Department of Orthopedic Surgery, Gävle Hospital, Gävle; Department of Orthopedic Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping and Center for Medical Image Science and Visualization, Linköping University, Linköping.
Department of Orthopedic Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Linköping and Center for Medical Image Science and Visualization, Linköping University, Linköping.
Acta Orthop. 2022 Jan 11;93:229-233. doi: 10.2340/17453674.2022.1380.
Background and purpose - To continuously assess the incidence of atypical femoral fractures (AFFs) in the population is important, to allow the evaluation of the risks and benefits associated with osteoporosis treatment. Therefore, we investigated the possibility to use the Swedish Fracture Register (SFR) as a surveillance tool for AFFs in the population and to explore means of improvement. Patients and methods - All AFF registrations in the SFR from January 1, 2015 to December 31, 2018 were enrolled in the study. For these patients, radiographs were obtained and combined with radiographs from 176 patients with normal femoral fractures, to form the study cohort. All images were reviewed and classified into AFFs or normal femur fractures by 2 experts in the field (gold-standard classification) and 1 orthopedic resident educated on the specific radiographic features of AFF (educated-user classification). Furthermore, we estimated the incidence rate of AFFs in the population captured by the register through comparison with a previous cohort and calculated the positive predictive value (PPV) and, where possible, the inter-observer agreement (Cohen's kappa) between the different classifications. Results - Of the 178 available patients with AFF in the SFR, 104 patients were classified as AFF using the goldstandard classification, and 89 using the educated-user classification. The PPV increased from 0.58 in the SFR classification to 0.93 in the educated-user classification. The interobserver agreement between the gold-standard classification and the educated-user classification was 0.81. Interpretation - With a positive predictive value of 0.58 the Swedish Fracture Register outperforms radiology reports and reports to the Swedish Medical Products Agency on adverse drug reactions as a diagnostic tool to identify atypical femoral fractures.
背景与目的 - 持续评估人群中非典型股骨骨折（AFF）的发生率对于评估骨质疏松症治疗的风险和获益非常重要。因此，我们研究了使用瑞典骨折登记处（SFR）作为人群中 AFF 监测工具的可能性，并探讨了改进的方法。
患者和方法 - 从 2015 年 1 月 1 日至 2018 年 12 月 31 日，所有在 SFR 中登记的 AFF 均被纳入本研究。对于这些患者，我们获取了 X 光片，并与 176 名正常股骨骨折患者的 X 光片进行了组合，形成了研究队列。所有图像均由 2 名该领域的专家（金标准分类）和 1 名接受过 AFF 特定影像学特征教育的骨科住院医师（受教育用户分类）进行了审查和分类。此外，我们通过与先前队列进行比较，估算了登记处中人群中 AFF 的发生率，并计算了阳性预测值（PPV），并在可能的情况下，计算了不同分类之间的观察者间一致性（Cohen's kappa）。
结果 - 在 SFR 中可用的 178 名 AFF 患者中，有 104 名患者使用金标准分类被归类为 AFF，89 名患者使用受教育用户分类被归类为 AFF。PPV 从 SFR 分类中的 0.58 增加到受教育用户分类中的 0.93。金标准分类和受教育用户分类之间的观察者间一致性为 0.81。
解释 - 瑞典骨折登记处的阳性预测值为 0.58，优于放射学报告和向瑞典药品管理局报告的药物不良反应报告，作为识别非典型股骨骨折的诊断工具。
