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Management of Atypical Femoral Fractures

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The Duration and Safety of Osteoporosis Treatment

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Abstract

Atypical femoral fractures are characterized by a lateral stress-mitrated reaction, a transverse fracture line, and medial beaking. These fractures occur as a small percentage of hip and femur fracture. Prior prolonged bisphosphonate treatment is most common, usually greater than 5 years. There is a high likelihood of bilateral fractures in approaching 50 %. MRI edema and bone scan activity are usually present. The key elements of treatment initiate with diagnostic imaging to determine location and activity. All patients should cease bisphosphonates and switch to anabolic agents such as PTH 1-34 as well as correct calcium and Vitamin D. Complete fractures are best treated by intramedullary nailing or compression plating requiring ORIF if a fracture line is present. Simple stress reaction without a cortical defect may respond to medical management.

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Notes

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    *Important References

    **Very Important References

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Author information

Authors and Affiliations

  1. Metabolic Bone Disease Service, Orthopaedics, Hospital for Special Surgery, 535 E. 70th St., New York, NY, 10021, USA

    Joseph M. Lane MD & Libi Z. Galmer DO

  2. Orthopaedic Surgery, Hospital for Special Surgery, New York Presbyterian Hospital, New York, NY, USA

    David S. Wellman MD

  3. Orthopaedic Surgery, Weill Cornell Medical College, New York, NY, USA

    David S. Wellman MD & Jonathan E. Jo BS

  4. Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA

    Abigail L. Campbell MD, MSc, BSE

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  1. Joseph M. Lane MD
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  2. Libi Z. Galmer DO
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  4. Abigail L. Campbell MD, MSc, BSE
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  5. Jonathan E. Jo BS
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Correspondence to Joseph M. Lane MD .

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Editors and Affiliations

  1. Division of Rheumatology, Department of Medicine, Cedars-Sinai Medical Center; University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA

    Stuart Silverman

  2. Institute of Clinical Research; Department of Medicine, Holbæk, Denmark, University of Southern Denmark, Odense Patient Data Explorative Network; Holbæk Hospital, Odense, Denmark

    Bo Abrahamsen

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Lane, J.M., Galmer, L.Z., Wellman, D.S., Campbell, A.L., Jo, J.E. (2016). Management of Atypical Femoral Fractures. In: Silverman, S., Abrahamsen, B. (eds) The Duration and Safety of Osteoporosis Treatment. Springer, Cham. https://doi.org/10.1007/978-3-319-23639-1_11

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  • DOI: https://doi.org/10.1007/978-3-319-23639-1_11

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23638-4

  • Online ISBN: 978-3-319-23639-1

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