Evaluation of factors affecting the occurrence of second atypical fracture after bone union of the first atypical fracture

Tsuchie, Hiroyuki; Miyakoshi, Naohisa; Kasukawa, Yuji; Nozaka, Koji; Saito, Kimio; Kinoshita, Hayato; Kobatyashi, Moto; Suzuki, Norio; Aizawa, Toshiaki; Abe, Hidekazu; Maekawa, Shigeto; Tomite, Takanori; Ono, Yuichi; Ouchi, Kentaro; Shibata, Nobusuke; Nagahata, Itsuki; Takeshima, Masaaki; Akagawa, Manabu; Yuasa, Yusuke; Sato, Chie; Shimada, Yoichi

Affiliations

¹Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan

²Department of Orthopedic Surgery, Kakunodate General Hospital, 3 Iwase, Kakunodate, Senboku 014-0394, Japan

³Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita 011-0948, Japan

⁴Department of Orthopedic Surgery, Hiraka General Hospital, 3-1, Yatsuguchi, Maego, Yokote 013-8610, Japan

⁵Department of Orthopedic Surgery, Yuri Kumiai General Hospital, Kawaguchi aza Yaushiro, Yurihonjyo 015-8511, Japan

⁶Department of Orthopedic Surgery, Northern Akita Municipal Hospital, 16-29 Shimosugi aza Kamishimizusawa, Kitaakita 018-4221, Japan

⁷Department of Orthopedic Surgery, Ugo Municipal Hospital, 44-5 Otomichi, Nishomonai, Ugo 012-1131, Japan

⁸Department of Orthopedic Surgery, Ogachi Central Hospital, 25 Yamada aza Isamigaoka, Yuzawa 012-0055, Japan

⁹Department of Orthopedic Surgery, Japanese Red Cross Akita Hospital, 222-1 Saruta aza Inawashirosawa, Kamikitate, Akita 010-1495, Japan

¹⁰Department of Orthopedic Surgery, Nakadori General Hospital, 3-15 Misono-cho, Minami-dori, Akita 010-8577, Japan

¹¹Department of Orthopedic Surgery, Yokote Municipal Hospital, 5-31 Negishimachi, Yokote 013-8602, Japan

¹²Department of Orthopedic Surgery, Oga Minato Municipal Hospital, 1-8-6 Funakawa aza Kaigandori, Oga 010-0051, Japan

¹³Department of Orthopedic Surgery, Omagari Kousei Medical Center, 8-65 Omagari Torimachi, Daisen 014-0027, Japan

¹⁴Department of Orthopedic Surgery, Honjyo Daiichi Hospital, 111 Iwabuchishita, Yurihonjyo 015-8567, Japan

¹⁵Department of Orthopedic Surgery, Akita City Hospital, 4-30 Matsuokamachi, Kawamoto, Akita 010-0933, Japan

¹⁶Department of Orthopedic Surgery, Omori Municipal Hospital, 245-205 Omori aza Sugouta, Yokote 013-0525, Japan

¹⁷Department of Orthopedic Surgery, Akita Rosai Hospital, 30 Karuizawa aza Shimotai, Odate 018-5604, Japan

Abstract and keywords

Purpose: Teriparatide is sometimes used in the treatment of atypical femoral fracture (AFF). Even if bone union is achieved, orthopedic physicians must consider the risk of relapse. This study aimed to investigate the factors affecting AFF recurrence, and to determine the appropriate treatment for osteoporosis after bone union.

Methods: One hundred thirty-one consecutive AFFs in 113 Japanese patients were included. Eleven patients had AFF in the unaffected limb (9 patients) after the first AFF or re-fracture at the original fracture site (2 patients) after bone union of the first AFF was confirmed. We divided all patients into two groups: the second fracture group (22 AFFs in 11 patients) and non-second fracture group (109 AFFs in 102 patients). We compared clinical information between the 2 groups and investigated the factors affecting AFF recurrence using the Student t-, Welch t-, and chi-square tests.

Results: Although there was no significant difference in clinical characteristics between the 2 groups, multivariate analysis of factors associated with AFF recurrence identified short duration of treatment with teriparatide and active vitamin D3 (p = 0.0408 and 0.0366, respectively) as risk factors. Even in the analysis excluding subtrochanteric AFF, short periods of teriparatide and active vitamin D3 administration were observed as risk factors (p = 0.0484 and 0.0346, respectively).

Conclusion: The administration of teriparatide for as long as possible after occurrence first AFF and the use of active vitamin D3 after completion of teriparatide therapy may be the most effective strategy to prevent the recurrence of AFF.

Keywords: Atypical femoral fracture; Teriparatide; Relapse; Bone union

Links

DOI: 10.1016/j.bone.2020.115671

PubMed: 33007529

WoS: 000604735600004

History

Received: 2020-04-27

Revised: 2020-09-26

Accepted: 2020-09-26

Online: 2020-09-30

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