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Surveillance of atypical femoral fractures in a nationwide fracture register
Background and purpose - To continuously assess the incidence of atypical femoral fractures (AFFs) in the population is important, to allow the evaluation of the risks and benefits associated with osteoporosis treatment. Therefore, we investigated the possibility to use the Swedish Fracture Register...
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Published in: | Acta orthopaedica 2022-01, Vol.93, p.229-233 |
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description | Background and purpose - To continuously assess the incidence of atypical femoral fractures (AFFs) in the population is important, to allow the evaluation of the risks and benefits associated with osteoporosis treatment. Therefore, we investigated the possibility to use the Swedish Fracture Register (SFR) as a surveillance tool for AFFs in the population and to explore means of improvement. Patients and methods - All AFF registrations in the SFR from January 1, 2015 to December 31, 2018 were enrolled in the study. For these patients, radiographs were obtained and combined with radiographs from 176 patients with normal femoral fractures, to form the study cohort. All images were reviewed and classified into AFFs or normal femur fractures by 2 experts in the field (gold-standard classification) and 1 orthopedic resident educated on the specific radiographic features of AFF (educated-user classification). Furthermore, we estimated the incidence rate of AFFs in the population captured by the register through comparison with a previous cohort and calculated the positive predictive value (PPV) and, where possible, the inter-observer agreement (Cohen's kappa) between the different classifications. Results - Of the 178 available patients with AFF in the SFR, 104 patients were classified as AFF using the goldstandard classification, and 89 using the educated-user classification. The PPV increased from 0.58 in the SFR classification to 0.93 in the educated-user classification. The interobserver agreement between the gold-standard classification and the educated-user classification was 0.81. Interpretation - With a positive predictive value of 0.58 the Swedish Fracture Register outperforms radiology reports and reports to the Swedish Medical Products Agency on adverse drug reactions as a diagnostic tool to identify atypical femoral fractures. |
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Therefore, we investigated the possibility to use the Swedish Fracture Register (SFR) as a surveillance tool for AFFs in the population and to explore means of improvement. Patients and methods - All AFF registrations in the SFR from January 1, 2015 to December 31, 2018 were enrolled in the study. For these patients, radiographs were obtained and combined with radiographs from 176 patients with normal femoral fractures, to form the study cohort. All images were reviewed and classified into AFFs or normal femur fractures by 2 experts in the field (gold-standard classification) and 1 orthopedic resident educated on the specific radiographic features of AFF (educated-user classification). Furthermore, we estimated the incidence rate of AFFs in the population captured by the register through comparison with a previous cohort and calculated the positive predictive value (PPV) and, where possible, the inter-observer agreement (Cohen's kappa) between the different classifications. Results - Of the 178 available patients with AFF in the SFR, 104 patients were classified as AFF using the goldstandard classification, and 89 using the educated-user classification. The PPV increased from 0.58 in the SFR classification to 0.93 in the educated-user classification. The interobserver agreement between the gold-standard classification and the educated-user classification was 0.81. Interpretation - With a positive predictive value of 0.58 the Swedish Fracture Register outperforms radiology reports and reports to the Swedish Medical Products Agency on adverse drug reactions as a diagnostic tool to identify atypical femoral fractures.</description><identifier>ISSN: 1745-3674</identifier><identifier>ISSN: 1745-3682</identifier><identifier>EISSN: 1745-3682</identifier><identifier>DOI: 10.2340/17453674.2022.1380</identifier><identifier>PMID: 35019144</identifier><language>eng</language><publisher>Sweden: Medical Journals Sweden, on behalf of the Nordic Orthopedic Federation</publisher><subject>atypical femoral fracture ; Bone ; Bone Density Conservation Agents - adverse effects ; Diphosphonates ; Femoral Fractures - diagnostic imaging ; Femoral Fractures - epidemiology ; Femoral Fractures - etiology ; Femur ; Fractures ; Humans ; Implants ; Incidence ; Lower Extremity ; Orthopedics ; Ortopedi ; Osteoporosis ; Radiography ; Radiological imaging</subject><ispartof>Acta orthopaedica, 2022-01, Vol.93, p.229-233</ispartof><rights>2021 The Author(s) 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c544t-51cc430494437e3c980e2ed09fed97678b86fbbc07724eaf4cf19aabe90cfa473</citedby><orcidid>0000-0001-9862-1064 ; 0000-0001-8566-2983 ; 0000-0003-0677-9265</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8815300/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8815300/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35019144$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-182449$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://gup.ub.gu.se/publication/313569$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Bögl, Hans Peter</creatorcontrib><creatorcontrib>Zdolsek, Georg</creatorcontrib><creatorcontrib>Barnisin, Lukas</creatorcontrib><creatorcontrib>Möller, Michael</creatorcontrib><creatorcontrib>Schilcher, Jörg</creatorcontrib><title>Surveillance of atypical femoral fractures in a nationwide fracture register</title><title>Acta orthopaedica</title><addtitle>Acta Orthop</addtitle><description>Background and purpose - To continuously assess the incidence of atypical femoral fractures (AFFs) in the population is important, to allow the evaluation of the risks and benefits associated with osteoporosis treatment. Therefore, we investigated the possibility to use the Swedish Fracture Register (SFR) as a surveillance tool for AFFs in the population and to explore means of improvement. Patients and methods - All AFF registrations in the SFR from January 1, 2015 to December 31, 2018 were enrolled in the study. For these patients, radiographs were obtained and combined with radiographs from 176 patients with normal femoral fractures, to form the study cohort. All images were reviewed and classified into AFFs or normal femur fractures by 2 experts in the field (gold-standard classification) and 1 orthopedic resident educated on the specific radiographic features of AFF (educated-user classification). Furthermore, we estimated the incidence rate of AFFs in the population captured by the register through comparison with a previous cohort and calculated the positive predictive value (PPV) and, where possible, the inter-observer agreement (Cohen's kappa) between the different classifications. Results - Of the 178 available patients with AFF in the SFR, 104 patients were classified as AFF using the goldstandard classification, and 89 using the educated-user classification. The PPV increased from 0.58 in the SFR classification to 0.93 in the educated-user classification. The interobserver agreement between the gold-standard classification and the educated-user classification was 0.81. Interpretation - With a positive predictive value of 0.58 the Swedish Fracture Register outperforms radiology reports and reports to the Swedish Medical Products Agency on adverse drug reactions as a diagnostic tool to identify atypical femoral fractures.</description><subject>atypical femoral fracture</subject><subject>Bone</subject><subject>Bone Density Conservation Agents - adverse effects</subject><subject>Diphosphonates</subject><subject>Femoral Fractures - diagnostic imaging</subject><subject>Femoral Fractures - epidemiology</subject><subject>Femoral Fractures - etiology</subject><subject>Femur</subject><subject>Fractures</subject><subject>Humans</subject><subject>Implants</subject><subject>Incidence</subject><subject>Lower Extremity</subject><subject>Orthopedics</subject><subject>Ortopedi</subject><subject>Osteoporosis</subject><subject>Radiography</subject><subject>Radiological imaging</subject><issn>1745-3674</issn><issn>1745-3682</issn><issn>1745-3682</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNp9kttu1DAQhi0EomXhBbhAeYEsPoxj-wapKqdKK3HB4daynXFwlU1WdtKqb0_SpSv2hquxZv7_G8nzE_KW0S0XQN8zBVI0Craccr5lQtNn5HJt1qLR_PnpreCCvCrlllKhwdCX5EJIygwDuCS773O-w9T3bghYjbFy08MhBddXEfdjXmt2YZozlioNlasGN6VxuE8tniZVxi6VCfNr8iK6vuCbv3VDfn7-9OP6a7379uXm-mpXBwkw1ZKFAIKCARAKRTCaIseWmoitUY3SXjfR-0CV4oAuQojMOOfR0BAdKLEhN0duO7pbe8hp7_KDHV2yj40xd9blKYUeLXitTGQyLlCgsvVBhta4xrcUvNNuYdVHVrnHw-zPaN18sEurm21BK5iQjfmv_mP6dfW4vU-zZZoDrPoPR_0i3mMbcJiWXz2znU-G9Nt2453VmkmxnGxD-BEQ8lhKxnjyMmrXHNinHNg1B3bNwWJ69-_Wk-Xp8OIPKcOxPA</recordid><startdate>20220101</startdate><enddate>20220101</enddate><creator>Bögl, Hans Peter</creator><creator>Zdolsek, Georg</creator><creator>Barnisin, Lukas</creator><creator>Möller, Michael</creator><creator>Schilcher, Jörg</creator><general>Medical Journals Sweden, on behalf of the Nordic Orthopedic Federation</general><general>Medical Journals Sweden</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><scope>ABXSW</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>DG8</scope><scope>ZZAVC</scope><scope>F1U</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-9862-1064</orcidid><orcidid>https://orcid.org/0000-0001-8566-2983</orcidid><orcidid>https://orcid.org/0000-0003-0677-9265</orcidid></search><sort><creationdate>20220101</creationdate><title>Surveillance of atypical femoral fractures in a nationwide fracture register</title><author>Bögl, Hans Peter ; Zdolsek, Georg ; Barnisin, Lukas ; Möller, Michael ; Schilcher, Jörg</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c544t-51cc430494437e3c980e2ed09fed97678b86fbbc07724eaf4cf19aabe90cfa473</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>atypical femoral fracture</topic><topic>Bone</topic><topic>Bone Density Conservation Agents - adverse effects</topic><topic>Diphosphonates</topic><topic>Femoral Fractures - diagnostic imaging</topic><topic>Femoral Fractures - epidemiology</topic><topic>Femoral Fractures - etiology</topic><topic>Femur</topic><topic>Fractures</topic><topic>Humans</topic><topic>Implants</topic><topic>Incidence</topic><topic>Lower Extremity</topic><topic>Orthopedics</topic><topic>Ortopedi</topic><topic>Osteoporosis</topic><topic>Radiography</topic><topic>Radiological imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bögl, Hans Peter</creatorcontrib><creatorcontrib>Zdolsek, Georg</creatorcontrib><creatorcontrib>Barnisin, Lukas</creatorcontrib><creatorcontrib>Möller, Michael</creatorcontrib><creatorcontrib>Schilcher, Jörg</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SWEPUB Linköpings universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Linköpings universitet</collection><collection>SwePub Articles full text</collection><collection>SWEPUB Göteborgs universitet</collection><collection>Directory of Open Access Journals</collection><jtitle>Acta orthopaedica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bögl, Hans Peter</au><au>Zdolsek, Georg</au><au>Barnisin, Lukas</au><au>Möller, Michael</au><au>Schilcher, Jörg</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surveillance of atypical femoral fractures in a nationwide fracture register</atitle><jtitle>Acta orthopaedica</jtitle><addtitle>Acta Orthop</addtitle><date>2022-01-01</date><risdate>2022</risdate><volume>93</volume><spage>229</spage><epage>233</epage><pages>229-233</pages><issn>1745-3674</issn><issn>1745-3682</issn><eissn>1745-3682</eissn><abstract>Background and purpose - To continuously assess the incidence of atypical femoral fractures (AFFs) in the population is important, to allow the evaluation of the risks and benefits associated with osteoporosis treatment. Therefore, we investigated the possibility to use the Swedish Fracture Register (SFR) as a surveillance tool for AFFs in the population and to explore means of improvement. Patients and methods - All AFF registrations in the SFR from January 1, 2015 to December 31, 2018 were enrolled in the study. For these patients, radiographs were obtained and combined with radiographs from 176 patients with normal femoral fractures, to form the study cohort. All images were reviewed and classified into AFFs or normal femur fractures by 2 experts in the field (gold-standard classification) and 1 orthopedic resident educated on the specific radiographic features of AFF (educated-user classification). Furthermore, we estimated the incidence rate of AFFs in the population captured by the register through comparison with a previous cohort and calculated the positive predictive value (PPV) and, where possible, the inter-observer agreement (Cohen's kappa) between the different classifications. Results - Of the 178 available patients with AFF in the SFR, 104 patients were classified as AFF using the goldstandard classification, and 89 using the educated-user classification. The PPV increased from 0.58 in the SFR classification to 0.93 in the educated-user classification. The interobserver agreement between the gold-standard classification and the educated-user classification was 0.81. Interpretation - With a positive predictive value of 0.58 the Swedish Fracture Register outperforms radiology reports and reports to the Swedish Medical Products Agency on adverse drug reactions as a diagnostic tool to identify atypical femoral fractures.</abstract><cop>Sweden</cop><pub>Medical Journals Sweden, on behalf of the Nordic Orthopedic Federation</pub><pmid>35019144</pmid><doi>10.2340/17453674.2022.1380</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0001-9862-1064</orcidid><orcidid>https://orcid.org/0000-0001-8566-2983</orcidid><orcidid>https://orcid.org/0000-0003-0677-9265</orcidid><oa>free_for_read</oa></addata></record> |
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source | PubMed Central; EBSCOhost SPORTDiscus - Ebooks |
subjects | atypical femoral fracture Bone Bone Density Conservation Agents - adverse effects Diphosphonates Femoral Fractures - diagnostic imaging Femoral Fractures - epidemiology Femoral Fractures - etiology Femur Fractures Humans Implants Incidence Lower Extremity Orthopedics Ortopedi Osteoporosis Radiography Radiological imaging |
title | Surveillance of atypical femoral fractures in a nationwide fracture register |
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