Incidence and demography of femur fractures with and without atypical features

Adrianne C. Feldstein, Dennis Black, Nancy Perrin, A. Gabriela Rosales, Darin Friess, David Boardman, Richard Dell, Arthur Santora, Julie M. Chandler, Mary M. Rix, Eric Orwoll

Research output: Contribution to journalArticle

105 Citations (Scopus)

Abstract

The case definition, community incidence, and characteristics of atypical femoral shaft fractures (FSFs) are poorly understood. This retrospective study utilized electronic medical records and radiograph review among women ≥50 years of age and men ≥65 years of age from January 1996 to June 2009 at Kaiser Permanente Northwest to describe the incidence rates and characteristics of subgroups of femur fractures. Fractures were categorized based on the American Society for Bone and Mineral Research (ASBMR) as atypical fracture major features (AFMs) (low force, shaft location, transverse or short oblique, noncomminuted) and AFMs with additional minor radiograph features (AFMms) (beaking, cortical thickening, or stress fracture). There were 5034 fractures in the study. The incidence rates of FSFs (without atypical features) and AFMs appeared flat (cumulative incidence: 18.2 per 100,000 person-years, 95% CI=16.0-20.7; 5.9 per 100,000 person-years, 95% CI=4.6-7.4; respectively) with 1,271,575 person-years observed. The proportion of AFMs that were AFMms increased over time. Thirty percent of AFMs had any dispensing of a bisphosphonate prior to the fracture, compared to 15.8% of the non-atypical FSFs. Years of oral glucocorticosteroid dispensing appeared highest in AFM and AFMm fractures. Those with AFMs only were older and had a lower frequency of bisphosphonate dispensing compared to those with AFMms. We conclude that rates of FSFs, with and without atypia, were low and stable over 13.5 years. Patients with only AFMs appear to be different from those with AFMms; it may be that only the latter group is atypical. There appear to be multiple associated risk factors for AFMm fractures.

Original languageEnglish (US)
Pages (from-to)977-986
Number of pages10
JournalJournal of Bone and Mineral Research
Volume27
Issue number5
DOIs
StatePublished - May 2012

Fingerprint

Femoral Fractures
Femur
Demography
Incidence
Diphosphonates
Stress Fractures
Electronic Health Records
Retrospective Studies

Keywords

  • ATYPICAL FRACTURE
  • BISPHOSPHONATE
  • SUBTROCHANTERIC AND FEMORAL SHAFT FRACTURES

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Incidence and demography of femur fractures with and without atypical features. / Feldstein, Adrianne C.; Black, Dennis; Perrin, Nancy; Rosales, A. Gabriela; Friess, Darin; Boardman, David; Dell, Richard; Santora, Arthur; Chandler, Julie M.; Rix, Mary M.; Orwoll, Eric.

In: Journal of Bone and Mineral Research, Vol. 27, No. 5, 05.2012, p. 977-986.

Research output: Contribution to journalArticle

Feldstein, AC, Black, D, Perrin, N, Rosales, AG, Friess, D, Boardman, D, Dell, R, Santora, A, Chandler, JM, Rix, MM & Orwoll, E 2012, 'Incidence and demography of femur fractures with and without atypical features', Journal of Bone and Mineral Research, vol. 27, no. 5, pp. 977-986. https://doi.org/10.1002/jbmr.1550
Feldstein, Adrianne C. ; Black, Dennis ; Perrin, Nancy ; Rosales, A. Gabriela ; Friess, Darin ; Boardman, David ; Dell, Richard ; Santora, Arthur ; Chandler, Julie M. ; Rix, Mary M. ; Orwoll, Eric. / Incidence and demography of femur fractures with and without atypical features. In: Journal of Bone and Mineral Research. 2012 ; Vol. 27, No. 5. pp. 977-986.
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abstract = "The case definition, community incidence, and characteristics of atypical femoral shaft fractures (FSFs) are poorly understood. This retrospective study utilized electronic medical records and radiograph review among women ≥50 years of age and men ≥65 years of age from January 1996 to June 2009 at Kaiser Permanente Northwest to describe the incidence rates and characteristics of subgroups of femur fractures. Fractures were categorized based on the American Society for Bone and Mineral Research (ASBMR) as atypical fracture major features (AFMs) (low force, shaft location, transverse or short oblique, noncomminuted) and AFMs with additional minor radiograph features (AFMms) (beaking, cortical thickening, or stress fracture). There were 5034 fractures in the study. The incidence rates of FSFs (without atypical features) and AFMs appeared flat (cumulative incidence: 18.2 per 100,000 person-years, 95{\%} CI=16.0-20.7; 5.9 per 100,000 person-years, 95{\%} CI=4.6-7.4; respectively) with 1,271,575 person-years observed. The proportion of AFMs that were AFMms increased over time. Thirty percent of AFMs had any dispensing of a bisphosphonate prior to the fracture, compared to 15.8{\%} of the non-atypical FSFs. Years of oral glucocorticosteroid dispensing appeared highest in AFM and AFMm fractures. Those with AFMs only were older and had a lower frequency of bisphosphonate dispensing compared to those with AFMms. We conclude that rates of FSFs, with and without atypia, were low and stable over 13.5 years. Patients with only AFMs appear to be different from those with AFMms; it may be that only the latter group is atypical. There appear to be multiple associated risk factors for AFMm fractures.",
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AU - Boardman, David

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