ArticleThe oncologist2017
Retrospective Review of Atypical Femoral Fracture in Metastatic Bone Disease Patients Receiving Denosumab Therapy.
Article in The oncologist, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
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Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 52 citations in OpenAlex.
- Medical Management of Patients After Atypical Femur Fractures: a Systematic Review and Recommendations From the European Calcified Tissue Society.The Journal of clinical endocrinology and metabolism · 2020Guideline
- Atypical femoral fracture in patients with bone metastasis receiving denosumab therapy: a retrospective study and systematic review.BMC cancer · 2019Pooled it
- Trial
- Denosumab combined with curettage after surgical dislocation of the hip in the treatment of giant cell tumors of bone in the femoral head and neck region: a single-center retrospective study.BMC musculoskeletal disorders · 2026Article
- Bisphosphonate beak without the bisphosphonate: atypical femoral fracture with denosumab.BMJ case reports · 2025Article
- Atypical Femoral Fracture During Long-Term Treatment With Denosumab in Patients With Metastatic Bone Tumors.Cureus · 2025Article
- Article
- Atypical Femur Fracture in a Teenager on Chronic Imatinib Therapy.Case reports in oncological medicine · 2025Article
- Atypical femoral fracture in a multiple myeloma patient undergoing treatment with denosumab: A case report and literature review.International journal of surgery case reports · 2023Article
- Atypical tibial fracture in breast cancer patient with bone metastasis receiving denosumab therapy: a case report and review of the literature.Journal of medical case reports · 2023Review
- Multicenter study on atypical femoral fractures in patients with bone metastases taking bone- modifying agents.Journal of bone oncology · 2023Article
- Refractory hypercalcemia of malignancy: a problem with many potential roots.Frontiers in endocrinology · 2023Article
- Atypical femoral fracture in a bisphosphonate-naïve patient on denosumab for osteoporosis.Archives of osteoporosis · 2022Article
- Experience with denosumab (XGEVA®) for prevention of skeletal-related events in the 10 years after approval.Journal of bone oncology · 2022Review
- Atypical femoral fracture in a metastatic bone disease patient six months after discontinuation of denosumab received sequentially to previous bisphosphonate therapy - A case report.Journal of musculoskeletal & neuronal interactions · 2021Article
- Evaluation and management of atypical femoral fractures: an update of current knowledge.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2021Review
- Case Report: Prophylactic Plate Fixation for Incomplete Atypical Ulnar Fractures Resulting From the Use of Denosumab for Bone Metastases.Frontiers in endocrinology · 2021Article
- Magnetic resonance imaging findings in the hyperacute phase of atypical femoral fracture: a case description.Quantitative imaging in medicine and surgery · 2020Article
- Incidence of atypical femoral fractures in the treatment of bone metastasis: An alert report.Journal of bone oncology · 2020Article
- Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDenosumab therapy is used to reduce skeletal-related events in metastatic bone disease (MBD). There have been reports of atypical femoral fracture (AFF) in osteoporotic patients treated with denosumab but none in the context of higher dose and more frequent denosumab therapy for MBD. The goal of this study was to assess the incidence of AFF in MBD. PATIENTS AND
methodsWe conducted a retrospective review of 253 patients who received a minimum of 12 doses of denosumab at 120 mg each for MBD. To identify patients with asymptomatic atypical stress reactions in the lateral subtrochanteric femur (which precede fractures), we reviewed the skeletal images of 66 patients who had received at least 21 doses of denosumab for AFF features.
resultsThese patients received a median of 17 doses, with a median treatment duration of 23 months. There was 1 case of undiagnosed clinical AFF detected after chart review and 2 cases of subclinical atypical femoral stress reaction observed on imaging review after 23 doses of denosumab over 33 months, 28 doses over 27 months, and 21 doses over 21 months, respectively. Scout computed tomography films showed diffuse cortical thickening of diaphysis with localized periosteal reaction of lateral femoral cortex. Bone scan and magnetic resonance imaging scan of 2 patients with stress reactions confirmed the diagnosis.
conclusionThe incidence of clinical AFF in this context is 0.4% (1/253; 95% confidence interval [CI] 0.1%-2.2%), and the incidence of atypical femoral stress reaction based on imaging review is 4.5% (3/66; 95% CI 1.6%-12.5%). Clinicians should be aware of the clinical prodrome (which may or may not be present) and antecedent imaging changes associated with AFF.
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