Open AccessEvaluation of the Nature and Etiologies of Risk Factors for Diaphyseal Atypical Femoral Fractures
Author(s) -
Tsuchie Hiroyuki,
Miyakoshi Naohisa,
Kasukawa Yuji,
Nozaka Koji,
Saito Kimio,
Kinoshita Hayato,
Kobayashi Moto,
Suzuki Norio,
Aizawa Toshiaki,
Abe Hidekazu,
Maekawa Shigeto,
Tomite Takenori,
Ono Yuichi,
Ouchi Kentaro,
Shibata Nobusuke,
Nagahata Itsuki,
Takeshima Masaaki,
Akagawa Manabu,
Yuasa Yusuke,
Sato Chie,
Shimada Yoichi
Publication year - 2021
Publication title -
medical principles and practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 45
eISSN - 1423-0151
pISSN - 1011-7571
DOI - 10.1159/000517484
Subject(s) - original paper
Objectives: Differences in mechanisms of subtrochanteric and diaphyseal atypical femoral fractures (AFFs) are speculated in studies that analyzed differences in the patients’ background. However, the etiologies of each type of AFF have not been studied in detail. This study aimed to investigate the nature and etiologies of the risk factors for diaphyseal AFFs. Materials and Methods: Eighty consecutive Japanese patients with 91 diaphyseal AFFs (AFF group) and 110 age-matched women with osteoporosis (non-AFF control group) were included. Their clinical data were compared; factors affecting AFFs were investigated, and the etiologies of the risk factors for diaphyseal AFFs were examined. Results: Multivariate analysis revealed that femoral serrated changes, bisphosphonate or denosumab usage, and lateral and anterior femoral curvatures were risk factors for diaphyseal AFFs ( p < 0.0011, p = 0.0137, and p < 0.0001, respectively). Multivariate analyses revealed that serrated changes and low serum 25(OH)D levels affected the lateral curvature ( p = 0.0088 and 0.0205, respectively), while serrated changes affected the anterior curvature ( p = 0.0006), each significantly affected the femoral curvature. High serum calcium (Ca) levels, lateral femoral curvature, and anterior femoral curvature were predictors of serrated changes ( p = 0.0146, 0.0002, and 0.0098, respectively). Conclusion: Risk factors for diaphyseal AFFs were bone resorption inhibitor usage, a strong femoral curvature, and serrated changes. Low serum 25(OH)D levels and serrated changes are risk factors for lateral curvature, while a high serum Ca level is a risk factor for serrated changes.