{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:47:49Z","timestamp":1787993269662,"version":"build-2784847793"},"reference-count":36,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Osteoporosis prevalence is expected to increase with global aging. Bisphosphonates and denosumab are effective treatments, but anxiety regarding safety concerns, medication-related osteonecrosis of the jaw and atypical femur fractures (AFFs), have contributed to a decline in bisphosphonate use in recent years. The Transcontinental Atypical Femoral Fracture Consortium (TrAFFiC) was established to identify potential higher risk clinical factors contributing to AFF development. Within TrAFFiC, an AFF registry was established. One hundred and sixty-six patients with AFFs were included. Seventy-seven (46%) patients sustained bilateral AFFs, totaling 243 AFFs (138 complete and 105 incomplete). Sixty-two (37%) individuals were of Asian ethnicity, with 40 (24%) specifically of Southeast Asian ethnicity. Comparisons within this AFF cohort revealed that Asian individuals were shorter and lower weight (152.0\u00a0cm vs 154.6\u00a0cm, p\u2009&amp;lt;\u2009.038; 57.5\u00a0kg vs 66.8\u00a0kg, p\u2009&amp;lt;\u2009.001) than non-Asian peers and were less likely to have a history of minimal trauma fractures prior to AFF (53% vs 84%, p\u2009&amp;lt;\u2009.001). Asian ethnicity [OR 2.10 (95% CI 1.06, 4.02), p\u2009=\u2009.034] and Southeast Asian ethnicity [OR 3.25 (95% CI 1.55, 6.8), p\u2009=\u2009.002] were associated with an increased likelihood of \u201cearlier onset\u201d AFF development, that is, an AFF sustained following \u22645\u00a0yr of antiresorptive treatment. Lastly, teriparatide use following incomplete AFF (n\u2009=\u200934) did not affect time to healing or pain resolution. In conclusion, Asian individuals sustained AFFs following a shorter duration of antiresorptive treatment compared with non-Asian AFF peers. In addition, Asian individuals were less likely to sustain additional minimal trauma fractures. While assessment for a drug holiday may be appropriate for patients at lower risk of AFF after 5\u00a0yr of oral antiresorptive treatment, in those with risk factors for \u201cearlier onset\u201d AFF, further research is required to guide whether a lower dose or shorter duration of treatment or prioritization of bone anabolic treatments should be considered.<\/jats:p>","DOI":"10.1093\/jbmr\/zjag070","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T11:42:27Z","timestamp":1776253347000},"source":"Crossref","is-referenced-by-count":1,"title":["Asian ethnicity is associated with shorter antiresorptive exposure prior to atypical femur fracture (AFF): a Transcontinental Atypical Femoral Fracture Consortium (TrAFFiC) cohort study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4957-1483","authenticated-orcid":false,"given":"Lucy","family":"Collins","sequence":"first","affiliation":[{"name":"Department of Medicine, School of Clinical Sciences, Monash University , 3168, VIC ,","place":["Australia"]},{"name":"Department of Endocrinology, Monash Health , 3168, VIC ,","place":["Australia"]},{"name":"Department of Endocrinology and Diabetes, Western Health , 3021, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cat","family":"Shore-Lorenti","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Sciences, Monash University , 3168, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Sciences, Monash University , 3168, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9940-4376","authenticated-orcid":false,"given":"Frances","family":"Milat","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Sciences, Monash University , 3168, VIC ,","place":["Australia"]},{"name":"Department of Endocrinology, Monash Health , 3168, VIC ,","place":["Australia"]},{"name":"Hudson Institute of Medical Research , 3168, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3837-0125","authenticated-orcid":false,"given":"Shoshana","family":"Sztal-Mazer","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Alfred Health , 3004, VIC ,","place":["Australia"]},{"name":"Department of Public Health and Preventative Medicine, Monash University , 3004, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Grill","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Western Health , 3021, VIC ,","place":["Australia"]},{"name":"Department of Medicine, The University of Melbourne , 3010, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Yates","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Western Health , 3021, VIC ,","place":["Australia"]},{"name":"Department of Endocrinology and Diabetes, The Royal Melbourne Hospital , 3050, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherie","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Medicine, The University of Melbourne , 3010, VIC ,","place":["Australia"]},{"name":"Department of Endocrinology and Diabetes, The Royal Melbourne Hospital , 3050, VIC ,","place":["Australia"]},{"name":"Department of Endocrinology, Austin Health , 3084, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-5529","authenticated-orcid":false,"given":"Christian M","family":"Girgis","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Royal North Shore Hospital , 2065, NSW ,","place":["Australia"]},{"name":"Department of Diabetes and Endocrinology, Westmead Hospital , 2145, NSW ,","place":["Australia"]},{"name":"Faculty of Medicine and Health, The University of Sydney , 2050, NSW ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5742-298X","authenticated-orcid":false,"given":"Aasis","family":"Unnanuntana","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , 10700,","place":["Thailand"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Dell","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Southern California Permanente Medical Group , CA , 95825,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roderick","family":"Clifton-Bligh","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Royal North Shore Hospital , 2065, NSW ,","place":["Australia"]},{"name":"Faculty of Medicine and Health, The University of Sydney , 2050, NSW ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2921-3742","authenticated-orcid":false,"given":"Peter R","family":"Ebeling","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Sciences, Monash University , 3168, VIC ,","place":["Australia"]},{"name":"Department of Endocrinology, Monash Health , 3168, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanh H","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Sciences, Monash University , 3168, VIC ,","place":["Australia"]},{"name":"Department of Endocrinology, Monash Health , 3168, VIC ,","place":["Australia"]},{"name":"Department of Endocrinology and Diabetes, Western Health , 3021, VIC ,","place":["Australia"]},{"name":"Department of Medicine, The University of Melbourne , 3010, VIC ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"issue":"2 Suppl 1","key":"2026051215510937100_ref1","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1016\/j.bone.2005.11.024","article-title":"Osteoporosis: a still increasing prevalence","volume":"38","author":"Reginster","year":"2006","journal-title":"Bone."},{"issue":"2","key":"2026051215510937100_ref2","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1210\/er.2018-00001","article-title":"Atypical femur fractures: review of epidemiology, relationship to bisphosphonates, prevention, and clinical 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