Extreme difficulties with mobility may be a unique risk factor predisposing to development of incident subtrochanteric fractures rather than other types of hip fracture. In patients with recent hip fracture who received zoledronic acid therapy, the incidence of new subtrochanteric fractures was too small to draw any meaningful conclusions.
我们的目的是描述骨质疏松性髋部骨折患者中初次发生的股骨转子下骨折的风险特征。分析参加 HORIZON-Recurrent Fracture 试验的髋部骨折患者的基线特征，比较发生初次发生股骨转子下骨折和其他髋部骨折患者的特点。患者为初次使用双膦酸盐或双膦酸盐洗脱期 6-24 个月，在接受低创伤性髋部骨折修复后，每年接受唑来膦酸 5mg 或安慰剂治疗。共有 2127 名男性和女性患者入组。在所有髋部骨折中，5.2%为股骨转子下骨折，54.8%为股骨颈骨折，33.0%为转子间骨折，7.1%为其他（一般为混合类型的复杂骨折）。根据主要髋部骨折类型，患者的基线（骨折前）存在显著差异，发生初次股骨转子下骨折的患者中存在严重活动问题的比例是其他患者的两倍（9.9%）。在骨折前，各组间的髋部骨折类型分布相似。在初次股骨转子下骨折患者中没有患者和其他符合条件的髋部骨折患者报告有过双膦酸盐的使用史。在平均 2 年的患者随访中，每个治疗组各发生了 1 例初次股骨转子下骨折和 1 例其他类型的髋部骨折。初次股骨转子下骨折在初次使用双膦酸盐的患者中并不少见。严重的活动困难可能是一个独特的危险因素，容易导致初次发生股骨转子下骨折，而不是其他类型的髋部骨折。在接受唑来膦酸治疗的髋部骨折患者中，新发股骨转子下骨折的发生率太小，无法得出任何有意义的结论。
