Kwan Cheuk Kin, Tang Ning, Fong Man Ki, Liu Wing Hong, Tso Chi Yin, Liu Chaoran, Wong Pui Yan, Zhang Ning, Cheung Wing Hoi, Wong Ronald Man Yeung
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.
Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hospital Authority, Hong Kong, China.
J Clin Med. 2025 Apr 1;14(7):2404. doi: 10.3390/jcm14072404.
: Bisphosphonates are effective in preventing osteoporotic fractures. However, the risk of atypical femur fractures (AFFs) increases with long-term bisphosphonate use. There are few existing publications on the analysis of clinical outcomes of atypical femur fracture cases in Chinese patients. Our objective was to review the clinical outcomes of AFF cases managed in a tertiary center in Hong Kong, China. : Cases of AFF managed in the Prince of Wales Hospital from 2010 to 2024 were included. Data on demographics, type and duration of bisphosphonate use prior to AFF, fixation method, and mobility 1 year post-operation were retrospectively retrieved. One-way ANOVA was used to compare the duration of use prior to the development of AFF between different types of bisphosphonates. : Sixty-nine cases of AFF were included, with a mean age of 73.8 ± 9.7 years. A total of 95.6% of patients had a history of bisphosphonate use, with a mean duration of usage of 6.8 ± 5.6 years prior to the occurrence of AFF. The duration of bisphosphonate use prior to the development of AFF was comparable between alendronate, ibandronate, and a history of using more than one type of anti-resorptive agent. A non-union rate of 5.8% was observed in the current cohort, with 48.2% returning to pre-morbid mobility 1 year post-operation. : AFF is more commonly seen in female patients with a history of bisphosphonate use. Considering the high success rate demonstrated in the current cohort, treating AFF with closed reduction followed by fixation with a long cephalomedullary device in dynamic locking together with immediate full-weight-bearing rehabilitation post-operation may be effective.
双膦酸盐在预防骨质疏松性骨折方面有效。然而，长期使用双膦酸盐会增加非典型股骨骨折（AFFs）的风险。关于中国患者非典型股骨骨折病例临床结果分析的现有出版物很少。我们的目的是回顾在中国香港一家三级中心治疗的AFF病例的临床结果。纳入2010年至2024年在威尔士亲王医院治疗的AFF病例。回顾性收集患者的人口统计学数据、AFF发生前双膦酸盐的使用类型和持续时间、固定方法以及术后1年的活动能力。采用单因素方差分析比较不同类型双膦酸盐在AFF发生前的使用持续时间。纳入69例AFF病例，平均年龄为73.8±9.7岁。共有95.6%的患者有双膦酸盐使用史，AFF发生前的平均使用时间为6.8±5.6年。阿仑膦酸盐、伊班膦酸盐以及使用过不止一种抗吸收剂的患者在AFF发生前的双膦酸盐使用持续时间相当。在当前队列中观察到不愈合率为5.8%，48.2%的患者术后1年恢复到病前活动能力。AFF在有双膦酸盐使用史的女性患者中更常见。考虑到当前队列显示的高成功率，采用闭合复位，然后用动态锁定的长髓内装置固定，并在术后立即进行全负重康复治疗AFF可能是有效的。
