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. 2021;30(5):430-436.
doi: 10.1159/000517484. Epub 2021 May 31.

Evaluation of the Nature and Etiologies of Risk Factors for Diaphyseal Atypical Femoral Fractures

Hiroyuki Tsuchie  1 , Naohisa Miyakoshi  1 , Yuji Kasukawa  1 , Koji Nozaka  1 , Kimio Saito  1   2 , Hayato Kinoshita  3 , Moto Kobayashi  4 , Norio Suzuki  5 , Toshiaki Aizawa  6 , Hidekazu Abe  7 , Shigeto Maekawa  8 , Takenori Tomite  9 , Yuichi Ono  10 , Kentaro Ouchi  11 , Nobusuke Shibata  12 , Itsuki Nagahata  13 , Masaaki Takeshima  14 , Manabu Akagawa  15 , Yusuke Yuasa  16 , Chie Sato  17 , Yoichi Shimada  1
Affiliations

Evaluation of the Nature and Etiologies of Risk Factors for Diaphyseal Atypical Femoral Fractures

Hiroyuki Tsuchie et al. Med Princ Pract. 2021.

Abstract

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.

Keywords: Atypical femoral fracture; Femoral curvature; Serrated change.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Anteroposterior radiograph of the left femur presenting an example of a “serrated change.” Some thickening of the femoral cortex over the outer cortical bone of the diaphysis is noted.
See this image and copyright information in PMC

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