Meier Raphael P H, Perneger Thomas V, Stern Richard, Rizzoli René, Peter Robin E
Department of Surgery, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
Arch Intern Med. 2012 Jun 25;172(12):930-6. doi: 10.1001/archinternmed.2012.1796.
Current evidence suggests that there is an association between bisphosphonate therapy and atypical femoral fractures, but the extent of this risk remains unclear.
Between 1999 and 2010, a total of 477 patients 50 years and older were hospitalized with a subtrochanteric or femoral shaft fracture at a single university medical center. Admission radiographs and medical and treatment records were examined, and patients were classified as having atypical or classic femoral fractures. A random sample of 200 healthy individuals without femoral fracture were also identified. Multivariate logistic regression was used to assess the association of bisphosphonate use and atypical femoral fracture, and the incidence rates of each type of fracture over time were calculated.
Thirty-nine patients with atypical fractures and 438 patients with classic fractures were identified. Of the patients with atypical fractures, 32 (82.1%) had been treated with bisphosphonates compared with 28 (6.4%) in the classic fractures group (odds ratios [OR], 66.9; 95% CI, 27.1-165.1) and 11.5% in the group without fracture (OR, 35.2; 95% CI, 13.9-88.8). Bisphosphonate use was associated with a 47% reduction in risk of classic fracture (OR, 0.5; 95% CI, 0.3-0.9). Considering the duration of use, the ORs (95% CIs) for atypical fractures were 35.1 (10.0-123.6) for less than 2 years, 46.9 (14.2-154.4) for 2 to 5 years, 117.1 (34.2-401.7) for 5 to 9 years, and 175.7 (30.0-1027.6) for more than 9 years compared with no use. A contralateral fracture occurred in 28.2% of atypical cases and in 0.9% of classic cases (OR, 42.6; 95% CI, 12.8-142.4). The incidence rate of atypical fractures was low (32 cases per million person-years) and increased by 10.7% per year on average.
Atypical femoral fractures were associated with bisphosphonate use; longer duration of treatment resulted in augmented risk. The incidence of atypical fractures increased over a 12-year period, but the absolute number of such fractures is very small.
目前的证据表明双膦酸盐治疗与非典型股骨骨折之间存在关联，但这种风险的程度仍不清楚。
1999年至2010年期间，共有477名50岁及以上的患者在一家大学医学中心因转子下或股骨干骨折住院。检查入院时的X光片以及医疗和治疗记录，将患者分为非典型或典型股骨骨折。还确定了200名无股骨骨折的健康个体的随机样本。采用多因素逻辑回归评估双膦酸盐使用与非典型股骨骨折的关联，并计算每种类型骨折随时间的发病率。
确定了39例非典型骨折患者和438例典型骨折患者。在非典型骨折患者中，32例（82.1%）接受过双膦酸盐治疗，而典型骨折组为28例（6.4%）（比值比[OR]为66.9；95%置信区间[CI]为27.1 - 165.1），无骨折组为11.5%（OR为35.2；95% CI为13.9 - 88.8）。使用双膦酸盐与典型骨折风险降低47%相关（OR为0.5；95% CI为0.3 - 0.9）。考虑使用时间，与未使用相比，非典型骨折的OR（95% CI）在使用少于2年时为35.1（10.0 - 123.6），2至5年时为46.9（14.2 - 154.4），5至9年时为117.1（34.2 - 401.7），超过9年时为175.7（30.0 - 1027.6）。28.2%的非典型病例发生了对侧骨折，而典型病例为0.9%（OR为42.6；95% CI为12.8 - 142.4）。非典型骨折的发病率较低（每百万人年32例），平均每年增加10.7%。
非典型股骨骨折与双膦酸盐的使用有关；治疗时间越长风险越高。非典型骨折的发病率在12年期间有所增加，但此类骨折的绝对数量非常少。
