The role of income and educational level as risk factors for atypical femur fractures: A Nationwide Danish Case-Cohort Study with Blinded Radiographic Review
Authors' conclusion
Socioeconomic differences in AFF rates were observed among BP users, but adjusted analyses did not support an independent association between income and AFF risk. Medium education was associated with lower AFF risk after adjustments.
Study context
- Population
- Danish individuals aged ≥ 50 years: all radiologically confirmed atypical femur fracture (AFF) cases 2010–2014 and a random sample of the general population; Bisphosphonate (BP) users164 AFF cases
- Participants
- 100,253 individuals
- Exposure
- Income and educational level among BP users
- Outcome
- Atypical femur fracture (AFF) risk by income and educational level
Methodological detailsnationwide, blinded radiographic review, Cox regression
- Nationwide
- Blinded radiographic review
- Cox regression
Main finding
As reported in the abstract
AFF rate among BP users by education
Each group vs Low/missing educationEstimate (CI)
Medium education
IRR 0.56(0.36–0.86)
Long education
IRR 0.53(0.28–0.95)
Medium educationage- and sex-adjusted Cox analysis
HR 0.63(0.41–0.96)
Observational data: associations, not effects.
Further findings
| Outcome | Values | P value |
|---|---|---|
| BP exposure, AFF cases vs background population | AFF cases 70.7% · Background population 7.9% | P < 0.05 |
| AFF IR among BP users | BP users IR 32.5 (CI 27.1–39.0) per 10,000 person-years |
Original publication
The role of income and educational level as risk factors for atypical femur fractures: A Nationwide Danish Case-Cohort Study with Blinded Radiographic Review. Osteoporos Int. Published 24 July 2026. doi:10.
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