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20-11-2023 | Original Article

Clinical characteristics, densitometric parameters and outcomes of patients with atypical femoral fractures related to bisphosphonate treatment for osteoporosis

Authors: Chun Ho Wong, Andy Ka Chun Kan, Kimberly Hang Tsoi, Stacey Sheung Yi Chan, Nancy Su Jiang, Connie Hong Nin Loong, Carol Ho Yi Fong, Janus Siu Him Wong, Graham Ka Hon Shea, Ching Lung Cheung, Chi Ho Lee, Kathryn Choon Beng Tan, Yu Cho Woo, David Tak Wai Lui

Published in: Endocrine

Abstract

Purpose

We described the clinical and densitometric characteristics and treatment outcomes of patients who developed atypical femoral fractures (AFF) while on bisphosphonate for osteoporosis.

Methods

We performed a retrospective cohort study including all adults aged ≥50 years who developed AFF while on bisphosphonates between 1 January 2008 and 31 December 2020, and subsequently managed in the Osteoporosis Centre at Queen Mary Hospital in Hong Kong. A control group of patients who developed fragility hip fractures while on bisphosphonates in the same period was included for comparison. We compared the clinical and densitometric characteristics between the two groups, and described the clinical outcomes for the AFF group.

Results

In total, 75 patients were included (AFF: n = 35; fragility hip fracture: n = 40). All were related to oral bisphosphonates. The AFF group was characterised by a longer duration of bisphosphonate use (median of 5 years), higher bone mineral density (BMD) and more acute neck-shaft angle (all p < 0.05). Following AFF, 8 patients (22.9%) did not receive any subsequent bone-active agents: due to refusal to use an injectable, or BMD out of osteoporotic range. Most of those who received bone-active agents were given teriparatide, followed by raloxifene, and achieved stable BMD. However, subsequent fragility risk remained high. Nonetheless, AFF did not confer excess morbidity and mortality.

Conclusion

AFF was characterised by usually long duration of bisphosphonate use, higher BMD and more acute neck-shaft angle. AFF did not confer significant impairment in mobility or mortality. Nonetheless, further research work is necessary to optimise bone health among patients who develop AFF.

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Title: Clinical characteristics, densitometric parameters and outcomes of patients with atypical femoral fractures related to bisphosphonate treatment for osteoporosis
Authors: Chun Ho Wong
Andy Ka Chun Kan
Kimberly Hang Tsoi
Stacey Sheung Yi Chan
Nancy Su Jiang
Connie Hong Nin Loong
Carol Ho Yi Fong
Janus Siu Him Wong
Graham Ka Hon Shea
Ching Lung Cheung
Chi Ho Lee
Kathryn Choon Beng Tan
Yu Cho Woo
David Tak Wai Lui
Publication date: 20-11-2023
Publisher: Springer US
Published in: Endocrine
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-023-03608-z

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