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Current Osteoporosis Reports
Published in: Current Osteoporosis Reports 4/2018

Open Access 01-08-2018 | Epidemiology and Pathophysiology (F Cosman and D Shoback, Section Editors)

Current Understanding of Epidemiology, Pathophysiology, and Management of Atypical Femur Fractures

Authors: Jessica Starr, Yu Kwang Donovan Tay, Elizabeth Shane

Published in: Current Osteoporosis Reports | Issue 4/2018

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Abstract

Purpose of Review

To summarize reports published since the 2013 American Society of Bone and Mineral Research Task Force Report on atypical femoral fractures (AFF).

Recent Findings

The absolute incidence of AFFs remains low. AFFs are primarily associated with prolonged bisphosphonate (BP) exposure, but have also been reported in unexposed patients and those receiving denosumab for osteoporosis and metastatic bone disease. Asians may be more susceptible to AFFs. Lateral femoral bowing and varus hip geometry, which increase loading forces on the lateral femoral cortex, may increase AFF risk. Altered bone material properties associated with BP therapy may predispose to AFFs by permitting initiation and increasing propagation of micro-cracks. Relevant genetic mutations have been reported in patients with AFFs. Single X-ray absorptiometry femur scans permit early detection of incomplete and/or asymptomatic AFFs. Orthopedists recommend intramedullary rods for complete AFFs and for incomplete, radiologically advanced AFFs associated with pain and/or marrow edema on MRI. Teriparatide may advance AFF healing but few data support its efficacy.

Summary

Greater understanding of biological and genetic predisposition to AFF may allow characterization of individual risk prior to initiating osteoporosis therapy and help allay fear in those at low risk for this complication, which remains rare in comparison to the osteoporotic fractures prevented by antiresorptive therapy.
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Metadata
Title
Current Understanding of Epidemiology, Pathophysiology, and Management of Atypical Femur Fractures
Authors
Jessica Starr
Yu Kwang Donovan Tay
Elizabeth Shane
Publication date
01-08-2018
Publisher
Springer US
Published in
Current Osteoporosis Reports / Issue 4/2018
Print ISSN: 1544-1873
Electronic ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-018-0464-6

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