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Atypical Femoral Fractures, Bisphosphonates, and Mechanical Stress

  • Biomechanics (M Silva and P Zysset, Section Editors)
  • Published:
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Abstract

Atypical fractures are stress fractures occurring in the femoral shaft and closely related to bisphosphonate use. We here discuss their radiographic definition and different putative etiologies, apart from mechanical stress. Long time reduction of skeletal remodeling because of bisphosphonate use is thought to allow time for the bone to deteriorate mechanically, resulting in reduced toughness. However, the risk of atypical fracture diminishes rapidly after cessation of treatment, which suggests more acute effects of bisphosphonate use. Microdamage normally accumulates at areas of high stress. Possibly, ongoing bisphosphonate use reduces the ability to resorb and replace areas of microdamage by targeted remodeling. This could lead to crack propagation beyond a point of no return, ending in macroscopic stress fracture.

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Conflict of Interest

P Aspenberg has received research support from AddBioAB. J Schilcher declares no conflicts of interest.

Human and Animal Rights and Informed Consent

All studies by the authors involving animal and/or human subjects were performed after approval by the appropriate institutional review boards. When required, written informed consent was obtained from all participants.

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  1. Department of Clinical and Experimental Medicine, Orthopedics, Faculty of Health Science, Linköping University, 581 85, Linköping, Sweden

    Per Aspenberg & Jörg Schilcher

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  1. Per Aspenberg
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Correspondence to Per Aspenberg.

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Aspenberg, P., Schilcher, J. Atypical Femoral Fractures, Bisphosphonates, and Mechanical Stress. Curr Osteoporos Rep 12, 189–193 (2014). https://doi.org/10.1007/s11914-014-0200-9

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