Atypical femoral fractures: What do we know about them? AAOS exhibit selection

Abstract

The causal relationship between prolonged bisphosphonate use and the occurrence of atypical femoral fractures has not yet been established. If a patient sustains an atypical femoral fracture, bisphosphonates must be stopped and an anabolic agent should be employed. These patients should also have daily calcium and vitamin-D supplementation. As fractures treated by intramedullary nailing heal by endochondral repair, such nailing is a preferred method of fixation for atypical femoral fractures. Atypical femoral fractures are relatively rare events, and the balance between patient efficacy and safety still favors bisphosphonate therapy for the treatment of osteoporosis. Bisphosphonates appear to have lingering efficacy against fractures even after the treatment is discontinued, so a drug holiday should be considered for most patients who take bisphosphonates for five years or more. Because many questions regarding atypical femoral fractures are unanswered, future studies should focus on bone histomorphometry and biomechanical properties of the femoral cortices as well as clinical drug trials regarding this particular problem. The small number of reported fractures may warrant development of a national registry of atypical femoral fractures. Copyright © 2013 by The Journal of Bone and Joint Surgery, Incorporated.