Atypical Femoral Fx

Question 1

Risk factors for atypical femoral fx?

Answer 1

Bisphosphonates >3 (esp >5 yrs), Asian, collagen disease, steroids (and diseases that get treated with them), diabetes, PPI’s

Question 2

w/u?

Answer 2

X-ray, MRI needed for confirmation (so if discovered on DXA, DXA+MRI). Assess other femur (25% incidence of contralat fx)

Question 3

Reasons why not to d/c bisphosphonates prematurely

Answer 3

Overall fx rate is higher off bisphosphonates
Mortality not increased after AFF
Return to function about same for AFF as for typical fx

Question 4

When to reassess bisphosphonate tx?

Answer 4

5 yrs. Consider 2-3 yr drug holiday for persons at lower risk for typical fx

Question 5

General management (besides d/c bisphosphonate) - no pain

Answer 5

Primarily medical. Consider anabolic steroids.

Question 6

Management complete fx?

Answer 6

Early fixation. Anabolic steroids after surgery.

Question 7

Management incomplete fx?

Answer 7

Controversial, primarily difficult to decide when to do early fixation vs. protected weight bearing and following.