J H Koh1, J P Myong2, J Yoo1, Y-W Lim3, J Lee1, S-K Kwok1, S-H Park1, J H Ju4. 1. Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-040, South Korea. 2. Department of Occupational & Environmental Medicine, Center for Occupational & Environmental Medicine (WHO Collaboratory Center), Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. 3. Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea. 4. Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-040, South Korea. juji@catholic.ac.kr.
Abstract
The risk factors for atypical femur fracture in patients exposed to bisphosphonates for at least 1 year were examined. Prolonged and continuous use of bisphosphonates, long-term use of glucocorticoids, and a higher body mass index were associated with increased risk of atypical femur fracture. INTRODUCTION: The purpose of the present study is to determine whether rheumatoid arthritis (RA) and other clinical factors are associated with an increased risk of bisphosphonate (BP)-related atypical femur fracture (AFF). METHODS: A retrospective nested case-control study of patients who had taken BPs for at least 1 year was conducted. Patients with AFF were identified by reviewing surgical and radiographic records. Three controls with no history of AFFs were randomly selected and age- and sex-matched to each patient with AFFs. Cox proportional hazard models were used to analyze the independent contribution of risk factors to BP-related AFF. RESULTS: Among the 35,104 patients prescribed BPs for at least 1 year, 43 females (mean age, 68 years) suffered AFFs (0.12%). Patients with AFFs were exposed to BPs for a mean of 7.3 years. Patients with AFFs were exposed to BPs for longer than those without AFFs and continued treatment without a drug holiday. More patients with AFF than controls had taken glucocorticoids and disease-modifying anti-rheumatic drugs. Multivariate Cox regression analyses estimated that long-term use of glucocorticoids, prolonged exposure to BP without cessation, and every 1 kg/m2 increase in the body mass index (BMI) increased the hazard ratio for AFFs by 3.0, 5.2, and 1.2, respectively. CONCLUSIONS: Prolonged and continuous use of BPs, long-term use of glucocorticoids, and a higher BMI increase the risk of AFFs. Switching long-term BP and glucocorticoid users to other bone-protective agents should be considered.
The risk factors for atypical femur fracture in patients exposed to bisphosphonates for at least 1 year were examined. Prolonged and continuous use of bisphosphonates, long-term use of glucocorticoids, and a higher body mass index were associated with increased risk of atypical femur fracture. INTRODUCTION: The purpose of the present study is to determine whether rheumatoid arthritis (RA) and other clinical factors are associated with an increased risk of bisphosphonate (BP)-related atypical femur fracture (AFF). METHODS: A retrospective nested case-control study of patients who had taken BPs for at least 1 year was conducted. Patients with AFF were identified by reviewing surgical and radiographic records. Three controls with no history of AFFs were randomly selected and age- and sex-matched to each patient with AFFs. Cox proportional hazard models were used to analyze the independent contribution of risk factors to BP-related AFF. RESULTS: Among the 35,104 patients prescribed BPs for at least 1 year, 43 females (mean age, 68 years) suffered AFFs (0.12%). Patients with AFFs were exposed to BPs for a mean of 7.3 years. Patients with AFFs were exposed to BPs for longer than those without AFFs and continued treatment without a drug holiday. More patients with AFF than controls had taken glucocorticoids and disease-modifying anti-rheumatic drugs. Multivariate Cox regression analyses estimated that long-term use of glucocorticoids, prolonged exposure to BP without cessation, and every 1 kg/m2 increase in the body mass index (BMI) increased the hazard ratio for AFFs by 3.0, 5.2, and 1.2, respectively. CONCLUSIONS: Prolonged and continuous use of BPs, long-term use of glucocorticoids, and a higher BMI increase the risk of AFFs. Switching long-term BP and glucocorticoid users to other bone-protective agents should be considered.
Authors: Maria Belen Zanchetta; Maria Diehl; Mirena Buttazzoni; Ana Galich; Fernando Silveira; Cesar E Bogado; Jose Rubén Zanchetta Journal: J Bone Miner Res Date: 2014-04 Impact factor: 6.741
Authors: Ronald Emkey; Pierre D Delmas; Stefan Goemaere; Uri A Liberman; Patrice E Poubelle; Anastasia G Daifotis; Nadia Verbruggen; Antonio Lombardi; Michelle Czachur Journal: Arthritis Rheum Date: 2003-04
Authors: Andrea Giusti; Neveen A T Hamdy; Olaf M Dekkers; Sharita R Ramautar; Sander Dijkstra; Socrates E Papapoulos Journal: Bone Date: 2010-12-31 Impact factor: 4.398
Authors: Marc C Hochberg; Susan Greenspan; Richard D Wasnich; Paul Miller; Desmond E Thompson; Philip D Ross Journal: J Clin Endocrinol Metab Date: 2002-04 Impact factor: 5.958
Authors: Elizabeth Shane; David Burr; Bo Abrahamsen; Robert A Adler; Thomas D Brown; Angela M Cheung; Felicia Cosman; Jeffrey R Curtis; Richard Dell; David W Dempster; Peter R Ebeling; Thomas A Einhorn; Harry K Genant; Piet Geusens; Klaus Klaushofer; Joseph M Lane; Fergus McKiernan; Ross McKinney; Alvin Ng; Jeri Nieves; Regis O'Keefe; Socrates Papapoulos; Tet Sen Howe; Marjolein C H van der Meulen; Robert S Weinstein; Michael P Whyte Journal: J Bone Miner Res Date: 2013-10-01 Impact factor: 6.741
Authors: K G Saag; R Emkey; T J Schnitzer; J P Brown; F Hawkins; S Goemaere; G Thamsborg; U A Liberman; P D Delmas; M P Malice; M Czachur; A G Daifotis Journal: N Engl J Med Date: 1998-07-30 Impact factor: 91.245
Authors: Charles A O'Brien; Dan Jia; Lilian I Plotkin; Teresita Bellido; Cara C Powers; Scott A Stewart; Stavros C Manolagas; Robert S Weinstein Journal: Endocrinology Date: 2003-12-22 Impact factor: 4.736
Authors: Wei Zhou; Jeroen G J van Rooij; Peter R Ebeling; Annemieke J M H Verkerk; M Carola Zillikens Journal: Curr Osteoporos Rep Date: 2021-02-15 Impact factor: 5.096
Authors: George F Georgiadis; Alexia P Balanika; Alexandros Ε Vasilakis; Dimitrios G Begkas; Christos S Baltas; Alexandros P Pastroudis Journal: J Musculoskelet Neuronal Interact Date: 2021-09-01 Impact factor: 2.041