Symptomatic atypical femoral fractures are related to underlying hip geometry

Genetic and acquired factors influencing the effectiveness and toxicity of drug therapy in osteoporosis

“…In addition, femoral hip geometry is associated with the propensity to AFF. In fact, increased varization of the femur is much more prevalent in women with AFF than in controls [104][105][106] .…”

Bone cross-sectional geometry is not associated with atypical femoral fractures in Asian female chronic bisphosphonate users

“…As AFFs have been associated with monogenetic diseases such as hypophosphatasia, X-linked hypophosphatemia, and pycnodysostosis, genetic differences could be a factor predisposing to formation of AFFs [15,16]. Because the mechanical strength of bone is dependent on both bone quality and bone geometry, hip geometry is thought to contribute to the risk of sustaining an AFF [7,9,[17][18][19]. Hip structural geometry in particular has been previously shown to predict for risk of fracture [20][21][22].…”

“…Alongside selective estrogen receptor modulators, recombinant parathyroid hormone, and strontium ranelate, bisphosphonates are commonly utilized for the prophylaxis of osteoporotic fractures and act by initiating osteoclast apoptosis, thereby decreasing bone resorption and increasing bone mineralization [4][5][6]. As they have been shown to reduce the incidence of hip fractures and improve bone mineral density, bisphosphonates remain the gold standard for the prevention of osteoporotic fractures and the reduction of bone loss in osteoporotic and postmenopausal patients [1,[6][7][8].…”

“…Given the prevalence of osteoporosis and the fact that bisphosphonates are ubiquitously prescribed, any osteoporotic patient with chronic bisphosphonate exposure is at risk of sustaining AFFs, which are associated with significant functional disability and slow recoveries [1,7,[9][10][11][12][13]. Although newer evidence suggests that AFFs are a form of stress fracture, their exact pathophysiology and relationship to bisphosphonate use are not well understood [1,5,9,10,14].…”

Teriparatide Prevented Near Atypical Femur Fracture by Reducing Cortical Thickening in a Symptomatic Patient With Prolonged Use of Oral Bisphosphonate: A Case Report

“…However, there is still debate about the management of how to screen lateral cortical thickening in patients on longterm BP. It has been reported that an acute/varus angle of the femoral neck and a narrow center-edge angle were also associated with the development of AFFs in long-term BP users [15]. We suggest to screen biannually for cortical thickening of femur and other potential risk factors with X-ray in a patient with prolonged use of oral BP along with the review of BMD, and consider the use of TPP therapy to prevent AFF by reversing cortical thickening.…”