title: Incidence of Atypical Femur Fractures in Cancer Patients: The MD Anderson Cancer Center Experience.
abstract: Atypical femoral fractures (AFFs) are rare adverse events attributed to bisphosphonate (BP) use. Few cases of AFF in cancer have been described; the aim of this study is to identify the incidence and risk factors for AFF in a large cancer center. This retrospective study was conducted at the MD Anderson Cancer Center. The incidence rate of AFF among BP users was calculated from January 1, 2004 through December 31, 2013. The control group (n = 51) included 2 or 3 patients on BPs matched for age (≤1 year) and gender. Logistic regression analysis was used to assess the relationship between clinical characteristics and AFF. Twenty-three AFF cases were identified radiographically among 10,587 BP users, the total BP exposure was 53,789 months (4482 years), and the incidence of AFF in BP users was 0.05 cases per 100,000 person-years. Meanwhile, among 300,553 patients who did not receive BPs there were 2 cases of AFF as compared with the 23 cases noted above. The odds ratio (OR) of having AFF in BP users was 355.58 times higher (95% CI, 84.1 to 1501.4, p < 0.0001) than the risk in non-BP users. The OR of having AFF in alendronate users was 5.54 times greater (OR 5.54 [95% CI, 1.60 to 19.112, p = 0.007]) than the odds of having AFF among other BP users. Patients who were on zoledronic acid (ZOL) had smaller odds of developing AFF compared with other BP users in this matched case control sample. AFFs are rare, serious adverse events that occur in patients with cancer who receive BP therapy. Patients with cancer who receive BPs for prior osteoporosis therapy or for metastatic cancer are at higher risk of AFF. © 2016 American Society for Bone and Mineral Research.
authors.affiliation: Bone Program of Texas, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Beatrice J
authors.initials: BJ
authors.lastname: Edwards
authors.affiliation: Bone Program of Texas, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Ming
authors.initials: M
authors.lastname: Sun
authors.affiliation: Departments of Dermatology and Pediatrics, and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: West
authors.affiliation: Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Michele
authors.initials: M
authors.lastname: Guindani
authors.affiliation: Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Yan Heather
authors.initials: YH
authors.lastname: Lin
authors.affiliation: Bone Program of Texas, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Huifang
authors.initials: H
authors.lastname: Lu
authors.affiliation: Bone Program of Texas, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Mimi
authors.initials: M
authors.lastname: Hu
authors.affiliation: Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Barcenas
authors.affiliation: Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Bird
authors.affiliation: Department of Medication Management & Analytics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Chun
authors.initials: C
authors.lastname: Feng
authors.affiliation: Bone Program of Texas, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Smita
authors.initials: S
authors.lastname: Saraykar
authors.affiliation: Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Debasish
authors.initials: D
authors.lastname: Tripathy
authors.affiliation: Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Gabriel N
authors.initials: GN
authors.lastname: Hortobagyi
authors.affiliation: Bone Program of Texas, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gagel
authors.affiliation: Division of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: William A
authors.initials: WA
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D005264:Femoral Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D012307:Risk Factors; D013781:Texas
keywords: ADVERSE EVENTS; ALENDRONATE; BISPHOSPHONATES; DENOSUMAB; DRUG-RELATED; HYPERCALCEMIA; MALIGNANCY; SKELETAL-RELATED EVENTS; METASTASIS; ZOLEDRONIC ACID