Atypical femoral fractures identified on DXA scanner – should we do more?

The use of bisphosphonates in the treatment of osteoporosis and management of fractures due to low bone mineral density is well established in the world of bone densitometry. Recent studies by a task force on behalf of American Society of Bone Mineral Research (ASBMR) have linked long-term bisphosphonate therapy with an increased risk of atypical femur fractures (AFF). This should not mean that we no longer use this form of treatment to deal with osteoporosis, it has been estimated that for each AFF caused, at least 30 vertebral and five hip fractures will be prevented.

There is a growing need to identify the patients likely to suffer AFF so that intervention can prevent them and lessen the burden of long-term bisphosphonate use without negating the positive aspects.

This AFF burden has been described as significant: Relatively well, active patients report poorer health and function after the fracture; are in hospital for longer; and can experience such complications as fat embolism. Two-thirds of subjects in another study had bilateral AFF, 17% needed revision of surgery due to hardware complications and many patients still used a walking aid one year post repair.

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