What do we know about atypical femoral fractures? Insights and enigmas - 26/11/11

Doi : 10.1016/j.jbspin.2011.03.015

Maurice Audran ^a,^⁎ , Bernard Cortet ^b, Thierry Thomas ^c
On behalf of the Bone division of the French Society for Rheumatology
^a UNAM, Inserm, U922, service de rhumatologie, CHU d’Angers, 49933 Angers cedex 9, France
^b Service de rhumatologie, CHU de Lille, 59000 Lille, France
^c Inserm U1059, service de rhumatologie, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France

Corresponding author.

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Abstract

Although the existence of atypical femoral fractures is well established and bisphosphonate therapy is thought to be a major risk factor, the underlying mechanisms are poorly understood. Epidemiological data show that atypical femoral fractures account for only a small proportion of diaphyseal subtrochanteric femoral fractures, being about 100 times less common than proximal femoral fractures. Consequently, the existence of atypical femoral fractures does not call into question the extremely favorable risk/benefit ratio of bisphosphonate therapy in patients with osteoporosis. Clearly, the number of fractures prevented by bisphosphonate therapy far exceeds the number of atypical femoral fractures potentially related to bisphosphonates.

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Keywords : Bisphosphonates, Atypical fractures, Osteoporosis