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Journal of Bone and Mineral Metabolism

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13-11-2022 | Femoral Fracture | Original Article

Factors affecting healing and progression of conservatively treated incomplete atypical femoral fractures: retrospective observational study

Authors: Meng Ai Png, Joyce Suang Bee Koh, P. Chandra Mohan, Choong Yin Howe, Tet Sen Howe

Published in: Journal of Bone and Mineral Metabolism | Issue 1/2023

Abstract

Introduction

Incomplete atypical femoral fractures (iAFF) may occur with prolonged bisphosphonate usage. Factors influencing iAFF healing and progression are not well understood. This study of conservatively managed iAFF assessed factors influencing iAFF healing and progression including the effects of bisphosphonates and teriparatide use.

Materials and Methods

Single-center retrospective observational study of 69 consecutive patients with 78 radiographically confirmed iAFF from 2002 to 2017. Serial radiographs assessed for focal cortical thickening, dreaded black line (DBL) and complete fracture. Chief outcome measures were DBL healing and complete fracture.

Results

DBL had a significant association (p < 0.05) with fracture progression by multivariable logistic regression (55.8% versus 25.7%, odds ratio [OR] 26.57 (95% CI 1.40–504.78)) and shorter fracture-free survival (mean 3.21 versus 6.27 years). Presence of symptoms was associated with shorter fracture-free survival (mean 2.68 versus 5.98 years).

Discontinuing bisphosphonates had significant associations (p < 0.001) by multivariable logistic regression with decreased fracture rate (11.6% versus 92.0%; OR 0.00, 95% CI 0.00–0.08) and longer fracture-free survival (mean 7.52 versus 1.99 years). DBL healing occurred in 36.4%, only when bisphosphonates were discontinued.

Age, sex, race, fracture site, glucocorticoid use, teriparatide supplementation and duration of bisphosphonate use showed no statistically significant effect although teriparatide use appeared to improve DBL healing (50% versus 17.9%, p = 0.188).

Conclusions

In conservatively managed iAFF, DBL healing occurred in 36.4% if bisphosphonates were discontinued. Bisphosphonates and DBL were significantly associated with fracture progression and together with symptoms with fracture survival.

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Title: Factors affecting healing and progression of conservatively treated incomplete atypical femoral fractures: retrospective observational study
Authors: Meng Ai Png
Joyce Suang Bee Koh
P. Chandra Mohan
Choong Yin Howe
Tet Sen Howe
Publication date: 13-11-2022
Publisher: Springer Nature Singapore
Keywords: Femoral Fracture
Bisphosphonate
Published in: Journal of Bone and Mineral Metabolism / Issue 1/2023
Print ISSN: 0914-8779
Electronic ISSN: 1435-5604
DOI: https://doi.org/10.1007/s00774-022-01378-8

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