Gárgyán István, Dózsai Dávid, Csonka István, Rárosi Ferenc, Bodzay Tamás, Csonka Ákos
Department of Traumatology, University of Szeged, Szeged, Hungary.
Jt Dis Relat Surg. 2022;33(1):24-32. doi: 10.52312/jdrs.2022.355. Epub 2022 Mar 28.
The aim of this study was to identify the risk factors for developing atypical femoral fractures (AFF) and to examine the effect of bisphosphonate (BP) therapy on delayed bone union and bilateral fractures.
Between January 1, 2012 and December 31, 2020, a total of 74 AFF patients (8 males, 66 females; mean age: 75.4±7.2 years; range, 51 to 94 years) were recorded in two centers and retrospectively analyzed. A control fragility fracture group (n=143) was compared to the AFF group according to fracture characteristics, surgical fixation methods, comorbidities, and medications. The AFF patients were selected and subdivided according to their BP therapy: Group 1 (without BP) and Group 2 (with BP). Group 2 was further classified into Group 2a (<5 years of BP) and Group 2b (<5 years of BP).
The multivariate logistic regression model showed that, BP drug use was the most significant risk factor in development of AFF (p<0.001, odds ratio= 10.749, 95% confidence interval: 3.886-29.733). The patients on BP showed longer bone union (Group 2 - 8.3±3.5 vs. Group 1 - 6.4±3.1 months, p=0.02; Group 2b - 9±3.8 vs. Group 2a - 7.3 ±3.9 months, p=0.09). Of all 19 cases of bilateral fractures, 14 were in Group 2 with BP use (p=0.11). Of 74 cases, 26 (35%) contralateral femoral X-rays were taken on admission and 24 (92%) showed AFF minor criteria signs. Of these 24 patients, 10 (42%) developed contralateral AFF.
The most significant risk factor in development of AFF was BP drug use. Longer BP therapy (>5 years) showed longer delayed bone union, which was not significant. There was a relatively high risk of developing AFFs and bilateral fractures on BP therapy. In case of an AFF, a contralateral femoral X-ray must be always performed for signs of an impending fracture.
本研究旨在确定非典型股骨骨折（AFF）发生的危险因素，并研究双膦酸盐（BP）治疗对骨愈合延迟和双侧骨折的影响。
在2012年1月1日至2020年12月31日期间，两个中心共记录了74例AFF患者（8例男性，66例女性；平均年龄：75.4±7.2岁；范围51至94岁），并进行回顾性分析。根据骨折特征、手术固定方法、合并症和用药情况，将脆性骨折对照组（n = 143）与AFF组进行比较。根据BP治疗情况对AFF患者进行选择和细分：第1组（未使用BP）和第2组（使用BP）。第2组进一步分为2a组（BP使用时间<5年）和2b组（BP使用时间≥5年）。
多因素逻辑回归模型显示，使用BP药物是AFF发生的最显著危险因素（p<0.001，比值比=10.749，95%置信区间：3.886 - 29.733）。使用BP的患者骨愈合时间更长（第2组 - 8.3±3.5个月 vs. 第1组 - 6.4±3.1个月，p = 0.02；2b组 - 9±3.8个月 vs. 2a组 - 7.3±3.9个月，p = 0.09）。在所有19例双侧骨折病例中，14例在使用BP的第2组（p = 0.11）。74例患者中，26例（35%）入院时进行了对侧股骨X线检查，24例（92%）显示有AFF次要标准体征。在这24例患者中，10例（42%）发生了对侧AFF。
AFF发生的最显著危险因素是使用BP药物。较长时间的BP治疗（≥5年）显示骨愈合延迟时间更长，但差异不显著。使用BP治疗时发生AFF和双侧骨折的风险相对较高。对于AFF患者，必须始终进行对侧股骨X线检查以寻找即将发生骨折的迹象。
