Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Management of atypical femoral fracture: a scoping review and comprehensive algorithm

Authors: Giuseppe Toro, Cristina Ojeda-Thies, Giampiero Calabrò, Gabriella Toro, Antimo Moretti, Guillermo Martínez-Díaz Guerra, Pedro Caba-Doussoux, Giovanni Iolascon

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

Login to get access

Abstract

Background

Atypical femoral fractures (AFF) are a rare type of femoral stress fracture recently described, potentially associated with prolonged bisphosphonate therapy. Evidence-based recommendations regarding diagnosis and management of these fractures are scarce. The purpose of this study is to propose an algorithm for the diagnosis and management of AFF.

Methods

We performed a PubMed search of the last ten years using the keywords “atypical femoral fractures” and identified further articles through an evaluation of the publications cited in these articles. Relevant studies were included by agreement between researchers, depending on their specialization. Pertinent points of debate were discussed based on the available literature, allowing for consensus regarding the proposed management algorithm.

Results

Using a systematic approach we performed a scoping review that included a total of 137 articles.

Conclusions

A practical guide for diagnosis and management of AFF based on the current concepts is proposed. In spite of the impressive large volume of published literature available since AFF were initially identified, the level of evidence is mostly poor, in particular regarding treatment choice. Therefore, further studies are required.
Literature
1.
Cooper C. Epidemiology of osteoporosis. Favus MJ Primer Metab. Bone Dis. Disord. Miner. Metab. 5th ed. Washington, DC: American Society for Bone and Mineral Research; 2003. p. 307–13
2.
3.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos. Osteoporos Int. 2006;17:1726–33.CrossRefPubMed
4.
Piscitelli P, Iolascon G, Argentiero A, Chitano G, Neglia C, Marcucci G, et al. Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records. Clin Interv Aging. 2012;7:575–83.CrossRefPubMedPubMedCentral
5.
Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, et al. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int. 2011;22:1277–88.CrossRefPubMedPubMedCentral
6.
Tarantino U, Capone A, Planta M, D’Arienzo M, Letizia Mauro G, Impagliazzo A, et al. The incidence of hip, forearm, humeral, ankle, and vertebral fragility fractures in Italy: results from a 3-year multicenter study. Arthritis Res Ther. 2010;12:R226.CrossRefPubMedPubMedCentral
7.
Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007;356:1809–22.CrossRefPubMed
8.
Chesnut CH, Skag A, Christiansen C, Recker R, Stakkestad JA, Hoiseth A, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res. 2004;19:1241–9.CrossRefPubMed
9.
Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA. 1999;282:1344–52.CrossRefPubMed
10.
Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA, et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006;296:2927–38.CrossRefPubMed
11.
Borromeo GL, Brand C, Clement JG, McCullough M, Crighton L, Hepworth G, et al. A large case-control study reveals a positive association between bisphosphonate use and delayed dental healing and osteonecrosis of the jaw. J Bone Miner Res. 2014;29:1363–8.CrossRefPubMed
12.
Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, et al. Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research: AFF task force report. J Bone Miner Res. 2014;29:1–23.CrossRefPubMed
13.
Thompson RN, Phillips JRA, McCauley SHJ, Elliott JRM, Moran CG. Atypical femoral fractures and bisphosphonate treatment: Experience in two large United Kingdom teaching hospitals. Bone Joint J. 2012;94-B:385–90.CrossRef
14.
Unnanuntana A, Saleh A, Mensah KA, Kleimeyer JP, Lane JM. Atypical Femoral Fractures: What Do We Know About Them?: AAOS Exhibit Selection. J Bone Joint Surg Am. 2013;95:e8 1.CrossRef
15.
Barcsa C, Endes J, Szappanos L. [Atypical fatigue fractures]. Beitr Zur Orthop Traumatol. 1978;25:578–82.
16.
Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CYC. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005;90:1294–301.CrossRefPubMed
17.
Audran M, Cortet B, Thomas T. What do we know about atypical femoral fractures? Insights and enigmas. Joint Bone Spine. 2011;78:568–71.CrossRefPubMed
18.
Rizzoli R, Åkesson K, Bouxsein M, Kanis JA, Napoli N, Papapoulos S, et al. Subtrochanteric fractures after long-term treatment with bisphosphonates: a European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, and International Osteoporosis Foundation Working Group Report. Osteoporos Int. 2011;22:373–90.CrossRefPubMedPubMedCentral
19.
Nieves JW, Bilezikian JP, Lane JM, Einhorn TA, Wang Y, Steinbuch M, et al. Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int. 2010;21:399–408.CrossRefPubMed
20.
Lenart BA, Neviaser AS, Lyman S, Chang CC, Edobor-Osula F, Steele B, et al. Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study. Osteoporos Int. 2009;20:1353–62.CrossRefPubMedPubMedCentral
21.
Koh JSB, Goh SK, Png MA, Kwek EBK, Howe TS. Femoral Cortical Stress Lesions in Long-Term Bisphosphonate Therapy: A Herald of Impending Fracture? J Orthop Trauma. 2010;24:75–81.CrossRefPubMed
22.
Kwek EBK, Goh SK, Koh JSB, Png MA, Howe TS. An emerging pattern of subtrochanteric stress fractures: A long-term complication of alendronate therapy? Injury. 2008;39:224–31.CrossRefPubMed
23.
Schilcher J, Koeppen V, Ranstam J, Skripitz R, Michaëlsson K, Aspenberg P. Atypical femoral fractures are a separate entity, characterized by highly specific radiographic features. A comparison of 59 cases and 218 controls. Bone. 2013;52:389–92.CrossRefPubMed
24.
25.
Shane E, Burr D, Ebeling PR, Abrahamsen B, Adler RA, Brown TD, et al. Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research: atypical femoral fractures task force report. J Bone Miner Res. 2010;25:2267–94.CrossRefPubMed
26.
Egol KA, Park JH, Rosenberg ZS, Peck V, Tejwani NC. Healing delayed but generally reliable after bisphosphonate-associated complete femur fractures treated with IM nails. Clin Orthop. 2014;472:2728–34.CrossRefPubMedPubMedCentral
27.
28.
Weil YA, Rivkin G, Safran O, Liebergall M, Foldes AJ. The Outcome of Surgically Treated Femur Fractures Associated With Long-Term Bisphosphonate Use. J Trauma. 2011;71:186–90.CrossRefPubMed
29.
Prasarn ML, Ahn J, Helfet DL, Lane JM, Lorich DG. Bisphosphonate-associated Femur Fractures Have High Complication Rates with Operative Fixation. Clin Orthop Relat Res. 2012;470:2295–301.CrossRefPubMedPubMedCentral
30.
Edwards BJ, Bunta AD, Lane J, Odvina C, Rao DS, Raisch DW, et al. Bisphosphonates and Nonhealing Femoral Fractures: Analysis of the FDA Adverse Event Reporting System (FAERS) and International Safety Efforts: A Systematic Review from the Research on Adverse Drug Events And Reports (RADAR) Project. J Bone Joint Surg Am. 2013;95:297.CrossRefPubMedPubMedCentral
31.
Saleh A, Hegde VV, Potty AG, Lane JM. Bisphosphonate Therapy and Atypical Fractures. Orthop Clin North Am. 2013;44:137–51.CrossRefPubMed
32.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32.CrossRef
33.
34.
35.
Giusti A, Hamdy NAT, Papapoulos SE. Atypical fractures of the femur and bisphosphonate therapy. Bone. 2010;47:169–80.CrossRefPubMed
36.
Hagen JE, Miller AN, Ott SM, Gardner M, Morshed S, Jeray K, et al. Association of Atypical Femoral Fractures with Bisphosphonate Use by Patients with Varus Hip Geometry. J Bone Jt Surg. 2014;96:1905–9.CrossRef
37.
Sasaki S, Miyakoshi N, Hongo M, Kasukawa Y, Shimada Y. Low-energy diaphyseal femoral fractures associated with bisphosphonate use and severe curved femur: a case series. J Bone Miner Metab. 2012;30:561–7.CrossRefPubMed
38.
Saita Y, Ishijima M, Mogami A, Kubota M, Baba T, Kaketa T, et al. The fracture sites of atypical femoral fractures are associated with the weight-bearing lower limb alignment. Bone. 2014;66:105–10.CrossRefPubMed
39.
40.
Marcano A, Taormina D, Egol KA, Peck V, Tejwani NC. Are Race and Sex Associated With the Occurrence of Atypical Femoral Fractures? Clin Orthop Relat Res. 2014;472:1020–7.CrossRefPubMedPubMedCentral
41.
Oh Y, Wakabayashi Y, Kurosa Y, Ishizuki M, Okawa A. Stress fracture of the bowed femoral shaft is another cause of atypical femoral fracture in elderly Japanese: a case series. J Orthop Sci. 2014;19:579–86.CrossRefPubMed
42.
Oh Y, Wakabayashi Y, Kurosa Y, Fujita K, Okawa A. Potential pathogenic mechanism for stress fractures of the bowed femoral shaft in the elderly: Mechanical analysis by the CT-based finite element method. Injury. 2014;45:1764–71.CrossRefPubMed
43.
Saita Y, Ishijima M, Mogami A, Kubota M, Baba T, Kaketa T, et al. The incidence of and risk factors for developing atypical femoral fractures in Japan. J Bone Miner Metab. 2015;33:311–8.CrossRefPubMed
44.
Feldstein AC, Black D, Perrin N, Rosales AG, Friess D, Boardman D, et al. Incidence and demography of femur fractures with and without atypical features. J Bone Miner Res. 2012;27:977–86.CrossRefPubMed
45.
Rosenberg ZS, La Rocca VR, Chan SS, Babb J, Akyol Y, Rybak LD, et al. Bisphosphonate-Related Complete Atypical Subtrochanteric Femoral Fractures: Diagnostic Utility of Radiography. Am J Roentgenol. 2011;197:954–60.CrossRef
46.
Reiter MJ, Bui-Mansfield LT, O’Brien SD, Tubb CC. Subtrochanteric Femur Fractures: Review of the Complete Pathologic Spectrum With Emphasis on Distinguishing Imaging Features. J Comput Assist Tomogr. 2015;39:47–56.CrossRefPubMed
47.
Tins BJ, Garton M, Cassar-Pullicino VN, Tyrrell PNM, Lalam R, Singh J. Stress fracture of the pelvis and lower limbs including atypical femoral fractures—a review. Insights Imaging. 2015;6:97–110.CrossRefPubMedPubMedCentral
48.
Papandrianos N, Alexiou S, Xouria X, Apostolopoulos DJ. Atypical Bilateral Stress Fractures of the Femoral Shaft Diagnosed by Bone Scintigraphy in a Woman With Osteoporosis. Clin Nucl Med. 2013;38:910–2.CrossRefPubMed
49.
Probst S, Rakheja R, Stern J. Atypical Bisphosphonate-Associated Subtrochanteric and Femoral Shaft Stress Fractures: Diagnostic Features on Bone Scan. Clin Nucl Med. 2013;38:397–9.CrossRefPubMed
50.
Park SY, Lee SH, Han SB. Atypical Subtrochanteric Femoral Fracture. J Orthop Sports Phys Ther. 2012;42:44.CrossRefPubMed
51.
Powrie N, Ismail A. Atypical femoral fractures as an incidental finding on dual X-ray absorptiometry. Rheumatology. 2015;54:218.CrossRefPubMed
52.
McKenna MJ, van der Kamp S, Heffernan E, Hurson C. Incomplete Atypical Femoral Fractures: Assessing the Diagnostic Utility of DXA by Extending Femur Length. J Clin Densitom. 2013;16:579–83.CrossRefPubMed
53.
Kim S, Yang KH, Lim H, Lee Y-K, Yoon HK, Oh C-W, et al. Detection of Prefracture Hip Lesions in Atypical Subtrochanteric Fracture with Dual-Energy X-ray Absorptiometry Images. Radiology. 2014;270:487–95.CrossRefPubMed
54.
McKiernan FE. Atypical Femoral Diaphyseal Fractures Documented by Serial DXA. J Clin Densitom. 2010;13:102–3.CrossRefPubMed
55.
Yates CJ, Bartlett MJ, Ebeling PR. An atypical subtrochanteric femoral fracture from pycnodysostosis: A lesson from nature. J Bone Miner Res. 2011;26:1377–9.CrossRefPubMed
56.
Whyte MP. Atypical Femoral Fractures, Bisphosphonates, and Adult Hypophosphatasia. J Bone Miner Res. 2009;24:1132–4.CrossRefPubMed
57.
Tjhia CK, Odvina CV, Rao DS, Stover SM, Wang X, Fyhrie DP. Mechanical property and tissue mineral density differences among severely suppressed bone turnover (SSBT) patients, osteoporotic patients, and normal subjects. Bone. 2011;49:1279–89.CrossRefPubMedPubMedCentral
58.
Güerri-Fernández RC, Nogués X, Quesada Gómez JM, Torres del Pliego E, Puig L, García-Giralt N, et al. Microindentation for in vivo measurement of bone tissue material properties in atypical femoral fracture patients and controls. J Bone MinerRes. 2013;28:162–8.CrossRef
59.
Wang Z, Ward MM, Chan L, Bhattacharyya T. Adherence to oral bisphosphonates and the risk of subtrochanteric and femoral shaft fractures among female medicare beneficiaries. Osteoporos Int. 2014;25:2109–16.CrossRefPubMedPubMedCentral
60.
Park-Wyllie LY. Bisphosphonate Use and the Risk of Subtrochanteric or Femoral Shaft Fractures in Older Women. JAMA. 2011;305:783.CrossRefPubMed
61.
Schilcher J, Michaëlsson K, Aspenberg P. Bisphosphonate Use and Atypical Fractures of the Femoral Shaft. N Engl J Med. 2011;364:1728–37.CrossRefPubMed
62.
Capeci CM. Bilateral Low-Energy Simultaneous or Sequential Femoral Fractures in Patients on Long-Term Alendronate Therapy. J Bone Jt Surg Am. 2009;91:2556.CrossRef
63.
Schilcher J, Koeppen V, Aspenberg P, Michaëlsson K. Risk of atypical femoral fracture during and after bisphosphonate use. Acta Orthop. 2015;86:100–7.CrossRefPubMedPubMedCentral
64.
Babu S, Sandiford NA, Vrahas M. Use of Teriparatide to improve fracture healing: What is the evidence? World J Orthop. 2015;6:457–61.PubMedPubMedCentral
65.
Visekruna M, Wilson D, McKiernan FE. Severely Suppressed Bone Turnover and Atypical Skeletal Fragility. J Clin Endocrinol Metab. 2008;93:2948–52.CrossRefPubMed
66.
Tarazona-Santabalbina FJ, Aguilella-Fernández L. Bisphosphonate long-term treatment related bilateral subtrochanteric femoral fracture. Can teriparatide be useful? Aging Clin Exp Res. 2013;25:605–9.CrossRefPubMed
67.
Meling T, Nawab A, Harboe K, Fosse L. Atypical femoral fractures in elderly women: a fracture registry-based cohort study. Bone Jt J. 2014;96-B:1035–40.CrossRef
68.
Giannotti S, Bottai V, Dell’Osso G, De Paola G, Ghilardi M, Guido G. Pseudoarthrosis in atypical femoral fracture: case report. Osteoporos Int. 2013;24:2893–5.CrossRefPubMed
69.
Tsuchie H, Miyakoshi N, Nishi T, Abe H, Segawa T, Shimada Y. Combined Effect of a Locking Plate and Teriparatide for Incomplete Atypical Femoral Fracture: Two Case Reports of Curved Femurs. Case Rep Orthop. 2015;2015:1–5.CrossRef
70.
Reddy SV, Gupta SK. Atypical femoral shaft fracture in a patient with non-metastatic prostate cancer on zoledronic acid therapy: effect of therapy or coincidence? Singapore Med J. 2012;53:e52–4.PubMed
71.
Huang H-T, Kang L, Huang P-J, Fu Y-C, Lin S-Y, Hsieh C-H, et al. Successful teriparatide treatment of atypical fracture after long-term use of alendronate without surgical procedure in a postmenopausal woman: a case report. Menopause J North Am Menopause Soc. 2012;19:1360–3.CrossRef
72.
Gomberg SJ, Wustrack RL, Napoli N, Arnaud CD, Black DM. Teriparatide, Vitamin D, and Calcium Healed Bilateral Subtrochanteric Stress Fractures in a Postmenopausal Woman with a 13-Year History of Continuous Alendronate Therapy. J Clin Endocrinol Metab. 2011;96:1627–32.CrossRefPubMed
73.
Carvalho NNC, Voss LA, Almeida MOP, Salgado CL, Bandeira F. Atypical Femoral Fractures during Prolonged Use of Bisphosphonates: Short-Term Responses to Strontium Ranelate and Teriparatide. J Clin Endocrinol Metab. 2011;96:2675–80.CrossRefPubMed
74.
Miyakoshi N, Aizawa T, Sasaki S, Ando S, Maekawa S, Aonuma H, et al. Healing of bisphosphonate-associated atypical femoral fractures in patients with osteoporosis: a comparison between treatment with and without teriparatide. J Bone Miner Metab. 2015;33:553–9.CrossRefPubMed
75.
Ha Y-C, Cho M-R, Park KH, Kim S-Y, Koo K-H. Is surgery necessary for femoral insufficiency fractures after long-term bisphosphonate therapy? Clin Orthop. 2010;468:3393–8.CrossRefPubMedPubMedCentral
76.
Banffy MB, Vrahas MS, Ready JE, Abraham JA. Nonoperative versus Prophylactic Treatment of Bisphosphonate-associated Femoral Stress Fractures. Clin Orthop Relat Res. 2011;469:2028–34.CrossRefPubMedPubMedCentral
77.
Saleh A, Hegde VV, Potty AG, Schneider R, Cornell CN, Lane JM. Management Strategy for Symptomatic Bisphosphonate-Associated Incomplete Atypical Femoral Fractures. HSS J ®. 2012;8:103–10.CrossRef
78.
Oh C-W, Oh J-K, Park K-C, Kim J-W, Yoon Y-C. Prophylactic Nailing of Incomplete Atypical Femoral Fractures. Sci World J. 2013;2013:1–4.CrossRef
79.
Togay P. Cortical Stress Reaction in Two Patients on Bisphosphonate Therapy: Case Report. Arch Rheumatol. 2015;30:164–7.CrossRef
80.
Rheinboldt M, Harper D, Stone M. Atypical femoral fractures in association with bisphosphonate therapy: a case series. Emerg Radiol. 2014;21:557–62.CrossRefPubMed
81.
Bottai V, Giannotti S, Dell’osso G, De Paola G, Menconi A, Falossi F, et al. Atypical femoral fractures: retrospective radiological study of 319 femoral fractures and presentation of clinical cases. Osteoporos Int. 2014;25:993–7.CrossRefPubMed
82.
Tosounidis TH, Lampropoulou-Adamidou K, Kanakaris NK. Intramedullary nailing of sequential bilateral atypical subtrochanteric fractures and the management of distal femoral intraoperative fracture. J Orthop Trauma. 2015. [Epub ahead of print].
83.
Fang C, Chau JY-M, Woo S-B, Lau T-W, Kwan K, Leung F. Propagation of Bisphosphonate-Related Femoral Stress Fractures Despite Femoral Nailing: A Cautionary Tale From 2 Cases. Geriatr Orthop Surg Rehabil. 2014;5:14–7.CrossRefPubMedPubMedCentral
84.
Kim YS, Chung PH, Kang S, Kim JP, Lee HM, Moon HS. A rare case of bilateral proximal femoral insufficiency fractures after interlocking IM nailing for bilateral atypical femoral shaft fractures. Arch Orthop Trauma Surg. 2015;135:1227–32.CrossRefPubMed
85.
Bonifacio L, Syson P. Construct Failure in an Atypical Femoral Fracture treated with Intramedullary Nailing: A Case Report. Malays Orthop J. 2014;8:82–4.CrossRefPubMedPubMedCentral
86.
Puah KL, Tan MH. Bisphosphonate-associated atypical fracture of the femur: Spontaneous healing with drug holiday and re-appearance after resumed drug therapy with bilateral simultaneous displaced fractures — a case report. Acta Orthop. 2011;82:380–2.CrossRefPubMedPubMedCentral
87.
Bamrungsong T, Pongchaiyakul C. Bilateral atypical femoral fractures after long-term alendronate therapy: a case report. J Med Assoc Thail Chotmaihet Thangphaet. 2010;93:620–4.
88.
Molvik H, Khan W. Bisphosphonates and their influence on fracture healing: a systematic review. Osteoporos Int. 2015;26:1251–60.CrossRefPubMed
89.
Kang JS, Won YY, Kim JO, Min BW, Lee KH, Park KK, et al. Atypical femoral fractures after anti-osteoporotic medication: a Korean multicenter study. Int Orthop. 2014;38:1247–53.CrossRefPubMedPubMedCentral
90.
De Das S, Setiobudi T, Shen L, De Das S. A rational approach to management of alendronate-related subtrochanteric fractures. J Bone Joint Surg (Br). 2010;92:679–86.CrossRef
91.
on behalf of the Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF), Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013;24:23–57.CrossRef
92.
Thompson RN, Armstrong CL, Heyburn G. Bilateral atypical femoral fractures in a patient prescribed denosumab — A case report. Bone. 2014;61:44–7.CrossRefPubMed
93.
Khow KSF, Yong TY. Atypical femoral fracture in a patient treated with denosumab. J Bone Miner Metab. 2015;33:355–8.CrossRefPubMed
94.
95.
96.
97.
98.
Paparodis R, Buehring B, Pelley E, Binkley N. A Case of an Unusual Subtrochanteric Fracture in a Patient Receiving Denosumab. Endocr Pract. 2013;19:e64–8.CrossRefPubMed
99.
Hanley DA, Adachi JD, Bell A, Brown V. Denosumab: mechanism of action and clinical outcomes: Denosumab: mechanism of action and clinical outcomes. Int J Clin Pract. 2012;66:1139–46.CrossRefPubMedPubMedCentral
100.
Drake MT, Clarke BL, Khosla S. Bisphosphonates: Mechanism of Action and Role in Clinical Practice. Mayo Clin Proc. 2008;83:1032–45.
101.
Iolascon G, Napolano R, Gioia M, Moretti A, Riccio I, Gimigliano F. The contribution of cortical and trabecular tissues to bone strength: insights from denosumab studies. Clin Cases Miner Bone Metab. 2013;10(1):47-51.
102.
McKiernan FE, Hocking J, Cournoyer S, Berg RL, Linneman J. A long femur scan field does not alter proximal femur bone mineral density measurements by dual-energy X-ray absorptiometry. J Clin Densitom. 2011;14:354–8.CrossRefPubMed
103.
Egol KA, Park JH, Prensky C, Rosenberg ZS, Peck V, Tejwani NC. Surgical treatment improves clinical and functional outcomes for patients who sustain incomplete bisphosphonate-related femur fractures. J Orthop Trauma. 2013;27:331–5.CrossRefPubMed
104.
Wang K, Moaveni A, Dowrick A, Liew S. Alendronate-associated femoral insufficiency fractures and femoral stress reactions. J Orthop Surg (Hong Kong). 2011;19:89–92.
105.
Lee Y-K, Ha Y-C, Kang BJ, Chang JS, Koo K-H. Predicting Need for Fixation of Atypical Femoral Fracture. J Clin Endocrinol Metab. 2013;98:2742–5.CrossRefPubMed
Metadata
Title
Management of atypical femoral fracture: a scoping review and comprehensive algorithm
Authors
Giuseppe Toro
Cristina Ojeda-Thies
Giampiero Calabrò
Gabriella Toro
Antimo Moretti
Guillermo Martínez-Díaz Guerra
Pedro Caba-Doussoux
Giovanni Iolascon
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-1086-8

Other articles of this Issue 1/2016

BMC Musculoskeletal Disorders 1/2016 Go to the issue

Research article

Risk factors for back pain in marines; a prospective cohort study

Research article

Biomechanical response of lumbar facet joints under follower preload: a finite element study

Research article

Intra-articular osteoid osteoma as a differential diagnosis of diffuse mono-articular joint pain

Research article

Sub-classification based specific movement control exercises are superior to general exercise in sub-acute low back pain when both are combined with manual therapy: A randomized controlled trial

Research article

Internalised stigma in people with rheumatoid arthritis: a cross sectional study to establish the psychometric properties of the ISMI-RA

Technical advance

Ultrasound-guided gastrocnemius recession: a new ultra–minimally invasive surgical technique