Atypical femoral fractures:  epidemiology, etiology, and patient management.
OBJECTIVE
To review the definition, epidemiology, and putative pathophysiology of atypical femoral fractures and propose strategies for the management of patients with atypical fractures as well as patients on long-term bisphosphonates without atypical fractures.


RESULTS
Recent epidemiologic evidence shows that the absolute incidence of atypical femoral fractures is small compared with the incidence of typical hip fractures. However, long-term bisphosphonate use may be an important risk factor for atypical fractures, and minimal additional antifracture benefit has been demonstrated for treatment durations longer than 5 years for patients with postmenopausal osteoporosis. This review gives advice to aid clinicians in the management of patients with incipient or complete atypical fractures.


CONCLUSIONS
Extremely limited evidence is available for how best to manage patients with atypical fractures. A comprehensive metabolic approach for the management of patients on long-term bisphosphonates will help to prevent oversuppression of bone remodeling that is implicated in the pathogenesis of these fractures.
Materials Science and Engineering, Cornell University, Ithaca, New York, USA.
Eve
E
Donnelly
Anas
A
Saleh
Aasis
A
Unnanuntana
Joseph M
JM
Lane
D001851:Bone Diseases, Metabolic / Q000209:etiology; D001859:Bone Neoplasms / Q000150:complications / Q000473:pathology; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D005264:Femoral Fractures / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D004164:Diphosphonates