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Atypical femoral fractures are a separate entity, characterized by highly specific radiographic features. A comparison of 59 cases and 218 controls
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Lund University, Sweden .
University Hospital Rostock, Germany .
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2013 (English)In: Bone, ISSN 8756-3282, E-ISSN 1873-2763, Vol. 52, no 1, 389-392 p.Article in journal (Refereed) Published
Abstract [en]

Background: Estimations of the risk of bisphosphonate associated atypical femoral fractures vary between different population-based studies, from considerable to neglectable. A possible explanation for these discrepancies could be different definitions of atypical fractures. We aimed to identify specific radiographic fracture characteristics associated with bisphosphonate use. less thanbrgreater than less thanbrgreater thanMethods: In a previous nationwide study, 59 atypical and 218 ordinary fractures were diagnosed. The atypical fractures were defined by their stress-type fracture pattern. All fractures were now re-assessed by a physician in training, without information about bisphosphonate use. The fracture angle (0-180 degrees) was measured. Presence of local lateral cortical thickening (a callus reaction), more than 2 fragments, or a medial spike was noted. The reader then made a judgment whether the fracture appeared as an atypical fracture based on the ASBMR criteria. less thanbrgreater than less thanbrgreater thanResults: Frequency distribution analysis of the fracture angle showed a distinct subgroup, comprising 25% of all 277 fractures, with a mean of 89 and SD of 10 degrees. Forty-two of 57 patients in this subgroup used bisphosphonates, whereas only 27 of 213 others did (specificity 0.93; 95% CI 0.88-0.96). Presence of a callus reaction had also a high specificity for bisphosphonate use (0.96; 95% CI 0.92-0.98). The ASBMR criteria had a lower specificity, increasing the number of atypical fractures without bisphosphonate use from 13 to 31. This led to a decrease in age-adjusted relative risk associated with bisphosphonate use from 47 (95% CI 26-87) to 19 (95% CI 12-29). less thanbrgreater than less thanbrgreater thanInterpretation: Stress fractures of the femoral shaft are a specific entity, which is easily diagnosed on radiographs and strongly related to bisphosphonate use. Differences in diagnostic criteria may partially explain the large differences in relative risk between different population-based studies.

Place, publisher, year, edition, pages
Elsevier , 2013. Vol. 52, no 1, 389-392 p.
Keyword [en]
Atypical femoral fracture, Bisphosphonate, Stress fracture, Osteoporosis
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-88359DOI: 10.1016/j.bone.2012.10.016ISI: 000312750700046OAI: diva2:602885

Funding Agencies|Swedish Research Council|VR 2009-6725|Linkoping University||Ostergotland County Council||King Gustaf V and Queen Victoria Free Mason Foundation||Eli Lilly Co.||

Available from: 2013-02-04 Created: 2013-02-04 Last updated: 2013-02-19

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Schilcher, JörgAspenberg, Per
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Department of Clinical and Experimental MedicineFaculty of Health SciencesOrthopaedics and Sports MedicineDepartment of Orthopaedics in Linköping
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