Abstract：
OBJECTIVE: 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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
目的：我们描述了在使用双膦酸盐治疗骨质疏松症时发生非典型股骨骨折（AFF）的患者的临床和密度特征以及治疗结果。
方法：我们进行了一项回顾性队列研究，包括所有年龄≥50岁、在2008年1月1日至2020年12月31日期间服用双膦酸盐后出现AFF的成年人，随后在香港玛丽医院骨质疏松中心进行治疗。纳入同期使用双膦酸盐时发生脆性髋部骨折的对照组进行比较。我们比较了两组的临床和光密度特征，并描述了AFF组的临床结果。
结果：总计，包括75例患者（AFF：n=35；脆性髋部骨折：n=40）。均与口服双膦酸盐有关。AFF组的特点是使用双膦酸盐的持续时间较长（中位数为5年），更高的骨密度（BMD）和更尖锐的颈干角（所有p<0.05）。在AFF之后，8例患者（22.9%）没有接受任何后续的骨活性剂：由于拒绝使用注射剂，或BMD超出骨质疏松范围。大多数接受骨活性剂的人都接受了特立帕肽，其次是雷洛昔芬,并获得稳定的BMD。然而,随后的脆弱性风险仍然很高。尽管如此，AFF没有赋予过高的发病率和死亡率。
结论：AFF的特点是双膦酸盐使用时间通常较长，更高的骨密度和更尖锐的颈轴角。AFF没有显著损害活动性或死亡率。尽管如此，需要进一步的研究工作来优化发展为AFF的患者的骨骼健康。
方法：我们进行了一项回顾性队列研究，包括所有年龄≥50岁、在2008年1月1日至2020年12月31日期间服用双膦酸盐后出现AFF的成年人，随后在香港玛丽医院骨质疏松中心进行治疗。纳入同期使用双膦酸盐时发生脆性髋部骨折的对照组进行比较。我们比较了两组的临床和光密度特征，并描述了AFF组的临床结果。
结果：总计，包括75例患者（AFF：n=35；脆性髋部骨折：n=40）。均与口服双膦酸盐有关。AFF组的特点是使用双膦酸盐的持续时间较长（中位数为5年），更高的骨密度（BMD）和更尖锐的颈干角（所有p<0.05）。在AFF之后，8例患者（22.9%）没有接受任何后续的骨活性剂：由于拒绝使用注射剂，或BMD超出骨质疏松范围。大多数接受骨活性剂的人都接受了特立帕肽，其次是雷洛昔芬,并获得稳定的BMD。然而,随后的脆弱性风险仍然很高。尽管如此，AFF没有赋予过高的发病率和死亡率。
结论：AFF的特点是双膦酸盐使用时间通常较长，更高的骨密度和更尖锐的颈轴角。AFF没有显著损害活动性或死亡率。尽管如此，需要进一步的研究工作来优化发展为AFF的患者的骨骼健康。
