The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel.
Arch Osteoporos. 2021 Jun 5;16(1):86. doi: 10.1007/s11657-021-00944-3.
Bisphosphonates are common treatment for osteoporosis. Among patients admitted with hip fracture, atypical femoral fractures (AFF) were more prevalent in those who were treated with Bisphosphonates for five or more years. Five years of Bisphosphonates treatment may signify an increased risk for AFF, though the absolute risk remains very low.
Atypical femoral fractures (AFF) are a rare complication of bisphosphonate (BP) treatment. We evaluated the correlation between BP exposure and AFF risk among hip fracture patients.
This retrospective nested case-control study included patients over age 50 years, operated for osteoporotic hip fracture between July 2014 and November 2018, who attended our Fracture Liaison Service. We classified fracture radiographs and compared demographic, clinical, biochemical, and drug purchase data between patients with AFF and those with typical osteoporotic hip fracture (controls). To correct for the younger age of patients with AFF, we matched each case (AFF) with three controls according to age ([Formula: see text] 1 year) and sex and performed a conditional logistic regression model.
Of 989 patients, 31 (3%) had AFF. Patients with AFF were younger than those with inter-trochanteric fractures (mean ± SD: 72.3 ± 10.3 vs. 80.2 ± 9.6 years, p < 0.001). Following matching, the mean Charlson's Comorbidity Index (CCI) was lower in the AFF than in the control group (2.9 ± 3.7 vs. 4.7 ± 4.2; p = 0.030) and a higher proportion of them were treated with BP for 5 years or more (58.1 vs. 16.0%; p < 0.001). Among patients admitted with hip fracture who were treated with BP for 5 years or more, the odds ratio of this fracture being atypical was significantly higher compared with no BP treatment (21.7; 95% CI-4.1-113.9).
Patients with AFF compared to typical hip fractures showed better baseline medical conditions irrespective of their younger age. Five years of BP treatment may be associated with an increased risk for AFF, though the absolute risk remains very low.
双膦酸盐是骨质疏松症的常用治疗方法。在因髋部骨折住院的患者中，接受双膦酸盐治疗 5 年或以上的患者中，非典型股骨骨折（AFF）更为常见。接受 5 年双膦酸盐治疗可能会增加 AFF 的风险，尽管绝对风险仍然很低。
AFF 是双膦酸盐（BP）治疗的罕见并发症。我们评估了 BP 暴露与髋部骨折患者 AFF 风险之间的相关性。
这项回顾性巢式病例对照研究纳入了 2014 年 7 月至 2018 年 11 月期间在我们骨折联络服务处就诊、因骨质疏松性髋部骨折接受手术的年龄在 50 岁以上的患者。我们对骨折 X 线片进行分类，并比较 AFF 患者与典型骨质疏松性髋部骨折（对照组）患者的人口统计学、临床、生化和药物购买数据。为了校正 AFF 患者的年龄较小，我们根据年龄（相差 [Formula: see text] 1 岁）和性别对每个病例（AFF）与 3 个对照进行匹配，并进行条件逻辑回归模型分析。
989 例患者中，31 例（3%）发生 AFF。与转子间骨折患者相比，AFF 患者年龄更小（平均±标准差：72.3±10.3 岁比 80.2±9.6 岁，p<0.001）。匹配后，AFF 组的Charlson 合并症指数（CCI）均值低于对照组（2.9±3.7 比 4.7±4.2；p=0.030），且 AFF 组中有更高比例的患者接受了 5 年或以上的 BP 治疗（58.1%比 16.0%；p<0.001）。在因髋部骨折接受 BP 治疗 5 年或以上的患者中，与未接受 BP 治疗相比，这种骨折为非典型性的比值比显著更高（21.7；95%CI-4.1-113.9）。
与典型髋部骨折相比，AFF 患者无论年龄较小，其基线健康状况均更好。5 年 BP 治疗可能与 AFF 风险增加相关，尽管绝对风险仍然很低。
