Evidence map›Paper›PMID 27766369›Full record

Observational studyOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2017

Sensitivity and specificity of radiographic characteristics in atypical femoral fractures.

A L Adams, F Xue, J Q Chantra, R M Dell, S M Ott, S Silverman, J C Giaconi, C Critchlow

Abstract readMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed
1.9field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 23 citations in OpenAlex.

  1. Article
  2. The definition of atypical femoral fractures should include periprosthetic femoral fractures (PAFFs).Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025
    Article
  3. Article
  4. Article
  5. Review
  6. Review
  7. Evaluation and management of atypical femoral fractures: an update of current knowledge.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2021
    Review
  8. Article
  9. Article
  10. Article
  11. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 1 country.

A L AdamsDepartment of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA. Annette.L.Adams@kp.org.
F XueCenter for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
J Q ChantraDepartment of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, 2nd Floor, Pasadena, CA, 91101, USA.
R M DellDepartment of Orthopedic Surgery, Kaiser Permanente Southern California, 9333 Imperial Hwy, Downey, CA, 90242, USA.
S M OttDepartment of Medicine, University of Washington, 1959 NE Pacific Street, UW Mailbox 356426, Seattle, WA, 98195, USA.
S SilvermanDepartment of Rheumatology, Cedars-Sinai/UCLA, 200 UCLA Medical Plaza, Los Angeles, CA, 90095, USA.
J C GiaconiCedars Sinai Imaging Medical Group, Cedars Sinai Medical Center, 8700 Beverly Blvd.,, Los Angeles, CA, 90048, USA.
C CritchlowCenter for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
Kaiser Permanente · USAmgen (United States) · USCedars-Sinai Medical Center · USUniversity of Washington · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Using the American Society for Bone and Mineral Research Task Force case definition for atypical femoral fractures, sensitivity and specificity of radiographic fracture characteristics were calculated. Fracture pattern was the most sensitive and specific characteristic. This suggests that some characteristics should be weighted more heavily when identifying these fractures.

introductionTo estimate the sensitivity and specificity of each radiographic criterion in the 2013 ASBMR atypical femoral fracture (AFF) case definition for distinguishing AFF from other subtrochanteric/diaphyseal fractures (non-AFF) among women enrolled in a large integrated health care organization.

methodsRadiographs from 55 physician-confirmed AFFs and a sample of 39 non-AFFs were reviewed by four independent expert reviewers representing four medical specialties. One image per fracture was selected for review. Using a standardized data collection tool, based on the 2013 AFF case definition, reviewers indicated the presence or absence of the following characteristics viewable on radiograph: fracture pattern, comminution, periosteal and/or endosteal thickening, and cortical thickening. Sensitivity and specificity for each characteristic was calculated for each reviewer and summarized across reviewers with the mean and range. Agreement across reviewers was quantified using Fleiss's kappa (FK) statistic.

resultsThe most sensitive factors distinguishing AFF from non-AFF were lateral cortex transverse fracture pattern (mean 93.6 %, range 85.5-98.2 %), medial cortex transverse or oblique fracture pattern (mean 84.1 %, range 72.7-98.2 %), and minimal/non-comminution (mean 93.2 %, range 89.1-98.2 %). Specificity was the greatest for lateral cortex transverse fracture pattern (mean 95.5 %, range 92.3-97.4 %). Agreement across reviewers was the highest for lateral cortex transverse fracture pattern (FK 0.83) and incomplete fracture through the lateral cortex only (FK 0.80).

conclusionLateral cortex transverse fracture pattern was the most sensitive and specific characteristic and the most highly agreed upon across reviewers. Other characteristics were less readily agreed upon across reviewers. Measurement of discrete combinations of individual characteristics may enhance sensitivity and/or specificity.

Indexed as

AgedAged, 80 and overBone Density Conservation AgentsDiagnosis, DifferentialDiaphysesDiphosphonatesFemaleFemoral FracturesFractures, StressHip FracturesHumansMiddle AgedRadiographySensitivity and SpecificityBone Density Conservation AgentsDiphosphonatesAtypical femoral fractureBisphosphonateOsteoporosis

Identifiers

PMID27766369
OpenAlexW2534768977

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.