Fracture Risk Following an Atypical Femoral Fracture.
ANTIRESORPTIVES
DISEASES AND DISORDERS OF/RELATED TO BONE
FRACTURE RISK ASSESSMENT
OSTEOPOROSIS
THERAPEUTICS
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:
01 2022
01 2022
Historique:
revised:
05
10
2021
received:
23
07
2021
accepted:
14
10
2021
pubmed:
21
10
2021
medline:
15
3
2022
entrez:
20
10
2021
Statut:
ppublish
Résumé
Atypical femoral fractures (AFFs) occurring during the course of osteoporosis treatment usually lead to discontinuation of anti-resorptive (AR) drugs. However, the risk of fracture after an AFF is unknown. We conducted a follow-up study of patients with AFF matched 1:3 for age and gender with patients with a peripheral major osteoporotic fracture (pMOF), in the setting of a fracture liaison service, to investigate the incidence of subsequent low-trauma fractures. Fifty-five patients with AFF (95% women, age [mean ± standard deviation] 75 ± 10 years, 89% exposed to AR drugs), followed for 6.2 ± 3.7 years, were compared to 165 matched controls with a pMOF (hip 85%) followed for 4.3 ± 2.6 years. During the follow-up, 38% of patients in the AFF group and 16% in the pMOF group received AR therapies. Continuation of AR drugs after an AFF was associated with contralateral AFF in 27% of subjects. The risks of new low-trauma, major osteoporotic and imminent (within 2 years) fractures, were similar between the two groups: incidence rate ratio (95% confidence interval [CI]) of subsequent fracture following AFF relative to pMOF, 1.30 (95% CI, 0.82-2.04), 1.28 (95% CI, 0.74-2.15), and 1.11 (95% CI, 0.54-2.15), respectively. Moreover, the risk of sustaining multiple fractures per participant was significantly increased among patients with AFF compared to pMOF (hazard ratio 1.48 [95% CI, 1.00-2.19]; p = 0.049). When taking mortality into account, the risk of subsequent fractures tended to be higher in the AFF group (sub-hazard ratio 1.42 [95% CI, 0.95-2.12]). In conclusion, patients who sustained an AFF are at high risk of subsequent fragility fractures, at least equal or even greater to the risk observed after a pMOF. However, continuation of AR drugs increases the risk of contralateral AFF. Therefore, optimal modalities for secondary fracture prevention after AFF require further evaluation. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Identifiants
pubmed: 34668223
doi: 10.1002/jbmr.4461
pmc: PMC9298806
doi:
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
87-94Informations de copyright
© 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Références
World Health Organ Tech Rep Ser. 1994;843:1-129
pubmed: 7941614
J Bone Miner Res. 2018 Feb;33(2):328-337
pubmed: 28960489
J Bone Miner Res. 2016 Mar;31(3):491-7
pubmed: 26676878
J Clin Endocrinol Metab. 2020 May 1;105(5):
pubmed: 31867670
Bone Joint J. 2019 Oct;101-B(10):1285-1291
pubmed: 31564154
Clin Orthop Relat Res. 2014 Sep;472(9):2728-34
pubmed: 23604648
Osteoporos Int. 2018 Jun;29(6):1277-1283
pubmed: 29675745
J Bone Miner Res. 2019 Jan;34(1):83-92
pubmed: 30280425
J Surg Orthop Adv. 2018 Spring;27(1):14-20
pubmed: 29762110
J Intern Med. 2017 Mar;281(3):300-310
pubmed: 28093824
JBMR Plus. 2021 Jun 19;5(8):e10515
pubmed: 34368607
Osteoporos Int. 2013 Feb;24(2):681-8
pubmed: 22736068
Bone. 2019 Nov;128:115033
pubmed: 31398503
Osteoporos Int. 2002;13(6):450-5
pubmed: 12107657
Endocr Rev. 2019 Apr 1;40(2):333-368
pubmed: 30169557
N Engl J Med. 2014 Sep 4;371(10):974-6
pubmed: 25184886
Injury. 2018 Dec;49(12):2264-2268
pubmed: 30245278
JAMA. 2007 Jan 24;297(4):387-94
pubmed: 17244835
J Bone Miner Res. 2012 Dec;27(12):2544-50
pubmed: 22836783
J Bone Joint Surg Am. 2021 Jan 20;103(2):123-130
pubmed: 33476100
Bone Joint J. 2017 Mar;99-B(3):295-302
pubmed: 28249967
Osteoporos Int. 2019 Nov;30(11):2349-2354
pubmed: 31428823
Bone Joint J. 2014 May;96-B(5):658-64
pubmed: 24788502
N Engl J Med. 2020 Aug 20;383(8):743-753
pubmed: 32813950
J Bone Miner Res. 1993 Sep;8(9):1137-48
pubmed: 8237484
Drug Saf. 2009;32(9):775-85
pubmed: 19670917
J Orthop Trauma. 2016 Apr;30(4):170-6
pubmed: 27003029
Arch Osteoporos. 2014;9:187
pubmed: 24970672
J Bone Metab. 2015 Nov;22(4):183-9
pubmed: 26713309
Skeletal Radiol. 2015 Nov;44(11):1579-84
pubmed: 26169723
Acta Orthop. 2015 Feb;86(1):100-7
pubmed: 25582459
J Clin Endocrinol Metab. 2012 Dec;97(12):4324-8
pubmed: 23076349
Osteoporos Int. 2014 Aug;25(8):2109-16
pubmed: 24846316
Osteoporos Int. 2017 Jun;28(6):1765-1769
pubmed: 28236126
Acta Orthop. 2012 Oct;83(5):548-50
pubmed: 22998530
Bone. 2007 May;40(5):1284-9
pubmed: 17292683
J Clin Endocrinol Metab. 2012 Jul;97(7):2272-82
pubmed: 22523337
Osteoporos Int. 2016 Oct;27(10):2945-53
pubmed: 27172936
Arch Intern Med. 2012 Jun 25;172(12):930-6
pubmed: 22732749
J Bone Miner Res. 2014 Jan;29(1):1-23
pubmed: 23712442
J Bone Miner Metab. 2015 Sep;33(5):553-9
pubmed: 25227287
Osteoporos Int. 2019 Dec;30(12):2515-2520
pubmed: 31555883
Osteoporos Int. 2002 Sep;13(9):731-7
pubmed: 12195537
Arch Osteoporos. 2021 Jun 2;16(1):82
pubmed: 34080059