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Mortality After Atypical Femoral Fractures: A Cohort Study
Uppsala University, Sweden.
Uppsala University, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
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2016 (English)In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 31, no 3, 491-497 p.Article in journal (Refereed) PublishedText
Abstract [en]

Although osteoporotic fracture rates can be reduced by bisphosphonates, prolonged therapy is associated with higher risk of atypical femoral fractures. Ordinary fragility fractures are linked to high mortality rates. We aimed to determine whether atypical femoral fractures also confer excess mortality. Radiographs were reviewed for all patients aged 55 years who had experienced a subtrochanteric or femoral shaft fracture in Sweden in 2008 to 2010. The fractures were classified as either atypical or ordinary. Data on medication use, coexisting conditions, and date of death were obtained from national registers. We estimated multivariable-adjusted relative risks of death after atypical femoral fractures compared with ordinary subtrochanteric or femoral shaft fractures and calculated age- and sex-standardized mortality ratios (SMRs) for atypical and ordinary fractures compared with the population average. During a mean of 4 years of follow-up, 39 of 172 (23%) patients with an atypical fracture had died compared with 588 of 952 (62%) with an ordinary fracture, corresponding to a relative risk of 0.51 (95% confidence interval [CI] 0.38-0.68). The lower risk was evident in both users and nonusers of bisphosphonates. No patient with atypical fracture died in the first year after fracture. Individuals with an ordinary fracture had a higher mortality risk than the general population (SMR=1.82; 95% CI 1.69-1.99), but no excess risk was found in patients with atypical fracture (SMR=0.92; 95% CI 0.65-1.26). We conclude that in contrast to ordinary subtrochanteric and femoral shaft fractures, atypical femoral fractures are not associated with excess mortality. (c) 2015 American Society for Bone and Mineral Research.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016. Vol. 31, no 3, 491-497 p.
Keyword [en]
ATYPICAL FRACTURE; OSTEOPOROSIS; FEMORAL FRACTURE; BISPHOSPHONATES; MORTALITY
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-127577DOI: 10.1002/jbmr.2767ISI: 000373596800003PubMedID: 26676878OAI: oai:DiVA.org:liu-127577DiVA: diva2:926007
Note

Funding Agencies|Swedish Research Council

Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2016-05-03

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Schilcher, JörgAspenberg, Per
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Division of Clinical SciencesDepartment of Orthopaedics in LinköpingFaculty of Medicine and Health Sciences
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Journal of Bone and Mineral Research
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