title: Bisphosphonates and atypical femoral fractures.
abstract: OBJECTIVE
  Bisphosphonates are used widely for the treatment of osteoporosis and prevention of fractures. Although generally well tolerated and effective, bisphosphonates (and denosumab, a newer antiresorptive agent) have been associated with unusual fractures of the femoral shaft.
  
  
  RESULTS
  New information about the incidence, pathophysiology, and management of atypical femoral fractures (AFFs) are reviewed. Histomorphometric studies have shown variable amounts of bone turnover suppression, but new studies suggest that healing near bone cracks may not occur in patients with AFF. Some studies suggest that hip and femur geometry make certain people more at risk for AFF. In some but not all studies, the risk of AFF appears to be related to duration of treatment. Thus, the benefit/risk ratio needs to be reassessed as bisphosphonate therapy is prolonged.
  
  
  CONCLUSIONS
  If we can better understand the pathogenesis of AFF, it may be possible to identify those patients at highest risk. In the meantime, clinicians must periodically assess risk for osteoporotic fracture versus risk for AFF in managing patients with osteoporosis.
authors.affiliation: Endocrinology and Metabolism (111P), McGuire Veterans Affairs Medical Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Adler
mesh_terms: D016723:Bone Remodeling; D000069448:Denosumab / Q000009:adverse effects; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use; D005264:Femoral Fractures / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000517:prevention & control; D012307:Risk Factors
chemical_list: D004164:Diphosphonates; D000069448:Denosumab