Fracture risk following an atypical femoral fracture

Article Article scientifique Article Fracture risk following an atypical femoral fracture eng 2021-10-20 2022 author Bégin Marie-Josée author Audet Marie-Claude author Chevalley Thierry 0000-0003-3338-1148 614741 author Portela Marina 843684 author Padlina Ivan 985029 author Hannouche Didier 842478 author Ing Lorenzini Kuntheavy 0000-0001-8472-7714 510277 author Meier Raphaël 517526 author Peter Robin 62978 author Uebelhart Brigitte Florence 26964 author Rizzoli René 22717 author Ferrari Serge Livio 0000-0002-1372-4417 24314 author Biver Emmanuel 0000-0001-6174-1951 714511 87-94 10.1002/jbmr.4461 34668223 0884-0431 Atypical femoral fractures (AFF) occurring during the course of osteoporosis treatment usually lead to anti-resorptive (AR) drugs discontinuation. However, the risk of fracture after an AFF is unknown. We conducted a follow-up study of patients with AFF matched 1:3 for age- and gender with patients with a peripheral major osteoporotic fracture (pMOF), in the setting of a fracture liaison service, to investigate the incidence of subsequent low-trauma fractures. Fifty-five patients with AFF (95% women, age (mean ± SD) 75 ± 10 years, 89% exposed to AR drugs), followed for 6.2 ± 3.7 years, were compared to 165 matched controls with a pMOF (hip 85%) followed for 4.3 ± 2.6 years. During the follow-up, 38% of patients in the AFF group and 16% in the pMOF group received AR therapies. Continuation of AR drugs after an AFF was associated with contralateral AFF in 27% of subjects. The risks of new low-trauma, major osteoporotic and imminent (within 2 years) fractures, were similar between the two groups: incidence rate ratio (95% CI) of subsequent fracture following AFF relative to pMOF, 1.30 (0.82, 2.04), 1.28 (0.74, 2.15) and 1.11 (0.54, 2.15), respectively. Moreover, the risk of sustaining multiple fractures per participant was significantly increased among patients with AFF compared to pMOF (hazard ratio 1.48 (1.00, 2.19); p = 0.049). When taking mortality into account, the risk of subsequent fractures tended to be higher in the AFF group (sub-hazard ratio 1.42 (0.95, 2.12)). In conclusion, patients who sustained an AFF are at high risk of subsequent fragility fractures, at least equal or even greater to the risk observed after a pMOF. However, continuation of AR drugs increases the risk of contralateral AFF. Therefore, optimal modalities for secondary fracture prevention after AFF require further evaluation. This article is protected by copyright. All rights reserved. Osteoporosis Diseases and disorders of/related to bone Fracture risk assessment Practice/policy-related issues Antiresorptives Therapeutics Dewey 616 Dewey 617 56 Département de médecine 221 57 Département de chirurgie 222 63 Département d'anesthésiologie, pharmacologie, soins intensifs et urgences 229 false 302 Groupe Desmeules Jules (pharmacologie/toxicologie) 567 289 Génétique des ostéoporoses 544 955 Thérapie cellulaire et troubles musculo-squelettiques 960 Journal of bone and mineral research 37 1 16ecf0d5-c542-45c8-be42-f87c830eb14d Article (Published version) Public Fracture Risk Following An Atypical.pdf 574262 application/pdf CC BY-NC-ND-4.0 7d1da754-2ef0-4b7a-830f-cfa8138693a8 Appendix Public jbmr4461-sup-0001-tables.docx 42685 application/vnd.openxmlformats-officedocument.wordprocessingml.document openAccess Faculté de médecine / Section de médecine clinique / Département de médecine Faculté de médecine / Section de médecine clinique / Département de chirurgie Faculté de médecine / Section de médecine clinique / Département d'anesthésiologie, pharmacologie, soins intensifs et urgences

Title	Published in	Year	Views	Downloads

Maladies osseuses : ce qui a changé en 2023	Revue médicale suisse	2024	40	2
Fracture risk following an atypical femoral fracture	Journal of bone and mineral research	2022	183	200

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Padlina, Ivan