title: Factors associated with atypical femoral fracture.
abstract: We aimed to investigate the proportion of atypical femoral fractures (AFF) among Korean femoral fracture patients and examined the factors associated with the development of AFF. Between 2003 and 2013, 607 female patients with low-energy femoral fractures who were hospitalized at a single university hospital were retrospectively enrolled in this study. Patients were classified into two groups according to the fracture site: Patients with subtrochanteric or diaphyseal femoral fractures were included in the AFF group, while patients with intertrochanteric or neck fractures were included in the typical femoral fracture (TFF) group. After comparing clinical and radiographic characteristics between groups, we used multivariable logistic regression analysis to explore risk factors for AFF. Thirty patients (4.9 %) with AFF and 577 patients (95.1 %) with TFF were identified. The AFF group was younger than the TFF group (p < 0.01), and more patients with AFF were treated with bisphosphonate (BP) (p < 0.01) or proton-pump inhibitor (p = 0.02). When comparing the radiographic parameters, the AFF group tended to have a higher cortical thickness index (p = 0.02) and lateral-to-medial cortex ratio (p < 0.01). After adjusting for clinical variables, BP use (OR 8.09, CI 3.09-21.19) and younger age (OR 1.06, CI 1.01-1.11) were associated with AFF. The proportion of AFF was 4.9 % among patients with femoral fractures. Younger age and use of BP before fracture increased the risk of development of AFF in Korean patients.
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.|Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.
authors.forename: Dam
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.|Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.
authors.forename: Yoon-Kyoung
authors.initials: YK
authors.lastname: Sung
authors.affiliation: Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.|Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.
authors.forename: Soo-Kyung
authors.initials: SK
authors.lastname: Cho
authors.affiliation: Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.
authors.forename: Minkyung
authors.initials: M
authors.lastname: Han
authors.affiliation: Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, South Korea. estone96@gmail.com.
authors.forename: Yee-Suk
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004164:Diphosphonates / Q000009:adverse effects; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D004164:Diphosphonates; D054328:Proton Pump Inhibitors
keywords: Atypical femoral fracture; Bisphosphonates; Proportion; Risk factor