Bisphosphonate Use and Risk of Atypical Femoral Fractures: A Danish Case-Cohort Study With Blinded Radiographic Review.

Autor:	Bauer DC; Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA 94143, USA., Black DM; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA 94143, USA., Dell R; Kaiser Permanente Southern California, Downey, CA 90242, USA., Fan B; Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94143, USA., Smith CD; Rockwool Foundation, Copenhagen 1472, Denmark., Ernst MT; Department of Public Health, University of Southern Denmark, Odense 5000, Denmark., Jurik AG; Department of Radiology, Aarhus University, Aarhus 8200, Denmark., Frøkjær JB; Departments of Radiology and Clinical Medicine, Aalborg University Hospital, Aalborg 9100, Denmark., Boesen M; Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg 2400, Denmark., Vittinghoff E; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA 94143, USA., Abrahamsen B; Department of Public Health, University of Southern Denmark, Odense 5000, Denmark.; Department of Clinical Research, Odense Patient Data Explorative Network, University of Southern Denmark, Odense 5000, Denmark.; Department of Medicine, Holbæk Hospital, Holbæk 4300, Denmark.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Oct 15; Vol. 109 (11), pp. e2141-e2150.
DOI:	10.1210/clinem/dgae023
Abstrakt:	Context: Prolonged bisphosphonate (BP) treatment for osteoporosis prevents hip and other fractures but causes atypical femoral fractures (AFF). Objective: To establish the relationship between patterns of BP use and the risk of AFF and hip fractures. Other potential risk factors for AFF were also examined. Methods: This population-based case-cohort study utilized data from the Danish National Healthcare system, including longitudinal records of medication use, healthcare utilization, and x-ray images. Among all 1.9 million Danish adults ≥50, those with subtrochanteric or femoral shaft fractures between 2010 and 2015 (n = 4973) were identified and compared to a random sample (n = 37 021). Bisphosphonate use was collected from 1995-2015. Fracture radiographs (n = 4769) were reviewed by blinded study radiologists to identify AFFs (n = 189) using established criteria. Traditional hip fractures in the random sample (n = 691) were identified by ICD-10. Results: Compared to <1 year of BP use, 5 to 7 years of use was associated with a 7-fold increase in AFF (adjusted HR = 7.29 [CI: 3.07, 17.30]); the risk of AFF fell quickly after discontinuation. The 5-year number needed to harm for one AFF was 1424, while the 5-year number needed to treat to prevent one hip fracture was 56. Glucocorticoid and proton pump inhibitor use were independently associated with increased AFF risk. Thirty-one percent of those with AFF had no BP exposure. Conclusion: The risk of AFF increases with duration of BP use but the beneficial effects of BP therapy in adults ≥50 dramatically exceed this increased risk. Nearly one-third of those with AFF have no BP exposure. (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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