title: Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: sensitivity and trim and fill studies.
abstract: OBJECTIVE
  This study carried out sensitivity analysis and trim-fill analysis between bisphosphonates and subtrochanteric, femoral shaft, and atypical femur fracture.
  
  
  METHODS
  A random-effects model was used finally. Sensitivity, trim and fill, and publication bias analyses were done.
  
  
  RESULTS
  Under a random-effects model (I(2)=87.535), the Z-value=5.672, p-value of test of null<0.001. Bisphosphonate exposure was associated with an increased risk of atypical femur fracture (3.243 [95% CI 2.160-4.870]). When any study is removed, the remaining sensitivity analysis results are still significant. Trim and fill results show that two studies were missed. After filling them, a funnel plot of precision by log risk ratio was more symmetrical.
  
  
  CONCLUSIONS
  This study suggests that (1) there is an increased risk of subtrochanteric, femoral shaft, and atypical femur fracture in bisphosphonate users; (2) any single study does not influence the total sensitivity; (3) two studies have been lost, theoretically.
authors.affiliation: 1 Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Orthopedics and Traumatology, Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China .
authors.forename: Jie
authors.initials: J
authors.lastname: Liu
authors.forename: Hong-xin
authors.initials: HX
authors.lastname: Zhang
authors.forename: Xiong-xiong
authors.initials: XX
authors.lastname: Lu
authors.forename: Jia-jia
authors.initials: JJ
authors.lastname: Hu
authors.forename: Lian-fu
authors.initials: LF
authors.lastname: Deng
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D004164:Diphosphonates / Q000009:adverse effects*; D005264:Femoral Fractures / Q000139:chemically induced* / Q000453:epidemiology; D005265:Femoral Neck Fractures / Q000139:chemically induced / Q000453:epidemiology; D006620:Hip Fractures / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D058866:Osteoporotic Fractures / Q000139:chemically induced* / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates