Atypical femoral fracture

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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 Manifestations

  • 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