if untreated, the fracture propagates medially and can progress to a complete one.incomplete fractures affect the lateral cortex only 6.changes first occur within the lateral cortex of the proximal femur with focal periosteal reaction, cortical thickening and other changes of insufficiency fractures 1,2,6.The proposed theory is that prolonged bisphosphonate use decreases osteoclast activity and inhibits bone remodeling, leading to microdamage that would normally be repaired but is inhibited, thus increasing skeletal fragility 2-4,12. Pathologyīiphosphonate and RANKL inhibitors such as denosumab are linked to this type of fracture but it has not been unquestionably proven due to a lack of high-quality data 2,5. fall from standing height) 1,4,5. They are often bilateral in case of an atypical femoral fracture, the opposite femur should also be imaged. Fractures can be atraumatic or result from a low-energy mechanism (e.g.
Most patients have been on long-term bisphosphonate therapy (>3-5 years) and report a weeks-to-months history of thigh or groin pain 1,2,5,6. both typical and atypical) of femoral fractures is lower in women who take bisphosphonates 5,6. They occur in older, postmenopausal women 1. The rate of this fracture pattern outlined above in women who are treated continuously with bisphosphonates is 1 in 1000 compared to 0.02 in 1000 for untreated women 1. no evidence of malignant bone tumor (primary or metastatic) or other bone diseases (e.g.not be femoral neck or intertrochanteric.must involve the lateral cortex medially may have "medial spike".mainly transverse medially may be oblique.
location in the femoral diaphysis: distal to the lesser trochanter but proximal to the supracondylar flare.The atypical fracture pattern occurs in the femur shaft and may be unilateral or bilateral.Ītypical femoral fractures have been defined by the American Society for Bone and Mineral Research by the following criteria 6,9:
Atypical femoral fractures, also known as bisphosphonate -related proximal femoral fractures, are an example of insufficiency fractures, although the direct causative link remains somewhat controversial 2.
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