Prevalence and risk factors for atypical femoral fracture among Lebanese patients with hip and shaft fractures

This retrospective study investigates the prevalence of atypical femoral fractures (AFFs) among patients admitted with hip and shaft fractures at a tertiary referral center in Beirut, Lebanon. We analyzed electronic medical records and radiology studies of patients aged above 40 admitted with hip and shaft fractures between January 2006 and December 2019. Fractures were confirmed by ICD9 or ICD10 codes. All cases were reviewed by radiologists, and AFFs were identified according to the 2013 revised ASBMR criteria. We identified 1366 hip and shaft fracture patients, of which 14 female patients had 19 AFFs. This represents a prevalence of 1.0% among all hip and shaft fractures patients and 1.7% among all female hip and shaft fracture patients. Bilateral AFFs were found in 5 of the 14 patients. Patients with AFF tended to be younger, with a mean age of 74.3 (+/- 8.6) yr compared to 78.0 (+/- 10.6) for patients with non-AFF fractures. A total of 36% of AFF patients had a prior history of non-traumatic fracture at first admission. A high percentage of patients with AFFs reported intake of proton pump inhibitors (42.9%) and glucocorticoids (21.4%). Bisphosphonate exposure was noted in 64.3% of AFF patients. None of the AFF patients were active smokers or consumed alcohol regularly. BMD assessments were available for 7 AFF patients, indicating osteoporosis in 4 and osteopenia in 3 cases. Hip axis length measurements showed no significant difference between AFF patients (N = 7) and sex and age-matched controls (N = 21). The study underlines the prevalence and characteristics of AFFs in Lebanon, which is consistent with the numbers reported in the literature (0.32%-5%). A larger prospective study that includes hospitals across the nation is needed to gain a more comprehensive view of the prevalence of AFFs in the Lebanese population. This study investigated the prevalence of atypical femoral fractures (AFFs) in Lebanon, which are rare fractures of the thigh bone associated with the use of bisphosphonate (BP), medications that are used to strengthen bones. We evaluated medical records of patients from the American University of Beirut Medical Center between 2006 and 2019. Out of 1440 hip and shaft fractures that were identified among 1366 patients, 19 were AFFs occurring in 14 patients. All patients with AFFs were women, and they were younger on average than the other hip and shaft fracture patients. These women did not smoke or drink alcohol. Many had a history of breaking bones before and were taking medications like BP and medications for heartburn. The findings of this study are aligned with other reports worldwide. They help us understand these rare fractures better, especially in Lebanon. It shows that more research is needed to better understand why these fractures happen and how to prevent them.