Skip to main content
SpringerLink
Log in

Clinical Presentation of Atypical Femur Fractures

  • Chapter
The Duration and Safety of Osteoporosis Treatment

  • 942 Accesses

Abstract

Atypical femur fractures (AFFs) appear to be a separate entity from osteoporotic hip fractures and have several characteristics in their clinical presentation that distinguish them as such. Atypical fractures are characterized by the presence of minimal to no trauma, such as walking or stepping off a curb. They also frequently present with prodromal pain in the affected thigh or groin prior to fracture. Contralateral symptoms may be present in as many as one in five patients, and bilateral (both sequential and simultaneous) fractures are common. Lastly, they may be associated with comorbidities such as rheumatoid arthritis and/or the administration of certain medications, such as glucocorticoids, estrogen, and most notably, bisphosphonates.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    *Important References

References

*Important References

  1. *Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American society for bone and mineral research. J Bone Miner Res. 2013. Epub May 28. *Description: 2013 ASBMR Task Force Document, second update. Details the latest research into atypical femur fractures and presents an updated definition, both clinical and radiologic. Much of this chapter is based on this definition.

    Google Scholar 

  2. Hedlund R, Lindgren U. Epidemiology of diaphyseal femoral fracture. Acta Orthop Scand. 1986;57(5):423–7.

    Article  PubMed  CAS  Google Scholar 

  3. Nieves JW, Bilezikian JP, Lane JM, et al. Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int. 2010;21(3):399–408.

    Article  PubMed  CAS  Google Scholar 

  4. *Bogdan Y, Tornetta P III, Einhorn TA, et al. Healing time and complications in operatively treated atypical femur fractures associated with bisphosphonate use: a multicenter retrospective cohort. In: OTA annual meeting podium presentation. p. 4. http://ota.org/media/77960/Geriatric-Papers.pdf. *Author Note/Disclosure: Large retrospective study of operatively treated fractures by same author as author of this chapter (Dr. Bogdan). At time of chapter writing, the above study has been submitted for publication; the findings noted in the chapter are from the most recent data analysis and are thus more current than the data presented in the reference.

  5. Ekstrom W, Nemeth G, Samnegard E, et al. Quality of life after a subtrochanteric fracture: a prospective cohort study on 87 elderly patients. Injury. 2009;40:371–6.

    Article  PubMed  Google Scholar 

  6. Salminen S, Pihlajamaki H, Avikainen V, et al. Specific features associated with femoral shaft fractures caused by low energy trauma. J Trauma. 1997;43:117–22.

    Article  PubMed  CAS  Google Scholar 

  7. Odvina CV, Zerwekh JE, Rao DS, et al. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005;90(3):1294–301.

    Article  PubMed  CAS  Google Scholar 

  8. Prasarn ML, Ahn J, Helfet DL, et al. Bisphosphonate-associated femur fractures have high complication rates with operative fixation. Clin Orthop Relat Res. 2012;470(8):2295–301.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Thompson RN, Phillips JR, McCauley SH, et al. Atypical femoral fractures and bisphosphonate treatment: experience in two large United Kingdom teaching hospitals. Bone Joint J. 2012;94(3):385–90.

    Article  CAS  Google Scholar 

  10. Wang K, Moaveni A, Dowrick A. Alendronate-associated femoral insufficiency fractures and femoral stress reaction. J Orthop Surg. 2011;19(1):89–92.

    Google Scholar 

  11. Visekruna N, Wilson D, McKiernan FE. Severely suppressed bone turnover and atypical skeletal fragility. J Clin Endocrinol Metab. 2008;93(8):2948–52.

    Article  PubMed  CAS  Google Scholar 

  12. Kwek EB, Goh SK, Koh JS, et al. An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury. 2008;39(2):224–31.

    Article  PubMed  Google Scholar 

  13. Koh JS, Goh SK, Png MA, et al. Femoral cortical stress lesions in long-term bisphosphonate therapy: a herald of impending fracture? J Orthop Trauma. 2010;24(2):75–81.

    Article  PubMed  Google Scholar 

  14. Weil YA, Rivkin G, Safran O, et al. The outcome of surgically treated femur fractures associated with long-term bisphosphonate use. J Trauma. 2011;71(1):186–90.

    Article  PubMed  CAS  Google Scholar 

  15. Capeci CM, Tejwani NC. Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy. J Bone Joint Surg Am. 2009;91(11):2556–61.

    Article  PubMed  Google Scholar 

  16. Whyte MP. Atypical femoral fractures, bisphosphonates, and adult hypophosphatasia. J Bone Miner Res. 2009;24(6):1132–4.

    Article  PubMed  Google Scholar 

  17. Chang ST, Tenforde AS, Grimsrud CD, et al. Atypical femur fractures among breast cancer and multiple myeloma patients receiving intravenous bisphosphonate therapy. Bone. 2012;51(3):524–7.

    Article  PubMed  CAS  Google Scholar 

  18. Puhaindran ME, Farooki A, Steensma MR, et al. Atypical subtrochanteric femoral fractures in patients with skeletal malignant involvement treated with intravenous bisphosphonates. J Bone Joint Surg Am. 2011;93(13):1235–42.

    Article  PubMed  Google Scholar 

  19. Park-Wyllie LY, Mamdani MM, Juurlink DL, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA. 2011;305(8):783–9.

    Article  PubMed  CAS  Google Scholar 

  20. Schilcher J, Michaëlsson K, Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med. 2011;364(18):1728–37.

    Article  PubMed  CAS  Google Scholar 

  21. Wang Z, Bhattachariyya T. Trends in incidence of subtrochanteric fragility fractures and bisphosphonate use among the US elderly, 1996–2007. J Bone Miner Res. 2011;26(3):553–60.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  22. *Edwards BJ, Bunta AD, Lane J. 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(4):297–307. *Description: Review of 317 atypical femoral fractures associated with alendronate use from a large database demonstrating that many of these fractures show a delayed healing response. Also includes a literature review.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Girgis CM, Sher D, Seibel MJ. Atypical femoral fractures and bisphosphonate use. N Engl J Med. 2010;362(19):1848–9.

    Article  PubMed  CAS  Google Scholar 

  24. Kanis JA, Johansson H, Oden A. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res. 2004;19(6):893–9.

    Article  PubMed  Google Scholar 

  25. Targownik LE, Lix LM, Metge CJ. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ. 2008;179(4):319–26.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Boston University Medical Center, 850 Harrison Ave, Dowling 2 North, Boston, MA, 02118, USA

    Yelena Bogdan MD & Thomas A. Einhorn MD

Authors
  1. Yelena Bogdan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas A. Einhorn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yelena Bogdan MD .

Editor information

Editors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center; University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA

    Stuart Silverman

  2. Institute of Clinical Research; Department of Medicine, Holbæk, Denmark, University of Southern Denmark, Odense Patient Data Explorative Network; Holbæk Hospital, Odense, Denmark

    Bo Abrahamsen

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Bogdan, Y., Einhorn, T.A. (2016). Clinical Presentation of Atypical Femur Fractures. In: Silverman, S., Abrahamsen, B. (eds) The Duration and Safety of Osteoporosis Treatment. Springer, Cham. https://doi.org/10.1007/978-3-319-23639-1_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-23639-1_9

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23638-4

  • Online ISBN: 978-3-319-23639-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation