Lee Kyung-Jae, Min Byung-Woo, Song Kwang-Soon, Bae Ki-Cheor, Cho Chul-Hyun, Lee Si-Wook
1Department of Orthopaedic Surgery, Keimyung University, Dongsan Medical Center, Daegu, South Korea.
J Bone Joint Surg Am. 2017 Oct 4;99(19):1683-1688. doi: 10.2106/JBJS.16.01440.
Although atypical femoral fracture (AFF) occurs more frequently in patients taking bisphosphonates and longer treatment is associated with higher risk, the causal relationship between AFF and bisphosphonates has not been established. Most patients with AFF have osteoporosis that is being treated with bisphosphonates, but we are not aware of any reports regarding the areal bone mineral density (aBMD) and discordance between the T-scores of the femur and spine in such patients. We investigated the prevalence of aBMD discordance and the characteristics of patients with AFF.
Medical records for 63 consecutive patients treated for AFF were retrospectively evaluated, and 48 patients, all female, were eligible for the study. The average age at the time of fracture was 73.0 years, the average duration of bisphosphonate use was 68.5 months, and the average presumed age at bisphosphonate initiation was 67.2 years. We evaluated the prevalence of discordance, defined as a difference between the T-score categories of the femur and spine in the same individual as well as demographic differences between the discordance and concordance groups. We also compared the prevalence of discordance in patients with AFF with that in 114 female patients with intertrochanteric femoral fracture (ITFF).
T-score concordance, minor discordance, and major discordance were seen in 14 (29%), 32 (67%), and 2 (4%) of the patients with AFF, respectively. The prevalence of discordance was significantly higher in those with AFF (71%) than in those with ITFF (23%) (p < 0.001). The average age at bisphosphonate initiation in the AFF group was lower in the discordance group (65.7 years) than in the concordance group (70.7 years) (p = 0.04).
The prevalence of T-score discordance between the hip and lumbar spine was relatively high in patients with AFF, and the presumed age at the initiation of bisphosphonate therapy was younger in patients with discordant T-scores in this study.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
尽管非典型股骨骨折（AFF）在服用双膦酸盐的患者中更频繁发生，且治疗时间越长风险越高，但AFF与双膦酸盐之间的因果关系尚未确立。大多数AFF患者患有骨质疏松症并正在接受双膦酸盐治疗，但我们未发现有关此类患者的骨面积密度（aBMD）以及股骨和脊柱T值不一致的任何报告。我们调查了aBMD不一致的患病率以及AFF患者的特征。
对连续63例接受AFF治疗的患者的病历进行回顾性评估，48例女性患者符合研究条件。骨折时的平均年龄为73.0岁，双膦酸盐的平均使用时间为68.5个月，开始使用双膦酸盐时的平均推测年龄为67.2岁。我们评估了不一致的患病率，其定义为同一个体股骨和脊柱T值类别之间的差异以及不一致组和一致组之间的人口统计学差异。我们还比较了AFF患者与114例女性转子间股骨骨折（ITFF）患者中不一致的患病率。
在AFF患者中，T值一致、轻度不一致和重度不一致分别见于14例（29%）、32例（67%）和2例（4%）。AFF患者中不一致的患病率（71%）显著高于ITFF患者（23%）（p < 0.001）。AFF组中开始使用双膦酸盐时的平均年龄在不一致组（65.7岁）低于一致组（70.7岁）（p = 0.04）。
AFF患者中髋部和腰椎T值不一致的患病率相对较高，在本研究中T值不一致的患者开始双膦酸盐治疗时的推测年龄更小。
治疗水平III。有关证据水平的完整描述，请参阅作者指南。
