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The incidence of and risk factors for developing atypical femoral fractures in Japan

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Abstract

The long-term treatment with anti-resorptive drugs for osteoporotic patients is suggested to be associated with an increase in atypical femoral fractures (AFFs). However, their incidence, patient characteristics, and risk factors have not been fully elucidated especially in Asian countries. This retrospective observational cohort study found fourteen AFFs in ten patients (four bilateral fractures) among 2,238 hip and femoral shaft fractures treated in our associated hospitals between 2005 and 2010; this incidence (0.63 %) was similar to Caucasians. Of the ten patients with AFFs, nine (90 %) and six (60 %) were using bisphosphonates (BPs) and glucocorticoids (GCs), respectively, compared to 14.3 and 8.6 % for patients with typical femoral fractures who were using these agents. As comorbid conditions, five patients had collagen disease (CD) and two had diabetes. A fracture location-, age- and gender-matched (1:3) case–control study revealed that administration of BPs, GCs, and suffering from collagen disease (CD) were significant risk factors for developing AFFs [odds ratios 36.0 (95 % confidence intervals 3.8–342.2), 13.0 (2.3–74.1) and 9.0 (1.6–50.3), respectively]. Interestingly, all of the patients with atypical subtrochanteric femoral fractures, defined as those within 5 cm of the lesser trochanter, were taking GCs due to CD, and the age of these patients (average of 54.8 years) was significantly younger than those with atypical diaphyseal femoral fractures (average of 77.2 years, p < 0.05). In conclusion, the incidence of AFFs in the Japanese population was similar to that of Caucasians, and taking BPs and GCs and suffering from CD were risk factors for developing AFFs.

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Acknowledgments

We thank all orthopedic surgeons working at Juntendo University Hospital, Juntendo Urayasu Hospital, Juntendo Shizuoka Hospital, Juntendo Nerima Hospital, Koto Hospital and Chiba Central Medical Center for providing the clinical data and information about the treatment courses of patients.

This work was not funded by any research or training grants. The authors declare no competing interests.

Conflict of interest

All authors state that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan

    Yoshitomo Saita, Muneaki Ishijima, Mitsuaki Kubota, Takefumi Kaketa, Lizu Liu & Kazuo Kaneko

  2. Department of Orthopaedic Surgery, Juntendo Shizuoka Hospital, Shizuoka, Japan

    Atsuhiko Mogami, Yasuhiro Homma, Nana Nagura, Tomoki Wada & Osamu Obayashi

  3. Department of Orthopaedic Surgery, Juntendo Urayasu Hospital, Chiba, Japan

    Tomonori Baba & Katsuo Shitoto

  4. Department of Orthopaedic Surgery, Juntendo Nerima Hospital, Tokyo, Japan

    Masashi Nagao, Yuko Sakamoto, Kensuke Sakai & Masahiko Nozawa

  5. Department of Orthopaedic Surgery, Koto Hospital, Tokyo, Japan

    Rui Kato & Hajime Kajihara

  6. Department of Orthopaedic Surgery, Chiba Central Medical Center, Chiba, Japan

    Kei Miyagawa & Hogaku Gen

  7. Juntendo Clinical Research Center, Juntendo University, Tokyo, Japan

    Joe Matsuoka

  8. Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Muneaki Ishijima

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  1. Yoshitomo Saita
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  2. Muneaki Ishijima
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  14. Tomoki Wada
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  15. Lizu Liu
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Correspondence to Muneaki Ishijima.

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Saita, Y., Ishijima, M., Mogami, A. et al. The incidence of and risk factors for developing atypical femoral fractures in Japan. J Bone Miner Metab 33, 311–318 (2015). https://doi.org/10.1007/s00774-014-0591-9

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  • DOI: https://doi.org/10.1007/s00774-014-0591-9

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