The Influence of Demographic Factors on the Location of Bisphosphonate-related Atypical Femoral Fractures
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ORIGINAL ARTICLE
The Influence of Demographic Factors on the Location of Bisphosphonate‑related Atypical Femoral Fractures Wei Yuan1 · Ernest B. K. Kwek1 Received: 16 July 2020 / Accepted: 23 July 2020 / Published online: 28 July 2020 © Indian Orthopaedics Association 2020
Abstract Background The location of bisphosphonate-related atypical femoral fractures (AFFs) is related to the femoral bow. Other factors that might also be related to the distribution of AFFs are not well studied. In this study, we attempt to define the demographic factors that influence the distribution AFFs in our local population. Materials and Methods The medical records of all the patients diagnosed with AFFs treated in our institution between 2008 and 2017 were retrospectively reviewed and divided based on fracture location into subtrochanteric and mid-shaft groups. Demographic data were collected and compared between the two groups. Independent factors affecting the location of AFFs were identified via multivariate analysis. Results Seventy-nine AFFs in 71 patients were included. Thirty-two fractures occurred at the subtrochanteric region and 47 occurred at the mid-shaft. Age, bone density, anterior femoral bow and lateral femoral bow were significantly different between the two groups, whereas height, weight, body mass index, presence of prodromal symptoms, type and duration of bisphosphonates were not significantly different. Multivariate analysis showed anterior femoral bow was the only independent factor associated with the location of AFFs. Conclusions Anterior femoral bow is the only factor that can predict the location of AFFs. In our population, other demographic factors were not found to be predictive. Keywords Atypical femoral fracture · Location · Femoral bow · Demographic factors · MeSH terms: bisphosphonates · Femoral fracture · Demography
Introduction Although Bisphosphonates are widely regarded as the first line treatment for patients with osteoporosis [1], the development of atypical femoral fractures as a potential complication of long-term bisphosphonate therapy has raised serious concerns regarding this adverse effect [2–5]. The mechanisms of development of atypical femoral fractures (AFFs) are not fully understood. It has been suggested that bisphosphonates alter the bone repair process and suppress bone turnover as well as intracortical bone * Ernest B. K. Kwek [email protected] Wei Yuan [email protected] 1
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
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remodeling. This leads to microdamage accumulation and reduced mechanical properties of affected bone [6]. AFFs typically occur at either the subtrochanteric region or femoral shaft. Several studies revealed that the femoral bow is related to the location of AFFs [7–9]. However, other factors that might also influence the location of AFFs are not well studied. In this study, we attempt to identify these factors within our study population.
Materials and Methods We retrospective
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