title: A Review of Atypical Femoral Fractures From a Tertiary Care Teaching Hospital: An Alarming Trend?
abstract: OBJECTIVE
  To evaluate the experience of a single tertiary care teaching hospital with the association between use of bisphosphonates and atypical femoral fractures, and to identify potential risk factors and chronologic incidence.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Tertiary-care teaching hospital.
  
  
  METHODS
  Thirty-two patients with a total of 43 fractures met inclusion criteria.
  
  
  METHODS
  Treatment for atypical femur fractures.
  
  
  METHODS
  Radiographic assessments, duration of bisphosphonate therapy, prodromal symptoms, associated medications/comorbidities.
  
  
  RESULTS
  Thirty-one female patients and 1 male patient, with a total of 43 fractures, with an average age of 71.0 (47-92 years) ± 11.01 years at time of fracture, had an average duration of bisphosphonate therapy of 7.57 (1-12 years) ± 3.07 years. Prodromal thigh pain was reported in 20 of 43 fractures (46.5%). Eleven of the forty-three (25.5%) fractures occurred between 2001 and 2005. From 2006 to May 2011, however, 32/43 (74.5%) were reported. Beta-blockers, ACE/ARBs, and Statins (43.8%) were the most common concomitant medications, whereas Levothyroxine (21.8%), H-2 blockers (15.6%), and Glucocorticoids (12.5%) were less common.
  
  
  CONCLUSIONS
  There is an increasing trend of atypical femur fractures in the current adult population. Bisphosphonate therapy beyond 7 years may place patients at increased risk.
  
  
  METHODS
  Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedics, St. Luke's University Hospital and Health Network, Bethlehem, PA; and†Department of Anatomy and Cell Biology, Temple University Hospital, Philadelphia, PA.
authors.forename: John-David
authors.initials: JD
authors.lastname: Black
authors.forename: Vamsi K
authors.initials: VK
authors.lastname: Kancherla
authors.forename: William G
authors.initials: WG
authors.lastname: De Long
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects; D015897:Comorbidity; D004164:Diphosphonates / Q000009:adverse effects*; D005264:Femoral Fractures / Q000139:chemically induced / Q000453:epidemiology* / Q000601:surgery*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D058866:Osteoporotic Fractures / Q000139:chemically induced / Q000453:epidemiology* / Q000517:prevention & control*; D010414:Pennsylvania / Q000453:epidemiology; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates