Department of Orthopedic Surgery, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec, QC, Canada.
Division of Rheumatology, Department of Medicine, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, Quebec, QC, Canada.
J Bone Miner Res. 2019 Jan;34(1):83-92. doi: 10.1002/jbmr.3584. Epub 2018 Oct 2.
Bisphosphonate use has been associated with atypical femoral fractures (AFFs), defined by the American Society of Bone and Mineral Research (ASBMR) Task Force criteria, which currently exclude periprosthetic fractures. The objectives of this study were to establish the prevalence of atypical periprosthetic femoral fractures (APFFs) in patients with hip and knee arthroplasties and to determine the clinical and radiological risk factors associated with these fractures. We performed a retrospective radiological review of all femoral fractures between January 1, 2006, and March 31, 2015, in Quebec City, Canada. Patients who sustained a periprosthetic femoral fracture (PFF) were identified and included in this study. We used the ASBMR Task Force criteria to identify atypical fractures and establish their prevalence. Data from medical records and radiological assessments of the femoral anatomy, the characteristics of the fracture, and the positioning of the prosthesis were collected. The prevalence of APFFs among PFFs was 8.3% (11/133). A strong association with bisphosphonates (p = 0.007) was observed, as well as an increased risk of APFFs among alendronate users compared to risedronate users (p = 0.04). A transverse fracture (p < 0.0001), a periosteal thickening of the lateral cortex at the fracture (p < 0.0001), a unicortical fracture (p = 0.02), and prodromal symptoms (p = 0.03) were associated with APFFs. The type of implant, its positioning, and the femoral geometry did not appear to be risk factors for APFFs compared to PFFs. © 2018 American Society for Bone and Mineral Research.
双膦酸盐的使用与非典型股骨骨折（AFF）有关，美国骨骼矿物质研究学会（ASBMR）工作组标准定义了 AFF，该标准目前排除了假体周围骨折。本研究的目的是确定髋关节和膝关节置换术后患者中发生非典型假体周围股骨骨折（APFF）的患病率，并确定与这些骨折相关的临床和影像学危险因素。我们对 2006 年 1 月 1 日至 2015 年 3 月 31 日期间在加拿大魁北克市发生的所有股骨骨折进行了回顾性影像学检查。确定了假体周围股骨骨折（PFF）患者并将其纳入本研究。我们使用 ASBMR 工作组标准来识别非典型骨折并确定其患病率。收集了病历和股骨解剖学、骨折特征以及假体定位的影像学评估数据。在 PFF 中，APFF 的患病率为 8.3%（11/133）。观察到与双膦酸盐之间存在很强的关联（p=0.007），与利塞膦酸盐相比，阿仑膦酸盐使用者发生 APFF 的风险增加（p=0.04）。横向骨折（p<0.0001）、骨折处外侧皮质骨膜增厚（p<0.0001）、单皮质骨折（p=0.02）和前驱症状（p=0.03）与 APFF 相关。与 PFF 相比，假体的类型、其定位和股骨几何形状似乎不是 APFF 的危险因素。 © 2018 美国骨骼矿物质研究学会。
