The Sydney AFF Score: A Simple Tool to Distinguish Females Presenting With Atypical Femur Fractures Versus Typical Femur Fractures.
ATYPICAL FEMUR
BISPHOSPHONATES
FEMORAL GEOMETRY
FRACTURE
FRACTURE RISK CALCULATOR
OSTEOPOROSIS
Journal
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
ISSN: 1523-4681
Titre abrégé: J Bone Miner Res
Pays: United States
ID NLM: 8610640
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
revised:
05
01
2021
received:
21
04
2020
accepted:
12
01
2021
pubmed:
3
2
2021
medline:
10
8
2021
entrez:
2
2
2021
Statut:
ppublish
Résumé
Atypical femur fractures (AFF) are a rare but serious complication of long-term bisphosphonate use. Although clearly defined by ASBMR criteria, a proportion of patients with AFFs may go unrecognized and the use of qualitative fracture criteria may lead to uncertainty in AFF diagnosis, with significant therapeutic implications. A score that rapidly and accurately identifies AFFs among subtrochanteric femur fractures using quantitative, measurable parameters is needed. In a retrospective cohort of 110 female patients presenting with AFFs or typical femur fractures (TFFs), multiple logistic regression and decision tree analysis were used to develop the Sydney AFF score. This score, based on demographic and femoral geometry variables, uses three dichotomized independent predictors and adds one point for each: (age ≤80 years) + (femoral neck width <37 mm) + (lateral cortical width at lesser trochanter ≥5 mm), (score, 0 to 3). In an independent validation set of 53 female patients at a different centre in Sydney, a score ≥2 demonstrated 73.3% sensitivity and 69.6% specificity for AFF (area under the receiver-operating characteristic curve [AUC] 0.775, SE 0.063) and remained independently associated with AFF after adjustment for bisphosphonate use. The Sydney AFF score provides a quantitative means of flagging female patients with atraumatic femur fractures who have sustained an AFF as opposed to a TFF. This distinction has clear management implications and may augment current ASBMR diagnostic criteria. © 2021 American Society for Bone and Mineral Research (ASBMR).
Substances chimiques
Bone Density Conservation Agents
0
Diphosphonates
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
910-920Informations de copyright
© 2021 American Society for Bone and Mineral Research (ASBMR).
Références
Milat F, Ebeling PR. Osteoporosis treatment: a missed opportunity. Med J Aust. 2016;205(4):185-190.
Girgis CM, Seibel MJ. Atypical femur fractures: a complication of prolonged bisphosphonate therapy? Med J Aust. 2010;193(4):196-198.
Girgis CM, Sher D, Seibel MJ. Atypical femoral fractures and bisphosphonate use. N Engl J Med. 2010;362(19):1848-1849.
Abrahamsen B, Eiken P, Eastell R. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study. J Bone Miner Res. 2009;24(6):1095-1102.
Feldstein AC, Black D, Perrin N, et al. Incidence and demography of femur fractures with and without atypical features. J Bone Miner Res. 2012;27(5):977-986.
Napoli N, Schwartz AV, Palermo L, et al. Risk factors for subtrochanteric and diaphyseal fractures: the Study of Osteoporotic Fractures. J Clin Endocrinol Metab. 2013;98(2):659-667.
Dell RM, Adams AL, Greene DF, et al. Incidence of atypical nontraumatic diaphyseal fractures of the femur. J Bone Miner Res. 2012;27(12):2544-2550.
Jha S, Wang Z, Laucis N, Bhattacharyya T. Trends in media reports, oral bisphosphonate prescriptions, and hip fractures 1996-2012: an ecological analysis. J Bone Miner Res. 2015;30(12):2179-2187.
Black DM, Rosen CJ. Clinical practice. Postmenopausal osteoporosis. N Engl J Med. 2016;374(3):254-262.
Black DM, Abrahamsen B, Bouxsein ML, Einhorn T, Napoli N. Atypical femur fractures: review of epidemiology, relationship to bisphosphonates, prevention, and clinical management. Endocr Rev. 2019;40(2):333-368.
Klop C, Welsing PM, Leufkens HG, et al. The epidemiology of hip and major osteoporotic fractures in a Dutch population of community-dwelling elderly: implications for the Dutch FRAX(R) algorithm. PLoS One. 2015;10(12):e0143800.
Schilcher J, Koeppen V, Aspenberg P, Michaelsson K. Risk of atypical femoral fracture during and after bisphosphonate use. Acta Orthop. 2015;86(1):100-107.
Schneider JP, Hinshaw WB, Su C, Solow P. Atypical femur fractures: 81 individual personal histories. J Clin Endocrinol Metab. 2012;97(12):4324-4328.
Girgis CM, Seibel MJ. Population and treatment-based incidence estimates of atypical fractures. Med J Aust. 2011;194(12):666.
Haider IT, Schneider PS, Edwards WB. The role of lower-limb geometry in the pathophysiology of atypical femoral fracture. Curr Osteoporos Rep. 2019;17(5):281-290.
Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014;29(1):1-23.
LeBlanc ES, Rosales AG, Genant HK, et al. Radiological criteria for atypical features of femur fractures: what we can learn when applied in a clinical study setting. Osteoporos Int. 2019;30(6):1287-1295.
Adams AL, Xue F, Chantra JQ, et al. Sensitivity and specificity of radiographic characteristics in atypical femoral fractures. Osteoporos Int. 2017;28(1):413-417.
Khorrami F, Ahmadi M, Sheikhtaheri A. Evaluation of SNOMED CT content coverage: a systematic literature review. Stud Health Technol Inform. 2018;248:212-219.
Mahjoub Z, Jean S, Leclerc JT, et al. Incidence and characteristics of atypical femoral fractures: clinical and geometrical data. J Bone Miner Res. 2016;31(4):767-776.
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837-845.
Apostolakis S, Guo Y, Lane DA, Buller H, Lip GY. Renal function and outcomes in anticoagulated patients with non-valvular atrial fibrillation: the AMADEUS trial. Eur Heart J. 2013;34(46):3572-3579.
Gu L, Xu F, Yuan J. Comparison of AIMS65, Glasgow-Blatchford and Rockall scoring approaches in predicting the risk of in-hospital death among emergency hospitalized patients with upper gastrointestinal bleeding: a retrospective observational study in Nanjing, China. BMC Gastroenterol. 2018;18(1):98.
Martelli S, Pivonka P, Ebeling PR. Femoral shaft strains during daily activities: implications for atypical femoral fractures. Clin Biomech (Bristol, Avon). 2014;29(8):869-876.
Cole LE, Vargo-Gogola T, Roeder RK. Targeted delivery to bone and mineral deposits using bisphosphonate ligands. Adv Drug Deliv Rev. 2016;99(Pt A):12-27.
Popp KL, Hughes JM, Smock AJ, et al. Bone geometry, strength, and muscle size in runners with a history of stress fracture. Med Sci Sports Exerc. 2009;41(12):2145-2150.
Lee SH, Lee YH, Suh JS. Lateral cortical thickening and bone heterogeneity of the subtrochanteric femur measured with quantitative CT as indicators for early detection of atypical femoral fractures in long-term bisphosphonate users. AJR Am J Roentgenol. 2017;209(4):867-873.
Imamura T, Tsurumoto T, Saiki K, et al. Morphological profile of atypical femoral fractures: age-related changes to the cross-sectional geometry of the diaphysis. J Anat. 2019;235(5):892-902.
Napoli N, Jin J, Peters K, et al. Are women with thicker cortices in the femoral shaft at higher risk of subtrochanteric/diaphyseal fractures? The study of osteoporotic fractures. J Clin Endocrinol Metab. 2012;97(7):2414-2422.
Chapurlat R, Bui M, Sornay-Rendu E, et al. Deterioration of cortical and trabecular microstructure identifies women with osteopenia or Normal bone mineral density at imminent and long-term risk for fragility fracture: a prospective study. J Bone Miner Res. 2020;35(5):833-844.
Lim SJ, Yeo I, Yoon PW, et al. Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study. Osteoporos Int. 2018;29(11):2427-2435.
Jang SP, Yeo I, So SY, et al. Atypical femoral shaft fractures in female bisphosphonate users were associated with an increased anterolateral femoral bow and a thicker lateral cortex: a case-control study. Biomed Res Int. 2017;2017:5932496.
Morin SN, Wall M, Belzile EL, et al. Assessment of femur geometrical parameters using EOS imaging technology in patients with atypical femur fractures; preliminary results. Bone. 2016;83:184-189.
Buitendijk SKC, van de Laarschot DM, Smits AAA, et al. Trabecular bone score and hip structural analysis in patients with atypical femur fractures. J Clin Densitom. 2019;22(2):257-265.
Schilcher J, Howe TS, Png MA, Aspenberg P, Koh JS. Atypical fractures are mainly subtrochanteric in Singapore and diaphyseal in Sweden: a cross-sectional study. J Bone Miner Res. 2015;30(11):2127-2132.
Oh Y, Wakabayashi Y, Kurosa Y, Fujita K, Okawa A. Potential pathogenic mechanism for stress fractures of the bowed femoral shaft in the elderly: mechanical analysis by the CT-based finite element method. Injury. 2014;45(11):1764-1771.
Haider IT, Schneider P, Michalski A, Edwards WB. Influence of geometry on proximal femoral shaft strains: implications for atypical femoral fracture. Bone. 2018;110:295-303.
Nguyen HH, Lakhani A, Shore-Lorenti C, et al. Asian ethnicity is associated with atypical femur fractures in an Australian population study. Bone. 2020;135:115319.
Maratt J, Schilling PL, Holcombe S, et al. Variation in the femoral bow: a novel high-throughput analysis of 3922 femurs on cross-sectional imaging. J Orthop Trauma. 2014;28(1):6-9.
Schilcher J, Michaelsson K, Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med. 2011;364(18):1728-1737.
Kolanu N, Brown AS, Beech A, Center JR, White CP. Natural language processing of radiology reports for the identification of patients with fracture. Arch Osteoporos. 2021;16(1):6. Available from: https://doi.org/10.1007/s11657-020-00859-5.
Black DM, Geiger EJ, Eastell R, et al. Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. N Engl J Med. 2020;383(8):743-753.