Hiroyuki Tsuchie1, Naohisa Miyakoshi1, Yuji Kasukawa1, Koji Nozaka1, Kimio Saito1,2, Hayato Kinoshita3, Moto Kobayashi4, Norio Suzuki5, Toshiaki Aizawa6, Hidekazu Abe7, Shigeto Maekawa8, Takenori Tomite9, Yuichi Ono10, Kentaro Ouchi11, Nobusuke Shibata12, Itsuki Nagahata13, Masaaki Takeshima14, Manabu Akagawa15, Yusuke Yuasa16, Chie Sato17, Yoichi Shimada1. 1. Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan. 2. Department of Orthopedic Surgery, Kakunodate General Hospital, Senboku, Japan. 3. Department of Orthopedic Surgery, Akita Kousei Medical Center, Akita, Japan. 4. Department of Orthopedic Surgery, Hiraka General Hospital, Yokote, Japan. 5. Department of Orthopedic Surgery, Yuri Kumiai General Hospital, Yurihonjyo, Japan. 6. Department of Orthopedic Surgery, Northern Akita Municipal Hospital, Kitaakita, Japan. 7. Department of Orthopedic Surgery, Ugo Municipal Hospital, Ugo, Japan. 8. Department of Orthopedic Surgery, Ogachi Central Hospital, Yuzawa, Japan. 9. Department of Orthopedic Surgery, Japanese Red Cross Akita Hospital, Akita, Japan. 10. Department of Orthopedic Surgery, Nakadori General Hospital, Akita, Japan. 11. Department of Orthopedic Surgery, Yokote Municipal Hospital, Yokote, Japan. 12. Department of Orthopedic Surgery, Oga Minato Municipal Hospital, Oga, Japan. 13. Department of Orthopedic Surgery, Omagari Kousei Medical Center, Daisen, Japan. 14. Department of Orthopedic Surgery, Honjyo Daiichi Hospital, Yurihonjyo, Japan. 15. Department of Orthopedic Surgery, Akita City Hospital, Akita, Japan. 16. Department of Orthopedic Surgery, Omori Municipal Hospital, Yokote, Japan. 17. Department of Orthopedic Surgery, Akita Rosai Hospital, Odate, Japan.
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.
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.
Authors: Clarita V Odvina; Joseph E Zerwekh; D Sudhaker Rao; Naim Maalouf; Frank A Gottschalk; Charles Y C Pak Journal: J Clin Endocrinol Metab Date: 2004-12-14 Impact factor: 5.958