The following article is part of our coverage of the Endocrine Society’s annual meeting (ENDO 2021) that is being held virtually from March 20-23, 2021. Endocrinology Advisor‘s staff will report on the top research in hormone science and clinical care. Check back for the latest news from ENDO 2021.
The following article is part of our coverage of the Endocrine Society’s annual meeting (ENDO 2021) that is being held virtually from March 20-23, 2021. Endocrinology Advisor‘s staff will report on the top research in hormone science and clinical care. Check back for the latest news from ENDO 2021. .
The risk for atypical femur fracture (AFF) was shown to be increased with longer bisphosphonate use and in elderly Asian women, and diet-induced weight loss in older adults resulted in significant loss of total hip bone mineral density (BMD), according to posters presented at the ENDO 2021 virtual conference, held March 20 to 23, 2021.
In this study, women aged over 50 years were evaluated for risk factors for AFF associated with long-duration bisphosphonate treatment in southern California between January 1, 2007, and November 30, 2017 (N=196,129). Researchers used electronic health records to study fracture radiographs of women across a range of demographic characteristics, including race, height, and weight. Benefit-risk was modeled for 1 to 10 years of bisphosphonate use to compare prevented fractures vs associated AFFs.
Among the studied population, 0.1% of women (n=277) sustained AFFs. The risk for AFF increased with longer bisphosphonate duration in multivariate adjustment. For more than 3 to 5 years, the hazard ratio (HR) increased from HR=8.9 (95% CI, 2.8-28) to HR=43.5 (95% CI, 13.7-138.1) for greater than 8 years.
The other risk factors for AFFs included Asian ancestry (HR=4.8; 95% CI, 3.6-6.6), height, weight, and glucocorticoid use. Discontinuing bisphosphonates was associated with a rapid decrease in AFF risk. In Asian women, the decrease in osteoporotic and hip fracture risk throughout 1 to 10 years of bisphosphonate use outweighed the increase in AFF risk, and the benefit-risk ratio was even more pronounced in White women.
After 3 years, 149 hip fractures were prevented in white women with 2 associated atypical fractures, compared with 91 hip fractures and 8 atypical fractures in Asian women.
Researchers are developing a risk score to predict AFF risk for an individual patient using the preliminary results to show that the benefit-risk ratio can be greatly improved by treating older, more osteoporotic Asian patients. Conversely, treating a 60-year old White osteopenic patient greatly reduces the benefit vs AFF risk.
“Absolute AFF risk remained very low compared with hip and other fracture risk reductions by bisphosphonate treatment in osteoporotic women,” concluded the researchers.
Future researchers should assess if weight loss and exercise for older adults with obesity could significantly reduce their fracture risk despite a decline in bone mineral density.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
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1. Black DM. Pharmacological management of fracture risk in the elderly. Presented at: ENDO 2021; March 20-23, 2021; Virtual. Session S38.
2. Villareal DT. Lifestyle management of bone health in older adults with obesity. Presented at: ENDO 2021; March 20-23, 2021; Virtual. Session S38.