THU0493 Are bisphosphonates solely responsible for atypical femoral fractures? a case series
Authors: M.S. Jamal, C. Cockill, S. knights
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Atypical femoral fracture (AFF) is an uncommon but important type of fracture. It is concerning because of the associated morbidity, bilateral nature of the condition and delay in healing which has significant implications on the health of the patients. <h3>Objectives</h3> To identify other risk factors contributing to development of atypical femoral fractures in our cohort of patients presenting to the fracture liaison service. <h3>Methods</h3> We identified a case series of 18 cases were retrospectively from June 2006 to January 2018 through the cohort of patients presenting to the fracture liaison service at Yeovil District Hospital NHS foundation trust, with features suggestive of Atypical femoral fractures. Individual patient cases were evaluated and notes and images reviewed. Atypical femoral fractures were diagnosed according to the 2013 American society of mineral and bone research (ASMBR) criteria. Demographic and co morbidity status was investigated from case notes. Blood results and dual enerty x-ray absorbtiometry (DEXA) images were accessed through electronic patient records. The results were compiled with Microsoft excel. Results: There were total 22 patient episodes, of which 4 patients had bilateral symptoms. Female to male ratio was 21:1. Median age of presentation was 71. The incidence of AFF was more in shaft fractures. 54% cases had prodromal symptoms lasting from 1–3 months. 9 cases had radiographic evidence of stress fractures of whom 6 were not identified until they fractured. 86% cases had either concurrent or previous bisphosphonate therapy. Duration of Bisphosphonate therapy was variable from 12 months to 30 years. 54% were taking Proton pump inhibitors and 41% were on long term glucocorticoids. 9% were active smokers. 50% episodes were in patients having two or more risk factors. 3 patients had no risk factors identified. Conclusions: Exposure to Bisphosphonates remains a major risk factor for development of AFF but our case series has shown that other risk factors do play an important part eg. prolonged courses of glucocorticoids and Proton pump inhibitor therapy. It is plausible that bisphosphonates are given for prolonged courses in patients on glucocorticoids and this combination seems to be a particular risk. The risk appears to be greater with multiple risk factors. The temporal relationship of fractures with relation to bisphosphonate therapy cannot be determined as it can happen even after the cessation of therapy. Further longitudinal and larger studies are required to identify whether Bisphosphonate would play a role to reduce the risk of Atypical Femoral fractures. <h3>References</h3> [1] Franceschetti P, Bondanelli M, Caruso G, Ambrosio M, Lorusso V, Zatelli M, Massari L, degli Uberti E. Risk factors for development of atypical femoral fractures in patients on long-term oral bisphosphonate therapy. Bone 2013;56(2):426–431: [2] Saita Y, Ishijima M, Mogami A, Kubota M, Baba T, Kaketa T, Nagao M, Sakamoto Y, Sakai K, Homma Y, Kato R, Nagura N, Miyagawa K, Wada T, Liu L, Matsuoka J, Obayashi O, Shitoto K, Nozawa M, Kajihara HGen H, Kaneko K. The incidence of and risk factors for developing atypical femoral fractures in Japan. Journal of Bone and Mineral Metabolism 2014 33(3):311–318. <h3>Disclosure of Interest</h3> None declared