Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
Bone. 2021 Feb;143:115671. doi: 10.1016/j.bone.2020.115671. Epub 2020 Sep 30.
Teriparatide is sometimes used in the treatment of atypical femoral fracture (AFF). Even if bone union is achieved, orthopedic physicians must consider the risk of relapse. This study aimed to investigate the factors affecting AFF recurrence, and to determine the appropriate treatment for osteoporosis after bone union.
One hundred thirty-one consecutive AFFs in 113 Japanese patients were included. Eleven patients had AFF in the unaffected limb (9 patients) after the first AFF or re-fracture at the original fracture site (2 patients) after bone union of the first AFF was confirmed. We divided all patients into two groups: the second fracture group (22 AFFs in 11 patients) and non-second fracture group (109 AFFs in 102 patients). We compared clinical information between the 2 groups and investigated the factors affecting AFF recurrence using the Student t-, Welch t-, and chi-square tests.
Although there was no significant difference in clinical characteristics between the 2 groups, multivariate analysis of factors associated with AFF recurrence identified short duration of treatment with teriparatide and active vitamin D (p = 0.0408 and 0.0366, respectively) as risk factors. Even in the analysis excluding subtrochanteric AFF, short periods of teriparatide and active vitamin D administration were observed as risk factors (p = 0.0484 and 0.0346, respectively).
The administration of teriparatide for as long as possible after occurrence first AFF and the use of active vitamin D after completion of teriparatide therapy may be the most effective strategy to prevent the recurrence of AFF.
特立帕肽有时用于治疗非典型股骨骨折（AFF）。即使实现了骨愈合，矫形医师仍需考虑复发的风险。本研究旨在探讨影响 AFF 复发的因素，并确定骨愈合后骨质疏松症的适当治疗方法。
纳入了 113 名日本患者的 131 例连续 AFF。11 例患者在首次 AFF 后出现对侧肢体 AFF（9 例），或在首次 AFF 骨愈合后原骨折部位再骨折（2 例）。我们将所有患者分为两组：第二骨折组（11 例患者的 22 例 AFF）和非第二骨折组（102 例患者的 109 例 AFF）。我们比较了两组的临床资料，并通过学生 t 检验、Welch t 检验和卡方检验调查了影响 AFF 复发的因素。
虽然两组的临床特征无显著差异，但多变量分析与 AFF 复发相关的因素表明，特立帕肽和活性维生素 D 的治疗时间较短（分别为 p=0.0408 和 0.0366）是风险因素。即使在排除转子下 AFF 的分析中，特立帕肽和活性维生素 D 治疗时间较短也被观察为风险因素（分别为 p=0.0484 和 0.0346）。
首次 AFF 发生后尽可能长时间地使用特立帕肽，以及在特立帕肽治疗结束后使用活性维生素 D，可能是预防 AFF 复发的最有效策略。
