Atypical femoral fracture

Definition

• Low-impact fracture, usually subtrochanteric and femoral shaft (i.e. below the femoral neck), related to long-term bisphosphonate use

Risk Factors

• Long-term antiresorptive therapy, such as bisphosphonate therapy

Investigations

• Screen for contralateral femoral fracture

Clinical Presentation

• Anterior thigh or groin pain
• Fall is often preceded by a snap or break
• Can be bilateral---screen!

Management

• Stop bisphosphonate or other antiresorptive treatment
• Consider starting teriparatide (Forteo)
• Assess for surgery