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J Bone Miner Res. 2016 Aug;31(8):1569-76. doi: 10.1002/jbmr.2818. Epub 2016 Apr 19.

Incidence of Atypical Femur Fractures in Cancer Patients: The MD Anderson Cancer Center Experience.

Author information

1
Bone Program of Texas, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
2
Departments of Dermatology and Pediatrics, and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
3
Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
4
Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
5
Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
6
Department of Medication Management & Analytics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
7
Division of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Abstract

Atypical femoral fractures (AFFs) are rare adverse events attributed to bisphosphonate (BP) use. Few cases of AFF in cancer have been described; the aim of this study is to identify the incidence and risk factors for AFF in a large cancer center. This retrospective study was conducted at the MD Anderson Cancer Center. The incidence rate of AFF among BP users was calculated from January 1, 2004 through December 31, 2013. The control group (n = 51) included 2 or 3 patients on BPs matched for age (≤1 year) and gender. Logistic regression analysis was used to assess the relationship between clinical characteristics and AFF. Twenty-three AFF cases were identified radiographically among 10,587 BP users, the total BP exposure was 53,789 months (4482 years), and the incidence of AFF in BP users was 0.05 cases per 100,000 person-years. Meanwhile, among 300,553 patients who did not receive BPs there were 2 cases of AFF as compared with the 23 cases noted above. The odds ratio (OR) of having AFF in BP users was 355.58 times higher (95% CI, 84.1 to 1501.4, p < 0.0001) than the risk in non-BP users. The OR of having AFF in alendronate users was 5.54 times greater (OR 5.54 [95% CI, 1.60 to 19.112, p = 0.007]) than the odds of having AFF among other BP users. Patients who were on zoledronic acid (ZOL) had smaller odds of developing AFF compared with other BP users in this matched case control sample. AFFs are rare, serious adverse events that occur in patients with cancer who receive BP therapy. Patients with cancer who receive BPs for prior osteoporosis therapy or for metastatic cancer are at higher risk of AFF.

KEYWORDS:

ADVERSE EVENTS; ALENDRONATE; BISPHOSPHONATES; DENOSUMAB; DRUG-RELATED; HYPERCALCEMIA; MALIGNANCY; SKELETAL-RELATED EVENTS; METASTASIS; ZOLEDRONIC ACID

PMID:
26896384
DOI:
10.1002/jbmr.2818
[Indexed for MEDLINE]
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