title: Periprosthetic Atypical Femoral Fractures in Patients on Long-term Bisphosphonates: A Multicenter Retrospective Review.
abstract: OBJECTIVE
  To define the characteristics of periprosthetic atypical femoral fractures (PAFFs) in patients on long-term bisphosphonate treatment and to provide a guide to the diagnosis and long-term treatment of these patients based on the literature.
  
  
  METHODS
  Multicenter retrospective review.
  
  
  METHODS
  Fifteen orthopaedic centers in the United States and Canada, including members of the Canadian Orthopaedic Trauma Society.
  
  
  METHODS
  Patients on long-term bisphosphonates who presented with either periprosthetic fractures or femoral fractures, over a 10-year period.
  
  
  METHODS
  Time to union and complications.
  
  
  RESULTS
  Clinically significant differences were identified in time to union, mortality, and complications. There was a statistically significant difference in complications. Imaging review demonstrated identical features in both atypical femoral fractures (AFFs) and PAFFs.
  
  
  CONCLUSIONS
  This is the largest comparative case series reported on PAFFS and AFFs and provides compelling evidence that PAFFs in patients on long-term bisphosphonates are indeed a subset of periprosthetic fractures that exhibit atypical femoral fracture (AFF) characteristics. As such, these fractures pose serious diagnostic and management challenges to trauma and arthroplasty surgeons.
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Canada; and†Boston University Medical Centre, Boston, MA.
authors.forename: Juan de Dios
authors.initials: Jde D
authors.lastname: Robinson
authors.forename: Ross K
authors.initials: RK
authors.lastname: Leighton
authors.forename: Kelly
authors.initials: K
authors.lastname: Trask
authors.forename: Yelena
authors.initials: Y
authors.lastname: Bogdan
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects; D002170:Canada / Q000453:epidemiology; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005264:Femoral Fractures / Q000139:chemically induced / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D057068:Periprosthetic Fractures / Q000139:chemically induced / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates