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BP use is associated with an increased risk of atypical femoral fractures
DOI:10.1038/bonekey.2012.247
In order to assess the association between bisphosphonate (BP) therapy and atypical femoral fracture risk, Meier et al. performed a retrospective study over 10 years looking at 521 patients over the age of 50 admitted to hospital with a femoral shaft fracture or subtrochanteric fracture. Their medical records and admission radiographs were used to classify their fracture and their use of BPs was then compared with 200 healthy subjects without fractures.
Of the 477 patients with confirmed subtrochanteric or femoral shaft fractures who did not fulfil exclusion criteria, only 39 (8.2%) had atypical fractures, as defined by criteria within the American Society of Bone and Mineral Research task for report. Fractures that began at the lateral femoral cortex, between the distal metaphysis and the lesser trochanter were atypical if they had a short oblique or transverse fracture line and classic if they were segmental, wedge-shaped, spiral or complex irregular.
Of the patients with atypical femoral fractures, 82.1% had been using BPs, which confirmed an augmented risk; this risk increased with the duration of BP treatment but the actual number of fractures over a 12-year period was small.
The comparison revealed that only 28 of the 438 patients (6.4%) with a classical fracture had been treated with BPs. Use of bisphosphonates was found to be associated with a reduction in classical fracture risk of 47% (OR, 0.5; 95% CI, 0.3–0.9).
Editor’s comment: This 10-year retrospective study from a major orthopedic center provides a well-documented insight into the true burden of atypical femur fractures compared to typical subtrochanteric and hip fractures. BP-associated atypical fractures represent fewer than 1 in 10 subtrochanteric fractures and fewer than 1 in 100 fragility hip fractures. Furthermore, a large proportion of non-BP-associated fractures could have been prevented by appropriate BP treatment.
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