Park Jung-Wee, Lee Young-Kyun, Ko Young-Seung, Byun Seong-Eun, Cho Young-Ho, Koo Kyung-Hoi
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2025 Apr;17(2):216-222. doi: 10.4055/cios24103. Epub 2025 Feb 18.
Long-term use of bisphosphonate is a risk factor for atypical femoral fractures (AFFs). Femoral bowing is known to be associated with AFFs. However, whether femoral bowing quickens the occurrence of AFF is unknown. The purpose of this study was to determine whether AFF occurs earlier in patients with severe femoral bowing than in those without severe bowing.
One hundred and sixty-four patients (186 AFFs) from January 2006 to December 2022 were included in this study. According to severity of femoral bowing, patients were divided into 2 groups: severe bowing group (26 femurs) and minimal to moderate bowing group (160 femurs). Age, sex, and completeness and location of AFF were compared between the 2 groups. We compared the time of AFF occurrence after bisphosphonate therapy using cumulative percentage between the 2 groups.
Age and sex were similar between the 2 groups, while body mass index (BMI) was lower (22.5 ± 3.0 kg/m vs. 24.5 ± 3.5 kg/m, = 0.003) in the severe bowing group. The duration of bisphosphonate use was shorter in the severe bowing group than in the minimal to moderate bowing group (3.3 ± 3.8 years vs. 5.0 ± 4.0 years, = 0.048). In the severe bowing group, 85% of AFFs were diaphyseal in contrast to the 46% in the minimal to moderate bowing group ( < 0.001). Cumulative percentage plot of AFFs in the severe bowing group was left-shifted compared to the minimal to moderate bowing group.
At the time of AFF diagnosis, the severe bowing group exhibited shorter duration of bisphosphonate use, lower BMI, and a higher incidence of diaphyseal location. Shortening the duration of bisphosphonate therapy may be advisable in patients with severe femoral bowing.
长期使用双膦酸盐是非典型股骨骨折（AFFs）的一个危险因素。已知股骨弯曲与AFFs有关。然而，股骨弯曲是否会加速AFF的发生尚不清楚。本研究的目的是确定严重股骨弯曲患者的AFF发生时间是否比无严重弯曲的患者更早。
本研究纳入了2006年1月至2022年12月期间的164例患者（186处AFFs）。根据股骨弯曲的严重程度，患者被分为两组：严重弯曲组（26个股骨）和轻度至中度弯曲组（160个股骨）。比较两组患者的年龄、性别以及AFF的完整性和位置。我们使用两组之间的累积百分比比较了双膦酸盐治疗后AFF发生的时间。
两组患者的年龄和性别相似，而严重弯曲组的体重指数（BMI）较低（22.5±3.0kg/m²对24.5±3.5kg/m²，P = 0.003）。严重弯曲组双膦酸盐的使用时间比轻度至中度弯曲组短（3.3±3.8年对5.0±4.0年，P = 0.048）。严重弯曲组中85%的AFFs发生在骨干，而轻度至中度弯曲组为46%（P<0.001）。与轻度至中度弯曲组相比，严重弯曲组AFFs的累积百分比图向左偏移。
在AFF诊断时，严重弯曲组双膦酸盐使用时间较短、BMI较低且骨干位置的发生率较高。对于严重股骨弯曲的患者，建议缩短双膦酸盐治疗时间。
