Identifying Incomplete Atypical Femoral Fractures With Single-Energy Absorptiometry: Declining Prevalence.
Identifying Incomplete Atypical Femoral Fractures With Single-Energy Absorptiometry: Declining Prevalence.
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DOI：
10.1210/js.2016-1118
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发表时间：
2017-03-01
影响因子：
4.1
通讯作者：
Heffernan E
中科院分区：
文献类型：
--
作者：
McKenna MJ;McKiernan FE;McGowan B;Silke C;Bennett K;van der Kamp S;Ward P;Hurson C;Heffernan E
非典型股骨骨折（AFFs）与长期双膦酸盐（BP）治疗有关。在AFF完成之前早期识别AFF提供了干预的机会，可能降低与这些骨折相关的发病率。单能X线吸收测定法（SE）是一种成像方法，最近被证明可以在骨折完成之前检测不完全AFF（iAFF）。在2013年5月至2014年9月期间，我们评估了173例使用SE进行iAFF的BP治疗超过5年的患者，这些患者在常规骨密度检测时就诊。我们将这些结果与我们先前发表的前瞻性研究（n = 257）进行了比较，在该研究中，使用双能X线吸收测定法对股骨进行iAFF成像。此外，我们估计了2006年至2014年我们机构转子下骨折患者中完全AFF的年患病率，并评估了2009年至2014年爱尔兰BP的处方趋势。没有患者使用SE股骨进行iAFF，而早期研究中的患病率为2.7%。在2006年至2014年期间，我们观察到我们医院的AFFs上升和下降，以及BP处方的类似全国趋势。AFFs似乎在减少。双能X线吸收测量系统的新定制扫描模式，以高图像质量可视化整个股骨并进行测量，有可能在骨折完成前识别iAFF，并确定AFF风险最高的患者。非典型股骨骨折（AFFs）是与长期双膦酸盐治疗相关的罕见事件。使用高清晰度成像与双能X线吸收仪，AFFs可以识别不完整的形式。
Atypical femur fractures (AFFs) are associated with long-term bisphosphonate (BP) therapy. Early identification of AFF prior to their completion provides an opportunity to intervene, potentially reducing morbidity associated with these fractures. Single-energy X-ray absorptiometry (SE) is an imaging method recently shown to detect incomplete AFF (iAFF) prior to fracture completion. Between May 2013 and September 2014, we assessed 173 patients who had been prescribed BP therapy for >5 years for iAFF using SE at their presentation for routine bone mineral density testing. We compared these findings with those of our previously published prospective study (n = 257) in which the femur was imaged for iAFF using dual-energy X-ray absorptiometry. In addition, we estimated the yearly prevalence of complete AFF among patients with subtrochanteric fracture at our institution from 2006 to 2014, and we evaluated prescribing trends for BP in Ireland from 2009 to 2014. No patients had iAFF using SE femur compared with a prevalence of 2.7% in the earlier study. Between 2006 and 2014, we observed a rise and decline in AFFs at our hospital and a similar national trend in BP prescribing. AFFs appear to be decreasing. New customized scan modes of dual-energy X-ray absorptiometry systems, which visualize the entire femur at high image quality and take measurements, have the potential to identify iAFF prior to fracture completion and to ascertain those at highest risk of AFF. Atypical femur fractures (AFFs) are rare events that are associated with long-term bisphosphonate therapy. Using high-definition imaging with dual-energy X-ray absorptiometry machines, AFFs may be identified in the incomplete form.