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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/18774

Title: Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research
Authors: Shane, Elizabeth
Burr, David
Abrahamsen, Bo
Adler, Robert A.
Brown, Thomas D.
Cheung, Angela M.
Cosman, Felicia
Curtis, Jeffrey R.
Dell, Richard
Dempster, David W.
Ebeling, Peter R.
Einhorn, Thomas A.
Genant, Harry K.
Klaushofer, Klaus
Lane, Joseph M.
McKiernan, Fergus
McKinney, Ross
Ng, Alvin
Nieves, Jeri
O'Keefe, Regis
Papapoulos, Socrates
Sen Howe, Tet
van der Meulen, Marjolein C. H.
Weinstein, Robert S.
Whyte, Michael P.
Issue Date: 2014
Abstract: Bisphosphonates (BPs) and denosumab reduce the risk of spine and nonspine fractures. Atypical femur fractures (AFFs) located in the subtrochanteric region and diaphysis of the femur have been reported in patients taking BPs and in patients on denosumab, but they also occur in patients with no exposure to these drugs. In this report, we review studies on the epidemiology, pathogenesis, and medical management of AFFs, published since 2010. This newer evidence suggests that AFFs are stress or insufficiency fractures. The original case definition was revised to highlight radiographic features that distinguish AFFs from ordinary osteoporotic femoral diaphyseal fractures and to provide guidance on the importance of their transverse orientation. The requirement that fractures be noncomminuted was relaxed to include minimal comminution. The periosteal stress reaction at the fracture site was changed from a minor to a major feature. The association with specific diseases and drug exposures was removed from the minor features, because it was considered that these associations should be sought rather than be included in the case definition. Studies with radiographic review consistently report significant associations between AFFs and BP use, although the strength of associations and magnitude of effect vary. Although the relative risk of patients with AFFs taking BPs is high, the absolute risk of AFFs in patients on BPs is low, ranging from 3.2 to 50 cases per 100,000 person-years. However, long-term use may be associated with higher risk (approximate to 100 per 100,000 person-years). BPs localize in areas that are developing stress fractures; suppression of targeted intracortical remodeling at the site of an AFF could impair the processes by which stress fractures normally heal. When BPs are stopped, risk of an AFF may decline. Lower limb geometry and Asian ethnicity may contribute to the risk of AFFs. There is inconsistent evidence that teriparatide may advance healing of AFFs. (c) 2014 American Society for Bone and Mineral Research.
Notes: [Shane, Elizabeth] Columbia Univ, New York, NY 10032 USA. [Burr, David] Indiana Univ Sch Med, Indianapolis, IN 46202 USA. [Abrahamsen, Bo] Univ Copenhagen, Gentofte Hosp, DK-1168 Copenhagen, Denmark. [Adler, Robert A.] Hunter Holmes McGuire Vet Adm Med Ctr, Richmond, VA USA. Univ Iowa, Iowa City, IA 52242 USA. [Cheung, Angela M.] Univ Hlth Network, Toronto, ON, Canada. [Cosman, Felicia; Nieves, Jeri] Helen Hayes Hosp, West Haverstraw, NY USA. [Curtis, Jeffrey R.] Univ Alabama Birmingham, Birmingham, AL USA. [Dell, Richard] Kaiser Permanente Bellflower, Bellflower, CA USA. [Dempster, David W.] Columbia Univ, New York, NY 10027 USA. [Ebeling, Peter R.] Univ Melbourne, Melbourne, Vic 3010, Australia. [Einhorn, Thomas A.] Boston Med Ctr, Boston, MA USA. [Genant, Harry K.] Univ Calif San Francisco, San Francisco, CA 94143 USA. [Ng, Alvin; Sen Howe, Tet] Singapore Gen Hosp, Singapore, Singapore. [Geusens, Piet] Univ Hasselt, Diepenbeek, Belgium. [Klaushofer, Klaus] Hanusch Hosp, Ludwig Boltzmann Inst Osteol, Vienna, Austria. [McKiernan, Fergus] Marshfield Clin Fdn Med Res & Educ, Marshfield, WI USA. [McKinney, Ross] Duke Univ, Sch Med, Durham, NC 27706 USA. [O'Keefe, Regis] Univ Rochester, Rochester, NY 14627 USA. [Papapoulos, Socrates] Leiden Univ, Med Ctr, NL-2300 RA Leiden, Netherlands. [van der Meulen, Marjolein C. H.] Cornell Univ, Ithaca, NY 14853 USA. [Weinstein, Robert S.] Univ Arkansas Med Sci, Little Rock, AR 72205 USA. [Whyte, Michael P.] Shriners Hosp Children, Sacramento, CA USA.
URI: http://hdl.handle.net/1942/18774
DOI: 10.1002/jbmr.1998
ISI #: 000328598000001
ISSN: 0884-0431
Category: A1
Type: Journal Contribution
Validation: ecoom, 2015
Appears in Collections: Research publications

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