Epidemiology and Postoperative Outcomes of Atypical Femoral Fractures in Older Adults: A Systematic Review.
Level 3 - non-randomized controlled study
Systematic review of predominantly observational epidemiological and treatment outcome studies.
PubMed 27999854 · doi:10.1007/s12603-015-0652-3
What was done
A systematic review of English-language studies was conducted to assess the epidemiology and postoperative outcomes (surgical, functional, and quality of life) of atypical femoral fractures (AFFs) in adults aged 65 and older, using the ASBMR Task Force diagnostic consensus definitions.
What was found
Twenty-three studies were included (14 on epidemiology, 11 on treatment outcomes; 2 addressed both). AFF incidence was low, ranging from 3.0 to 9.8 per 100,000 person-years, with relative risk increasing after more than 3 years of bisphosphonate therapy. Most AFF cases occurred in older adults (≥65 years), but in 6 studies the mean age of bisphosphonate-related AFF patients was younger (66–75 years) than those with typical proximal femoral fractures (75–89 years). Postoperative outcomes varied across studies; prophylactic surgery was noted as potentially beneficial for incomplete AFFs, while evidence for specific fixation devices or teriparatide was inconclusive.
Why it matters
The review indicates that absolute risk of AFF remains low compared to the fracture reduction benefits of bisphosphonates, while highlighting an absence of standardized evidence for post-fracture surgical or medical management.
Limits
The review relies on observational studies with heterogeneous populations, surgical interventions, and outcome definitions. Total patient count across included studies, risk of bias assessments, and quantitative pooled estimates were not reported in the abstract.
Cited by
- supports Bisphosphonates are associated with abnormal femoral fractures.