Risk score created to identify atypical vs. typical femur fr
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A model factoring in age, femoral neck width and lateral cortical width at lesser trochanter may be able to differentiate atypical vs. typical femur fractures in women, according to study data.

Atypical femur fractures (AFF) are a rare but serious complication of long-term bisphosphonate use. Although clearly defined by ASBMR criteria, a proportion of patients with AFFs may go unrecognized and the use of qualitative fracture criteria may lead to uncertainty in AFF diagnosis, with significant therapeutic implications.

A score that rapidly and accurately identifies AFFs among subtrochanteric femur fractures using quantitative, measurable parameters is needed. In a retrospective cohort of 110 female patients presenting with AFFs or typical femur fractures (TFFs), multiple logistic regression and decision tree analysis were used to develop the Sydney AFF score.

This score, based on demographic and femoral geometry variables, uses three dichotomized independent predictors and adds one point for each: (age less than 80 years)+(femoral neck width less than 37 mm)+(lateral cortical width at lesser trochanter greater than 5 mm), (score, 0 to 3).

In an independent validation set of 53 female patients at a different centre in Sydney, a score more than 2 demonstrated 73.3% sensitivity and 69.6% specificity for AFF (area under the receiver-operating characteristic curve [AUC] 0.775, SE 0.063) and remained independently associated with AFF after adjustment for bisphosphonate use.

The Sydney AFF score provides a quantitative means of flagging female patients with atraumatic femur fractures who have sustained an AFF as opposed to a TFF. This distinction has clear management implications and may augment current ASBMR diagnostic criteria.

Source: https://asbmr.onlinelibrary.wiley.com/doi/abs/10.1002/jbmr.4255
K. S●●●●n r●j I●●●●●●l and 3 others like this
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