Atypical Femur Fractures-An Analysis of 69 Patients from 15 Years

Area of Science:

• Orthopedics
• Pharmacology
• Geriatric Medicine

Background:

• Bisphosphonates effectively prevent osteoporotic fractures but increase the risk of atypical femur fractures (AFFs) with prolonged use.
• Limited data exists on the clinical outcomes of AFF in Chinese populations.
• This study addresses the need for localized data on AFF management and outcomes.

Purpose of the Study:

• To review the clinical outcomes of atypical femur fracture (AFF) cases managed in a Hong Kong tertiary center.
• To analyze the association between bisphosphonate use duration and AFF occurrence.
• To evaluate the effectiveness of surgical intervention and rehabilitation protocols for AFF.

Main Methods:

• Retrospective analysis of 69 AFF cases managed at Prince of Wales Hospital (2010-2024).
• Data collected included demographics, bisphosphonate history, fixation methods, and 1-year post-operative mobility.
• One-way ANOVA compared bisphosphonate use duration across different drug types.

Main Results:

• The cohort comprised 69 patients (mean age 73.8 years), with 95.6% having a history of bisphosphonate use (mean duration 6.8 years).
• Duration of bisphosphonate use was similar for alendronate, ibandronate, and multi-agent users.
• The study observed a 5.8% non-union rate and 48.2% return to pre-morbid mobility at 1 year post-operation.

Conclusions:

• Atypical femur fractures (AFFs) are more prevalent in female patients with a history of bisphosphonate use.
• Closed reduction and fixation with a long cephalomedullary device, coupled with immediate full-weight-bearing, demonstrated high success rates.
• This treatment approach may be an effective strategy for managing AFF in the studied population.