Evidence map›Paper›PMID 42498817›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2026

The role of income and educational level as risk factors for atypical femur fractures: A Nationwide Danish Case-Cohort Study with Blinded Radiographic Review.

Kasper Westphal Leth, Benjamin Bakke Hansen, Hans Peter Bögl, Daphne Wezenberg, Austin R Thompson, Richard Dell, Bo Fan, Anne Grethe Jurik, Jens Brøndum Frøkjær, Mikael Ploug Boesen and 5 more

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In one paragraph

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, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
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0citing papers in PubMed
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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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

15 authors.

Kasper Westphal LethResearch Unit OPEN, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark. Kasper.Westphal.Leth@rsyd.dk.ORCID http://orcid.org/0009-0003-5156-3532
Benjamin Bakke HansenResearch Unit OPEN, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark.
Hans Peter BöglDepartment of Orthopedic Surgery, Gävle Hospital, Gävle, Sweden.
Daphne WezenbergClinical Department of Orthopaedics in Linköping, Region Östergötland, Linköping, Sweden.
Austin R ThompsonDepartment of Epidemiology & Biostatistics, University of California, San Francisco, USA.
Richard DellDepartment of Epidemiology & Biostatistics, University of California, San Francisco, USA.
Bo FanDepartment of Radiology and Biomedical Imaging, University of California, San Francisco, USA.
Anne Grethe JurikDepartment of Radiology, Aarhus University, Aarhus, Denmark.
Jens Brøndum FrøkjærDepartments of Radiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark.
Mikael Ploug BoesenDepartment of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.
Annette L AdamsDepartment of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Jörg SchilcherClinical Department of Orthopaedics in Linköping, Region Östergötland, Linköping, Sweden.
Dennis M BlackDepartment of Epidemiology & Biostatistics, University of California, San Francisco, USA.
Douglas C BauerDepartment of Epidemiology & Biostatistics, University of California, San Francisco, USA.
Bo AbrahamsenDepartment of Public Health, University of Southern Denmark, Odense, Denmark.

Funding

Pooling International Cohort Studies of Long-Term Bisphosphonate Use and Atypical Femur FracturesR01AR082562 · NIAMS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Annette L Adams, Douglas C Bauer · 2022 to 2026
$5.4M
NIAMS NIH HHS R01 AR082562NIH HHS R01AR082562
6 · The paper itself

Abstract

Socioeconomic factors and atypical femur fracture (AFF) risk during bisphosphonate treatment are poorly understood. Among Danish bisphosphonate users, medium, and long educational levels were associated with lower AFF rates, with medium education remaining associated with lower AFF risk after adjustment, even within a universal healthcare system. PURPOSE: Atypical femur fracture (AFF) is a rare but serious fracture type associated with bisphosphonate (BP) treatment. While clinical risk factors are well studied, socioeconomic factors among BP users remain unexplored. We therefore examined whether income and educational level were associated with AFF risk in Denmark.

methodsWe included all radiologically confirmed AFF cases from 2010 to 2014, identified through blinded reviews of potential AFFs among individuals aged ≥ 50 years, and register-data for a random sample of the general population ≥ 50 (n = 100,253). Health, income, and education data were obtained from Danish national registers. We estimated incidence rates (IR), incidence rate ratios (IRR), and hazard ratios (HR) using Cox regression.

resultsAmong 164 AFF cases, 116 had BP exposure, and exposure was higher among AFF cases than in the background population (70.7% vs. 7.9%, p < 0.05). The AFF IR among BP users was 32.5 per 10,000 person-years (CI 27.1-39.0). Crude AFF rates differed by income and education, but income was not associated with AFF risk in adjusted Cox regression. BP users with medium or long education had a lower IRR than those with low/missing education (medium: IRR (CI): 0.56 (0.36-0.86); long: IRR (CI): 0.53 (0.28-0.95)). In age- and sex-adjusted Cox analyses, medium education remained associated with a lower AFF risk 0.63 (0.41-0.96).

conclusionSocioeconomic differences in AFF rates were observed among BP users, but adjusted analyses did not support an independent association between income and AFF risk. Medium education was associated with lower AFF risk after adjustments.

Indexed as

Atypical femur fractureBisphosphonatesEpidemiologyRadiographyRegister basedSocioeconomic

Identifiers

PMID42498817

What OpenQuestion holds

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Registered trials

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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.