ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2019
Atypical femur fracture incidence in women increases with duration of bisphosphonate exposure.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The Genetics of Atypical Femur Fractures-a Systematic Review.Current osteoporosis reports · 2021Pooled it
- Atypical femur fractures: insights from the Asian Federation of Osteoporosis Societies consensus paper.Osteoporosis and sarcopenia · 2026Article
- Epidemiology, Pathophysiology and Management of Atypical Femur Fractures: an Update.Current osteoporosis reports · 2025Review
- Prevalence of incomplete atypical femoral fractures using single energy absorptiometry after long-term anti-resorptive therapy.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2025Article
- Atypical femoral fracture in a patient with nutritional osteomalacia: a case report and literature review.Journal of surgical case reports · 2025Article
- Latent metabolic bone disease, skeletal dysplasia and other conditions related to low bone formation among 38 patients with subtrochanteric femoral fractures: a retrospective observational study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Observational
- Differences in bone histomorphometry between White postmenopausal women with and without atypical femoral fracture after long-term bisphosphonate therapy.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2024Article
- Global, regional, national trends of femur fracture and machine learning prediction: Comprehensive findings and questions from global burden of disease 1990-2019.Journal of orthopaedic translation · 2024Article
- Identifying Complete Atypical Femur Fractures in Adults with Bisphosphonate Exposure.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2024Article
- Osteoporosis and Fracture Risk among Older US Asian Adults.Current osteoporosis reports · 2023Review
- Periprosthetic fractures: an unrecognized osteoporosis crisis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2023Article
- Disorganization and Musculoskeletal Diseases: Novel Insights into the Enigma of Unexplained Bone Abnormalities and Fragility Fractures.Current osteoporosis reports · 2023Review
- Whole Exome Sequencing in Two Southeast Asian Families With Atypical Femur Fractures.JBMR plus · 2022Article
- Oral Bisphosphonates Are Associated With Increased Risk of Severe Acute Kidney Injury in Elderly Patients With Complex Health Needs: A Self-Controlled Case Series in the United Kingdom.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022Article
- NOX4 blockade suppresses titanium nanoparticle-induced bone destruction via activation of the Nrf2 signaling pathway.Journal of nanobiotechnology · 2022Article
- Asian Ethnicity and Femoral Geometry in Atypical Femur Fractures: Independent or Interdependent Risk Factors?JBMR plus · 2022Article
- Gene Network of Susceptibility to Atypical Femoral Fractures Related to Bisphosphonate Treatment.Genes · 2022Article
- Fracture Risk Following an Atypical Femoral Fracture.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022Article
- Progression of atypical femur stress fracture after discontinuation of bisphosphonate therapy.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2021Article
- Pearls from a Clinician-Researcher in an Integrated Health care Delivery System.The Permanente journal · 2021Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
In a northern California population of older women who were treated with oral bisphosphonate drugs, the incidence of atypical femur fracture, a rare complication of treatment, increased with longer duration of bisphosphonate exposure. These findings align with those previously reported in an independent southern California population.
introductionThe age-adjusted incidence of atypical femur fracture (AFF) reported in southern California increased with bisphosphonate (BP) exposure, ranging up to 113 per 100,000 person-years for 8-10-year exposure. This study examines the incidence of AFF in a northern California population.
methodsWomen age 45-89 years who initiated oral BP during 2002-2014 in Kaiser Permanente Northern California were followed for AFF outcome, defined by a primarily transverse diaphyseal femur fracture through both cortices, with focal periosteal/endosteal hypertrophy, minimal trauma, and minimal/no comminution. Total BP exposure was determined from dispensed prescriptions. The incidence of AFF, calculated for 2-year BP categories ranging from < 2 to > 10 years, was age-adjusted using the 2000 US Census.
resultsAmong 94,542 women, 107 experienced an AFF during or < 1 year after BP cessation (mean exposure 6.6 ± 3.0 years and total days' supply 5.7 ± 2.8 years at AFF). A strong relationship between AFF incidence and increasing BP exposure was seen, more than doubling for each 2-year category until 8-10 years. Among women with 2- to < 4-year BP, the crude and age-adjusted incidence was 18 and 9 per 100,000 person-years but increased over 2- and 5-fold for women with 4- to < 6- and 6- to < 8-year BP, respectively. For those receiving ≥ 8-year BP, the crude and age-adjusted incidence peaked at 196 and 112 per 100,000 person-years exposure.
conclusionIncidence of AFF increases markedly after 4-6 years of BP. These trends align with southern California and confirm a strong BP duration-related risk of this rare but serious event.
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