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Fracture Risk Following an Atypical Femoral Fracture |
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| Authors: | Marie-Josée Bégin Marie-Claude Audet Thierry Chevalley Marina Portela Ivan Padlina Didier Hannouche Kuntheavy Ing Lorenzini Raphaël Meier Robin Peter Brigitte Uebelhart René Rizzoli Serge Ferrari Emmanuel Biver |
| Institution: | 1. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing - original draft;2. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland Contribution: Data curation, Formal analysis, Investigation, Writing - review & editing;3. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland;4. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland Contribution: Data curation, Writing - review & editing;5. Division of Orthopedic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland Contribution: Resources, Visualization, Writing - review & editing;6. Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland Contribution: Data curation, Writing - review & editing;7. Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland Contribution: Conceptualization, Data curation, Funding acquisition, Investigation, Writing - review & editing;8. Division of Orthopedic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland Contribution: Data curation, Writing - review & editing;9. Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland Contribution: Conceptualization, Funding acquisition, Methodology, Resources, Supervision, Writing - review & editing |
| Abstract: | 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). |
| Keywords: | ANTIRESORPTIVES THERAPEUTICS FRACTURE RISK ASSESSMENT OSTEOPOROSIS DISEASES AND DISORDERS OF/RELATED TO BONE |