ReviewOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2018
A proposal for an atypical femur fracture treatment and prevention clinical practice guideline.
Review in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 34 citations in OpenAlex.
- [Osteoporosis-Definition, risk assessment, diagnosis, prevention and treatment (update 2024) : Guidelines of the Austrian Society for Bone and Mineral Research].Wiener klinische Wochenschrift · 2024Guideline
- Asian Federation of Osteoporosis Societies 2025 consensus on atypical femoral fractures in patients with osteoporosis.Osteoporosis and sarcopenia · 2025Review
- Epidemiology, Pathophysiology and Management of Atypical Femur Fractures: an Update.Current osteoporosis reports · 2025Review
- Article
- Atypical femur fracture in a male without history of bisphosphonate use: a case report.Journal of medical case reports · 2024Article
- Importance of Whole-Body Scintigraphy or Positron Emission Tomography for Early Detection of Femoral Lesions in Breast Cancer Patients Treated with Bisphosphonates.Clinics in orthopedic surgery · 2023Article
- The role of the fracture liaison service in the prevention of atypical femoral fractures.Therapeutic advances in musculoskeletal disease · 2023Review
- Radiological Reversibility of Incomplete Atypical Femoral Fracture with Cessation of Bisphosphonate: Including an Early Stage of Incomplete Fracture.Indian journal of orthopaedics · 2022Article
- Preventive bilateral femoral nailing in atypical femoral fracture non responder to anabolic therapy: case report and mini-review.Acta bio-medica : Atenei Parmensis · 2022Article
- Fracture Risk Following an Atypical Femoral Fracture.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022Article
- Bilateral atypical fractures of the femur: Ten years AFTER ten years of bisphosphonate therapy.Bone reports · 2021Article
- Article
- Long-term bisphosphonate treatment coupled with ovariectomy in mice provokes deleterious effects on femoral neck fracture pattern and modifies tibial shape.Bone & joint open · 2020Article
- Atypical femur fractures: current understanding and approach to management.Therapeutic advances in musculoskeletal disease · 2020Review
- Reliability and diagnostic utility of radiographs in patients with incomplete atypical femoral fractures.Skeletal radiology · 2019Article
- Effects of teriparatide on histomorphological features in a patient with an atypical femoral fracture and chronic kidney disease.Porto biomedical journalArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The prevention as well as the treatment of atypical femur fractures (AFFs) remains controversial but there have been many clinical recommendations suggested. We have summarized these recommendations as well as expanded upon them in this paper.
introductionThe purpose of the paper was to develop a clinical practice guideline that both treats AFF and decreases the risk of AFF in patients requiring antiresorptive medications. Examples of these medications include bisphosphonates and denosumab for the treatment of osteoporosis.
methodsA literature review looking for recommendations on AFF identification, management, and prevention was done. We also performed an updated review of clinical guidelines on AFF prevention and treatment that were developed for the Kaiser Permanente osteoporosis/fracture prevention team.
resultsConcise clinical practice guidelines are presented that can be applied in treatment of AFF as well as help reduce the risk of developing an AFF in patients requiring antiresorptive medications. These guidelines are based on using both typical fracture and AFF risk assessment to determine duration of antiresorptive of 3 to 5 years before consideration if a drug holiday is needed. Specific groups such as younger Asian women should be reassessed at 3 years with DXA and FRAX to see if a drug holiday is needed whereas patients at higher risk for typical fractures may be reassessed at 5 years of treatment. The DXA rescreening can now be accessed if focal or generalized lateral cortex changes are present that may indicate incomplete AFFs are present. If an incomplete AFF is discovered either by DXA or by other imaging studies, it is imperative to stop antiresorptive medications and to take additional measures to lower the risk of progression to a complete AFF. If complete AFF does occur, then antiresorptive medications should be stopped and additional measures should be taken to decrease the risk of developing an AFF on the contralateral femur.
conclusionsClinical practice guidelines for the treatment and prevention of AFF will benefit clinicians who are frequently faced with having to make clinical decisions in patients requiring antiresorptive medications.
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