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Background: The subtrochanteric femoral fracture requires special attention in a Fracture Liaison Service (FLS) unit to screen for atypical fracture.
Objectives: To analyze the characteristics of the subtrochanteric fracture in a FLS.
Methods: Patients >50 years were attended for fragility fracture of the proximal femur during the period 2022-2024 were included. The type of fracture and fracture, risk factors as well as previous treatment for osteoporosis were analyzed. For atypical femoral fracture we applied ≥4 of the following major criteria (Shane et al. J Bone Miner Res. 2014): 1) No or minimal trauma; 2) line begins laterally and is basically transverse; 3) may progress to complete with medial spicule; 4) not comminuted or minimally comminuted; and 5) periosteal thickening in external cortex.
Results: A total of 390 patients were included, 82.8% women, mean age 79 years. 192 (49%) fractures were of the femoral neck, 142 were pertrochanteric (43%) and 30 (7%) were subtrochanteric. The table shows the characteristics of the patients. The subtrochanteric fracture was associated with a higher body mass index and previous treatment with bisphosphonate. Multivariate analysis resulted in OR 1.124 (95% CI 1.045-1.209; p =0.002) for BMI and OR 2.811 (95% CI 1.146-6.895; p =0.02) for previous bisphosphonate. In patients with subtrochanteric fracture, 6 had received alendronate, 1 risedronate and 1 denosumab. One patient (previous alendronate) met criteria for atypical femoral fracture (0.25% of the whole sample, 3.3% of subtrocanteric type and 2.1% of patients with previous treatment with bisphosphonate or denosumab). None of the patients had a contralateral femoral fracture during the average follow-up of 24 months.
| All patients
| Subcapital or pertrocanteric hip fracture (n=360) | Subtrocanteric hip fracture (n=30) | p | |
|---|---|---|---|---|
| Female, N (%) | 323 (82.8) | 297 (82.5) | 26 (86.6) | 0.56 |
| Age, mean (SD) | 79.0 (9.3) | 78.9 (9.4) | 80.0 (7.4) | 0.50 |
| Assessment during admission, N (%) | 248 (63.6) | 240 (66.6) | 22 (73.3) | 0.45 |
| Years of education <8, N (%) | 311 (79.7) | 284 (78.8) | 27 (90) | 0.14 |
| Risk factors, N (%) | ||||
| Body mass index, mean (SD ) | 25.9 (5.0) | 25.8 (4.7) | 28.7 (5.3) | <0.001 |
| Previous fragility fracture | 99 (25.3) | 86 (23.9) | 11 (36.6) | 0.12 |
| Parent hip fracture | 69 (17.7) | 63 (17.5) | 6 (20) | 0.73 |
| Current smoker | 45 (11.5) | 42 (11.6) | 3 (10) | 0.78 |
| Glucocorticoids | 30 (7.7) | 26 (7.2) | 4 (13.3) | 0.22 |
| Rheumatoid arthritis | 13 (3.3) | 12 (3.3) | 1 (3.3) | 0.99 |
| Secondary osteoporosis | 76 (19.5) | 68 (18.8) | 8 (26.6) | 0.30 |
| Alcohol | 15 (3.8) | 14 (3.8) | 1 (3.3) | 0.63 |
| Previous densitometry, N (%) | 100 (25.6) | 89 (24.7) | 11 (36.6) | 0.15 |
| Femoral neck T score, mean (SD) | -2.1 (1.0) | -2.2 (1.0) | -2.0 (1.1) | 0.36 |
| Previous bisphosphonate or denosumab, N (%) | 47 (12.0) | 39 (10.8) | 8 (26.6) | 0.01 |
Conclusion: Subtrocanteric femoral fractures are associated with higher BMI and the use of bisphosphonate or denosumab. Atypical fracture is rare, accounting only 3% of subtrocanteric type.
REFERENCES: [1] Shane E, Burr D, Abrahamsen B et al. J Bone Miner Res. 2014;29:1.
Acknowledgements: NIL.
Disclosure of Interests: None declared.
© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (