title: Management of atypical femoral fracture: a scoping review and comprehensive algorithm.
abstract: Atypical femoral fractures (AFF) are a rare type of femoral stress fracture recently described, potentially associated with prolonged bisphosphonate therapy. Evidence-based recommendations regarding diagnosis and management of these fractures are scarce. The purpose of this study is to propose an algorithm for the diagnosis and management of AFF.
  
  
  
  We performed a PubMed search of the last ten years using the keywords "atypical femoral fractures" and identified further articles through an evaluation of the publications cited in these articles. Relevant studies were included by agreement between researchers, depending on their specialization. Pertinent points of debate were discussed based on the available literature, allowing for consensus regarding the proposed management algorithm.
  
  
  
  Using a systematic approach we performed a scoping review that included a total of 137 articles.
  
  
  
  A practical guide for diagnosis and management of AFF based on the current concepts is proposed. In spite of the impressive large volume of published literature available since AFF were initially identified, the level of evidence is mostly poor, in particular regarding treatment choice. Therefore, further studies are required.
authors.affiliation: Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Via De Crecchio, 4, 80138, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Toro
authors.affiliation: Trauma Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ojeda-Thies
authors.affiliation: Unit of Orthopaedics and Traumatology, Villa Malta Hospital, Sarno, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Calabrò
authors.affiliation: Unit of Radiology, Santa Maria della Speranza Hospital, Battipaglia, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Toro
authors.affiliation: Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Via De Crecchio, 4, 80138, Naples, Italy.
authors.forename: Antimo
authors.initials: A
authors.lastname: Moretti
authors.affiliation: Metabolic Bone Disease Unit, Department of Endocrinology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Guillermo Martínez-Díaz
authors.initials: GM
authors.lastname: Guerra
authors.affiliation: Trauma Unit, Department of Orthopaedic Surgery and Traumatology, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Caba-Doussoux
authors.affiliation: Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Via De Crecchio, 4, 80138, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Iolascon
mesh_terms: D000465:Algorithms; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D019317:Evidence-Based Medicine / Q000592:standards; D005264:Femoral Fractures / Q000175:diagnosis / Q000601:surgery*; D005269:Femur / Q000000981:diagnostic imaging; D015775:Fractures, Stress / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011859:Radiography
chemical_list: D004164:Diphosphonates