Available online 12 August 2022

Proximal femoral fracture is known to be associated with high one-year mortality rate.

Studies have shown that the mortality rate of atypical femoral fracture may be lower than that of typical proximal femoral fracture, although results from existing studies are inconsistent.

Using systematic review, we identified seven studies reporting one-year mortality rate of atypical femoral fracture and two studies comparing mortality rate of atypical femoral fracture versus typical femoral fracture

Pooled analysis showed that one-year mortality rate following atypical femoral fracture was approximately 10%, which may be lower than the reported mortality rate following typical femoral fracture. Evidence is insufficient to conclude if there was difference in mortality risk between atypical femoral fracture and typical femoral fracture

To summarize all available data, using systematic review and meta-analysis, to estimate 1.) one-year mortality risk following AFF and 2.) risk ratio of mortality following AFF versus TFF.

Potentially eligible studies were identified from Medline and EMBASE databases from inception to February 2022 using search strategy that comprised of terms for “Atypical Femoral Fracture” and “Mortality”. Eligible study must consist of a cohort of patients with atypical femoral fracture. Then, the study must report one-year mortality rate following AFF or report effect estimates with 95% confidence intervals (95% CIs) comparing incident mortality between patients with AFF and TFF. Point estimates with standard errors were retrieved from each study and were combined using the generic inverse variance method.

A total of 8,967 articles were identified. After two rounds of independent review by three investigators, we identified seven studies reporting one-year mortality rate of AFF and three studies comparing mortality rate of AFF versus TFF. Pooled analysis revealed pooled one-year mortality rate following AFF of 0.10 (95% CI, 0.05 – 0.16, I2 93.3%). Two studies compared mortality risks of the AFF versus TFF and revealed conflicting results.

One-year mortality rate following AFF was approximately 10%. However, evidence is insufficient to conclude if there was difference in mortality risk between AFF and TFF.

Atypical femoral fracture

Mortality

Systematic review

Meta-analysis

© 2022 Published by Elsevier Inc. on behalf of the AACE.