Bisphosphonates are the most commonly prescribed type of medication for the treatment of osteoporosis. Studies have shown that bisphosphonates reduce the incidence of vertebral and nonvertebral fractures when used to treat postmenopausal osteoporosis1-4. The indications for use of bisphosphonates also extend to other metabolic bone diseases such as glucocorticoid-induced osteoporosis, Paget disease, hypercalcemia due to a variety of causes, and skeletal metastases5-7. Treatment with bisphosphonates, however, is not without adverse effects. Because bisphosphonates act by inhibiting osteoclast function and inducing osteoclast apoptosis8,9, there is a substantial concern regarding the potential side effects related to severe suppression of the bone turnover rate. Several case reports and case series have indicated an association between a unique fracture type, so-called “atypical femoral fractures,” and prolonged bisphosphonate use10-14. These fractures differ from typical osteoporotic femoral fractures in many respects, including the mechanism of injury, location, and fracture configuration. Although the American Society for Bone and Mineral Research (ASBMR) published a task force report on atypical femoral fractures in 201015, little information about this type of fracture is known. The present report will critically review current evidence on the characteristics, epidemiology, pathogenesis, and treatment outcomes of atypical femoral fractures to identify gaps in knowledge calling for future research and to provide guidance for orthopaedic surgeons. Many case reports and case reviews have described several common radiographic features of atypical femoral fractures associated with bisphosphonate use, including a transverse, noncomminuted fracture at the subtrochanteric or femoral shaft region with a medial cortical spike at the fracture area (Fig. 1). Other features include prodromal pain and generalized thickening of the femoral cortices on radiographs13,14,16,17. Because of the lack of clear criteria …

Thailand has transitioned from an aging society to an aged society, which implies that the prevalence of age-related disorders will increase; however, epidemiological data specific to the prevalence of age-related degenerative musculoskeletal disorders among Thai older adults remain limited. Accordingly, the aim of this study was to investigate the prevalence of age-related musculoskeletal diseases, including osteoporosis, sarcopenia, and high falls risk among healthy community-dwelling Thai older adults. This cross-sectional nationwide study enrolled Thai adults aged ≥60 yr from 2 randomly selected provinces from each of the 6 regions of Thailand via stratified multistage sampling during March 2021 to August 2022. All enrolled participants were evaluated for BMD, skeletal muscle mass, grip strength, and gait speed. Osteoporosis was diagnosed according to the World Health Organization definition, and sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Falls risk was determined using the self-rated Fall Risk Questionnaire. A total of 2991 eligible participants were recruited. The mean age of participants was 69.2 ± 6.5 yr (range: 60–107), and 63.1% were female. The prevalence of osteoporosis, sarcopenia, and high falls risk was 29.7%, 18.1%, and 38.5%, respectively. Approximately one-fifth of subjects (19.1%) had at least 2 of 3 risk factors (ie, osteoporosis, sarcopenia, and high falls risk) for sustaining a fragility fracture, and 3.4% had all 3 risk factors. In conclusion, the results of this study revealed a high and increasing prevalence of osteoporosis, sarcopenia, and high falls risk in healthy community-dwelling Thai older adults. Since these conditions are all major risk factors for fragility fracture, modification of Thailand’s national health care policy is urgently needed to address the increasing prevalence of these conditions among healthy community-dwelling older adults living in Thailand.

Background: Several risk assessments have been developed to evaluate fall risk in older adults, but it has not been conclusively established which of these tools is most effective for assessing fall risk in this vulnerable population. Recently, the U.S. Centers for Disease Control and Prevention (CDC) developed the self-rated Fall Risk Questionnaire (self-rated FRQ), a 12-item questionnaire designed to screen older adults who are at risk of falling and has been widely used in many centers. This study aimed to determine the validity and reliability of the self-rated FRQ in older adults with osteoporosis. Methods: This prospective study was conducted at the Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand from December 2019 to March 2020. Sixty-eight men or postmenopausal women aged > 65 years who were diagnosed with osteoporosis either by bone mineral density T-score or by occurrence of fragility fracture were evaluated with the self-rated FRQ, the Thai falls risk assessment test (Thai-FRAT), the timed get-up-and-go test (TUG test), the Berg Balance Scale (BBS), and the 5 times sit-to-stand test (5TSTS test). Validity of the self-rated FRQ was assessed by evaluating the correlations (r) between the self-rated FRQ score and the scores from the other four assessments. Reliability of the self-rated FRQ was evaluated by measuring test-retest reliability and internal consistency. Results: The self-rated FRQ was moderately strongly correlated with the BBS, TUG test, and 5TSTS test (r = 0.535 to 0.690; p < 0.001), and fairly correlated with the Thai-FRAT (r = 0.487; p < 0.001). Test-retest reliability of the self-rated FRQ was high, with a Kappa of 1. Internal consistency of the self-rated FRQ was excellent (Cronbach’s alpha: 0.936). Conclusions: The self-rated FRQ was found to be a valid and reliable tool for evaluating fall risk in older adults with osteoporosis. Since assessment of fall risk requires a multifaceted measurement tool, the self-rated FRQ is an appropriate tool that can be integrated into the fall risk assessment algorithm in older adults with osteoporosis.