J Bone Metab.  2015 Aug;22(3):87-91. 10.11005/jbm.2015.22.3.87.

Atypical Femoral Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research

• Yang KH
• Min BW
• Ha YC

• KMID: 2170103
• DOI: http://doi.org/10.11005/jbm.2015.22.3.87

Abstract

Bisphosphonate (BP) is a useful anti-resorptive agent which decreases the risk of osteoporotic fracture by about 50%. However, recent evidences have shown its strong correlation with the occurrence of atypical femoral fracture (AFF). The longer the patient takes BP, the higher the risk of AFF. Also, the higher the drug adherence, the higher the risk of AFF. It is necessary to ask the patients who are taking BP for more than 3 years about the prodromal symptoms such as dull thigh pain. Simple radiography, bone scan, and magnetic resonance imaging (MRI) are good tools for the diagnosis of AFF. The pre-fracture lesion depicted on the hip dual energy X-ray absorptiometry (DXA) images should not be missed. BP should be stopped immediately after AFF is diagnosed and calcium and vitamin D (1,000 to 2,000 IU) should be administered. The patient should be advised not to put full weight on the injured limb. Daily subcutaneous injection of recombinant human parathyroid hormone (PTH; 1-34) is recommended if the patient can afford it. Prophylactic femoral nailing is indicated when the dreaded black line is visible in the lateral femoral cortex, especially in the subtrochanteric area.

Keyword

Atypical femoral fracture; Bisphosphonate; Position statement

MeSH Terms

Absorptiometry, Photon
Calcium
Diagnosis
Extremities
Femoral Fractures*
Hip
Humans
Injections, Subcutaneous
Magnetic Resonance Imaging
Osteoporotic Fractures
Parathyroid Hormone
Prodromal Symptoms
Radiography
Thigh
Vitamin D
Calcium
Parathyroid Hormone
Vitamin D

Figure

• 

  Fig. 1 Periosteal callus (arrow and circle) on the lateral cortex of subtrochanter is noted in the pre- and post-operative radiograms. Fracture is not comminuted and caused by simple fall. The medial beak in the distal fragment is eminent.

• 

  Fig. 2 Simple radiograms shows bowing of the femoral shaft and dreaded black line in the apex of curvature. Fracture is associated with huge amount of endosteal callus. Bone scan shows hot spot at the lesion in the right femur. Hot spot in the left femur is due to femoral nailing after atypical femoral shaft fracture.

• 

  Fig. 3 Dual energy X-ray absorptiometry (DXA) image of the hip joint sometimes depicts periosteal callus (arrow) in the lateral femoral cortex.

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  Fig. 4 Atypical femoral fracture is frequently associated with excessive femoral bowing. Straightening and iatrogenic fracture frequently occurs during intramedullary nailing.

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