Atypical femoral fractures and bisphosphonate therapy

Dr Carla Moran, Dr Eric Heffernan and Dr Malachi McKenna examine the features and treatment of atypical femoral fractures and the links with bisphosphonate therapies. Recently, clinicians have raised concerns regarding the association between bisphosphonate use and so-called ‘atypical femoral fracture’ (AFF). Here we review the definition, clinical and radiographic features, and treatment of AFF, along with an exploration of the possible link with bisphosphonate therapy. With regard to definition and epidemiology, AFFs can occur anywhere along the femoral diaphysis from just distal to the lesser trochanter to proximal to the supracondylar flare of the distal femoral metaphysis. They occur…