Warren Christopher, Gilchrist Nigel, Coates Mark, Frampton Chris, Helmore Joy, McKie John, Hooper Gary
Department of Older Person's Health, The Princess Margaret Hospital, Christchurch, New Zealand.
ANZ J Surg. 2012 Dec;82(12):908-12. doi: 10.1111/j.1445-2197.2012.06199.x. Epub 2012 Sep 3.
Recent reports have suggested that a certain type of subtrochanteric and diaphyseal femoral fractures maybe associated with bisphosphonate (BP) therapy. We assessed the association between BP use in atypical and typical femoral fractures in a retrospective study and also looked at the rate of coding errors.
All cases between July 2003 and June 2008 with International Classification of Disease, 10th revision discharge codes for femoral fractures (S72.2 subtrochanteric and S72.3 fracture of shaft of femur) were reviewed. Cases were excluded if there was significant trauma, underlying bone disease or coding error. The remaining cases' films were assessed by an independent, blinded, single radiologist to assess for atypical features (thickened cortices, transverse fractures, medial cortical spike) with additional exclusion criteria of periprosthetic fractures and bone pathology. Odds ratios were calculated comparing BP use in atypical and typical fractures.
Six atypical fractures were found in the study period. Compared with the 65 typical fractures, there was an association between BP use and atypical fractures (odds ratio 5.5) but it did not reach statistical significance (0.97-31). Atypical femoral fractures accounted for <0.1% of total fracture admissions during this period. There was a 20% rate of miscoding.
This study shows a nonsignificant trend towards alendronate/BP use and atypical femoral fractures compared with typical femoral fractures. These fractures were rare <0.1% and the benefit and treatment of osteoporosis with BPs currently seems likely to outweigh the perceived risks. Individual case and radiology review is important as coding errors were frequent.
最近的报告表明，某种类型的股骨转子下和骨干骨折可能与双膦酸盐（BP）治疗有关。我们在一项回顾性研究中评估了BP使用与非典型和典型股骨骨折之间的关联，并研究了编码错误率。
回顾了2003年7月至2008年6月期间所有患有国际疾病分类第10版股骨骨折出院编码（S72.2转子下和S72.3股骨干骨折）的病例。如果存在重大创伤、潜在骨病或编码错误，则排除这些病例。其余病例的X线片由一名独立、不知情的放射科医生进行评估，以评估非典型特征（增厚的皮质、横行骨折、内侧皮质尖），并附加排除假体周围骨折和骨病理的标准。计算非典型和典型骨折中使用BP的比值比。
在研究期间发现6例非典型骨折。与65例典型骨折相比，BP使用与非典型骨折之间存在关联（比值比5.5），但未达到统计学显著性（0.97 - 31）。在此期间，非典型股骨骨折占骨折入院总数的<0.1%。编码错误率为20%。
本研究显示，与典型股骨骨折相比，阿仑膦酸盐/BP使用与非典型股骨骨折之间存在无统计学显著性的趋势。这些骨折很罕见<0.1%，目前使用BP治疗骨质疏松症的益处似乎可能超过感知到的风险。由于编码错误频繁，个体病例和影像学评估很重要。
