A Review of Atypical Femoral Fractures From a Tertiary Care Teaching Hospital: An Alarming Trend?

Objective: To evaluate the experience of a single tertiary care teaching hospital with the association between use of bisphosphonates and atypical femoral fractures, and to identify potential risk factors and chronologic incidence. Design: Retrospective review. Setting: Tertiary-care teaching hospital. Patients: Thirty-two patients with a total of 43 fractures met inclusion criteria. Intervention: Treatment for atypical femur fractures. Main Outcome Measurements: Radiographic assessments, duration of bisphosphonate therapy, prodromal symptoms, associated medications/comorbidities. Results: Thirty-one female patients and 1 male patient, with a total of 43 fractures, with an average age of 71.0 (47-92 years) +/- 11.01 years at time of fracture, had an average duration of bisphosphonate therapy of 7.57 (1-12 years) +/- 3.07 years. Prodromal thigh pain was reported in 20 of 43 fractures (46.5%). Eleven of the forty-three (25.5%) fractures occurred between 2001 and 2005. From 2006 to May 2011, however, 32/43 (74.5%) were reported. Beta-blockers, ACE/ARBs, and Statins (43.8%) were the most common concomitant medications, whereas Levothyroxine (21.8%), H-2 blockers (15.6%), and Glucocorticoids (12.5%) were less common. Conclusions: There is an increasing trend of atypical femur fractures in the current adult population. Bisphosphonate therapy beyond 7 years may place patients at increased risk. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.