Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 May 23:17:227.
doi: 10.1186/s12891-016-1086-8.

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

Giuseppe Toro  1 , Cristina Ojeda-Thies  2 , Giampiero Calabrò  3 , Gabriella Toro  4 , Antimo Moretti  1 , Guillermo Martínez-Díaz Guerra  5 , Pedro Caba-Doussoux  2 , Giovanni Iolascon  1
Affiliations

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

Giuseppe Toro et al. BMC Musculoskelet Disord. .

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.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Radiograph of a patient with a complete AFF. Note the substantially transverse orientation of the fracture line at the lateral cortex, the medial spike and the generalized cortical thickening
Fig. 2
Fig. 2
Radiograph of a patient with an incomplete AFF (a and b, detail). a. Note the femoral bowing. b. Note the location of the fracture line on the lateral cortex,and the focal cortical thickening at the fracture site
Fig. 3
Fig. 3
Summary of the article selection process
Fig. 4
Fig. 4
Bone scintigraphy of a case of incomplete AFF
Fig. 5
Fig. 5
STIR-weighted MRI of the same case shown in Fig. 4. Note the increased fluid signal
Fig. 6
Fig. 6
Diagnostic algorithm for atypical femoral fractures
Fig. 7
Fig. 7
Evaluation of the state of bone metabolism and its correction. BRAFF = Bisphosphonate-related Atypical Femoral Fracture
Fig. 8
Fig. 8
Evaluation of the contralateral femur
Fig. 9
Fig. 9
Fracture treatment decision-making
Fig. 10
Fig. 10
Modified AFF pathogenic scheme proposed by Oh et al. [41, 42] reprinted with permission of authors
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    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
    1. Piscitelli P. Ten years of hip fractures in Italy: For the first time a decreasing trend in elderly women. World J Orthop. 2014;5:386. doi: 10.5312/wjo.v5.i3.386. - DOI - PMC - PubMed
    1. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos. Osteoporos Int. 2006;17:1726–33. doi: 10.1007/s00198-006-0172-4. - DOI - PubMed
    1. 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. doi: 10.2147/CIA.S36828. - DOI - PMC - PubMed
    1. 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. doi: 10.1007/s00198-011-1601-6. - DOI - PMC - PubMed

Publication types