Atypical Femur Fractures: 81 Individual Personal Histories

Schneider, Jennifer P.; Hinshaw, William B.; Su, Christina; Solow, Phyllis

doi:10.1210/jc.2012-2590

Cited by 33 publications

(30 citation statements)

References 10 publications

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“…An increased risk of AFF has been postulated in glucocorticoid and proton pump inhibitor users, individuals with diabetes and rheumatoid arthritis, and individuals of Asian ancestry. In one study, many of the patients with AFF were younger, active women with osteopenia; it is possible that many were not at high risk for typical fracture …”

Section: Safety Of Bisphosphonates and Effect Of Discontinuation On Amentioning

confidence: 99%

“…In one study, many of the patients with AFF were younger, active women with osteopenia; it is possible that many were not at high risk for typical fracture. (84) Reports of AFF with denosumab therapy should be kept in mind when considering switching from BP to denosumab therapy, and a careful scrutiny of the relevant risk factors for AFF should be performed. (85) Importantly, documented AFFs have also occurred in individuals without any history of antiresorptive therapy.…”

Section: Osteonecrosis Of the Jaw (Onj)mentioning

confidence: 99%

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Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research

Adler

Fuleihan

Bauer

et al. 2015

Journal of Bone and Mineral Research

542

270

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Bisphosphonates (BPs) are the most commonly used medications for osteoporosis, but optimal duration of therapy is unknown. This ASBMR report provides guidance on BP therapy duration with a risk benefit perspective. Two trials provided evidence for long-term BP use. In the Fracture Intervention Trial Long-term Extension (FLEX), postmenopausal women receiving alendronate for 10 years had fewer clinical vertebral fractures than those switched to placebo after 5 years. In the HORIZON extension, women who received 6 annual infusions of zoledronic acid had fewer morphometric vertebral fractures compared with those switched to placebo after 3 years. Low hip T-score between −2 and −2.5 in FLEX and below −2.5 in HORIZON extension predicted a beneficial response to continued therapy. Hence, the Task Force suggests that after 5 years of oral BP or 3 years of intravenous BP, women should be reassessed. Women with previous major osteoporotic fracture, those who fracture on therapy, or others at high risk should generally continue therapy for up to 10 years (oral) or 6 years (intravenous), with periodic risk-benefit evaluation. Older women, those with a low hip T-score or high fracture risk score are considered high risk. The risk of osteonecrosis of the jaw and atypical femoral fracture increases with BP therapy duration, but such rare events are far outweighed by fracture risk reduction with BPs in high risk patients. For women not at high fracture risk after 3–5 years of BP treatment, a drug holiday of 2–3 years can be considered, with periodic reassessment. The algorithm provided for long term BP use is based on limited evidence in mostly Caucasian postmenopausal women and only for vertebral fracture reduction. It is probably applicable to men and patients with glucocorticoid-induced osteoporosis, with some adaptations. It is unlikely that future osteoporosis trials will provide data for formulating definitive recommendations.

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Section: Safety Of Bisphosphonates and Effect Of Discontinuation On Amentioning

confidence: 99%

Section: Osteonecrosis Of the Jaw (Onj)mentioning

confidence: 99%

Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research

Adler

Fuleihan

Bauer

et al. 2015

Journal of Bone and Mineral Research

542

270

View full text Add to dashboard Cite

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“…At least one of the fractures (reported by one of us in 2006 [13]) which was listed in the 2010 task force report was comminuted and thus inconsistent with the noncomminuted restriction. We also reported in 2012 two additional cases that met the definition except for that restriction [5] and argued at that time that comminuted cases had been observed by us and deserved recognition. We were gratified to see that a modified definition including "limited" comminution was incorporated into the task force update.…”

Section: Introductionmentioning

confidence: 67%

“…In a publication in 2012, we emphasized the growing importance of atypical non-AFF fractures [5]. Two thoughtful reviews of risks associated with antiresorptive therapy [16,17] published in 2011 did not mention non-AFF BP-associated fractures.…”

Section: Methodsmentioning

confidence: 99%

“…Three non-BP fractures were reported by Girgis [4] as not currently taking BP. No other history was provided; thus these cases cannot be definitively assigned to the nonassociation category, as these fractures can occur after the BP medication has been stopped [5]. The remaining 5 cases reported in abstract form by Dell and co-workers [6] with reportedly good x-ray evidence were the only other unambiguous exceptions.…”

Section: Introductionmentioning

confidence: 99%

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Bisphosphonate-associated Atypical Fractures that are not “Atypical Femoral Fractures”

Hinshaw¹,

Schneider²

2017

BJMMR

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The Sydney AFF Score: A Simple Tool to Distinguish Females Presenting With Atypical Femur Fractures Versus Typical Femur Fractures

Crouch

Dhanekula

Burn

et al. 2020

Journal of Bone and Mineral Research

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Atypical femur fractures (AFF) are a rare but serious complication of long‐term bisphosphonate use. Although clearly defined by ASBMR criteria, a proportion of patients with AFFs may go unrecognized and the use of qualitative fracture criteria may lead to uncertainty in AFF diagnosis, with significant therapeutic implications. A score that rapidly and accurately identifies AFFs among subtrochanteric femur fractures using quantitative, measurable parameters is needed. In a retrospective cohort of 110 female patients presenting with AFFs or typical femur fractures (TFFs), multiple logistic regression and decision tree analysis were used to develop the Sydney AFF score. This score, based on demographic and femoral geometry variables, uses three dichotomized independent predictors and adds one point for each: (age ≤80 years) + (femoral neck width <37 mm) + (lateral cortical width at lesser trochanter ≥5 mm), (score, 0 to 3). In an independent validation set of 53 female patients at a different centre in Sydney, a score ≥2 demonstrated 73.3% sensitivity and 69.6% specificity for AFF (area under the receiver‐operating characteristic curve [AUC] 0.775, SE 0.063) and remained independently associated with AFF after adjustment for bisphosphonate use. The Sydney AFF score provides a quantitative means of flagging female patients with atraumatic femur fractures who have sustained an AFF as opposed to a TFF. This distinction has clear management implications and may augment current ASBMR diagnostic criteria. © 2021 American Society for Bone and Mineral Research (ASBMR).

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Atypical Femur Fractures: 81 Individual Personal Histories

Cited by 33 publications

References 10 publications

Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research

Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research

Bisphosphonate-associated Atypical Fractures that are not “Atypical Femoral Fractures”

The Sydney AFF Score: A Simple Tool to Distinguish Females Presenting With Atypical Femur Fractures Versus Typical Femur Fractures

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