Skip to main content

Advertisement

SpringerLink
Log in

Review: Epidemiology and Pathophysiology of Atypical Femur Fractures

  • Epidemiology and Pathophysiology (PR Ebeling and EF Eriksen, Section Editors)
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

The recent recognition of the clinical phenomenon of atypical femoral fractures has garnered significant scientific interest. In this review, we will discuss and summarize the salient developments in the current understanding of the epidemiology, pathophysiology, and radiology of atypical femoral fractures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Nieves JW, Cosman F. Atypical subtrochanteric and femoral shaft fractures and possible association with bisphosphonates. Curr Osteoporos Rep. 2010;8:34–9.

    Article  PubMed  Google Scholar 

  2. Shane E, Burr D, Ebeling PR, Abrahamsen B, Adler RA, Brown TD, et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010;25:2267–94. This is the seminal report from the task force commissioned by the American Society of Bone and Mineral Research, which proposed the original case definition and summarized the collective experience and published data on AFFs.

    Google Scholar 

  3. Kumm DA, Rack C, Rutt J. Subtrochanteric stress fracture of the femur following total knee arthroplasty. J Arthroplasty. 1997;12:580–3.

    Article  CAS  PubMed  Google Scholar 

  4. Husada G, Libberecht K, Peeters T, Populaire J. Bilateral mid-diaphyseal femoral stress fractures in the elderly. Eur J Trauma. 2005;31:68–71.

    Article  Google Scholar 

  5. Somford MP, Draijer FW, Thomassen BJ, Chavassieux PM, Boivin G, Papapoulos SE. Bilateral fractures of the femur diaphysis in a patient with rheumatoid arthritis on long-term treatment with alendronate: clues to the mechanism of increased bone fragility. J Bone Miner Res. 2009;24:1736–40.

    Article  PubMed  Google Scholar 

  6. Odvina CV, Levy S, Rao S, Zerwekh JE, Sudhaker Rao D. Unusual mid-shaft fractures during long term bisphosphonate therapy. Clin Endocrinol. 2010;72:161–8.

    Article  CAS  Google Scholar 

  7. Sayed-Noor AS, Sjoden GO. Case reports: two femoral insufficiency fractures after long-term alendronate therapy. Clin Orthop Relat Res. 2009;467:1921–6.

    Article  PubMed  Google Scholar 

  8. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005;90:1294–301.

    Article  CAS  PubMed  Google Scholar 

  9. Goh SK, Yang KY, Koh JS, Wong MK, Chua SY, Chua DT, et al. Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br. 2007;89:349–53.

    Article  PubMed  Google Scholar 

  10. Salminen S, Pihlajamaki H, Avikainen V, Kyro A, Bostman O. Specific features associated with femoral shaft fractures caused by low-energy trauma. J Trauma. 1997;43:117–22.

    Article  CAS  PubMed  Google Scholar 

  11. Neviaser AS, Lane JM, Lenart BA, Edobor-Osula F, Lorich DG. Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma. 2008;22:346–50.

    Article  PubMed  Google Scholar 

  12. Ing-Lorenzini K, Desmeules J, Plachta O, Suva D, Dayer P, Peter R. Low-energy femoral fractures associated with the long-term use of bisphosphonates: a case series from a Swiss university hospital. Drug Saf. 2009;32:775–85.

    Article  CAS  PubMed  Google Scholar 

  13. Visekruna M, Wilson D, McKiernan FE. Severely suppressed bone turnover and atypical skeletal fragility. J Clin Endocrinol Metab. 2008;93:2948–52.

    Article  CAS  PubMed  Google Scholar 

  14. Capeci CM, Tejwani NC. Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy. J Bone Joint Surg. 2009;91:2556–61.

    Article  PubMed  Google Scholar 

  15. Demiralp B, Ilgan S, Ozgur Karacalioglu A, Cicek EI, Yildrim D, Erler K. Bilateral femoral insuffiency fractures treated with inflatable intramedullary nails: a case report. Arch Orthop Trauma Surg. 2007;127:597–601.

    Article  PubMed  Google Scholar 

  16. Kwek EB, Goh SK, Koh JS, Png MA, Howe TS. An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury. 2008;39:224–31.

    Article  PubMed  Google Scholar 

  17. Schneider JP. Should bisphosphonates be continued indefinitely? An unusual fracture in a healthy woman on long-term alendronate. Geriatrics. 2006;61:31–3.

    PubMed  Google Scholar 

  18. Lee P, van der Wall H, Seibel MJ. Looking beyond low bone mineral density: multiple insufficiency fractures in a woman with postmenopausal osteoporosis on alendronate therapy. J Endocrinol Investig. 2007;30:590–7.

    CAS  Google Scholar 

  19. Cheung RK, Leung KK, Lee KC, Chow TC. Sequential nontraumatic femoral shaft fractures in a patient on long-term alendronate. Hong Kong Med J. 2007;13:485–9.

    PubMed  Google Scholar 

  20. Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. 2008;83:1032–45.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Abrahamsen B, Eiken P, Eastell R. Cumulative alendronate dose and the long-term absolute risk of subtrochanteric and diaphyseal femur fractures: a register-based national cohort analysis. J Clin Endocrinol Metab. 2010;95:5258–65.

    Article  CAS  PubMed  Google Scholar 

  22. Abrahamsen B, Eiken P, Eastell R. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study. J Bone Miner Res. 2009;24:1095–102.

    Article  CAS  PubMed  Google Scholar 

  23. Hsiao FY, Huang WF, Chen YM, Wen YW, Kao YH, Chen LK, et al. Hip and subtrochanteric or diaphyseal femoral fractures in alendronate users: a 10-year, nationwide retrospective cohort study in Taiwanese women. Clin Ther. 2011;33:1659–67.

    Article  CAS  PubMed  Google Scholar 

  24. Kim SY, Schneeweiss S, Katz JN, Levin R, Solomon DH. Oral bisphosphonates and risk of subtrochanteric or diaphyseal femur fractures in a population-based cohort. J Bone Miner Res. 2011;26:993–1001.

    Article  CAS  PubMed  Google Scholar 

  25. Nieves JW, Bilezikian JP, Lane JM, Einhorn TA, Wang Y, Steinbuch M, et al. Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int. 2010;21:399–408.

    Article  CAS  PubMed  Google Scholar 

  26. Wang Z, Bhattacharyya T. Trends in incidence of subtrochanteric fragility fractures and bisphosphonate use among the US elderly, 1996-2007. J Bone Miner Res. 2011;26:553–60.

    Article  CAS  PubMed  Google Scholar 

  27. Lenart BA, Neviaser AS, Lyman S, Chang CC, Edobor-Osula F, Steele B, et al. Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study. Osteoporos Int. 2009;20:1353–62.

    Article  CAS  PubMed  Google Scholar 

  28. Girgis CM, Sher D, Seibel MJ. Atypical femoral fractures and bisphosphonate use. N Engl J Med. 2010;362:1848–9.

    Article  CAS  PubMed  Google Scholar 

  29. Giusti A, Hamdy NA, Dekkers OM, Ramautar SR, Dijkstra S, Papapoulos SE. Atypical fractures and bisphosphonate therapy: a cohort study of patients with femoral fracture with radiographic adjudication of fracture site and features. Bone. 2011;48:966–71.

    Article  CAS  PubMed  Google Scholar 

  30. Schilcher J, Michaelsson K, Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med. 2011;364:1728–37.

    Article  CAS  PubMed  Google Scholar 

  31. Thompson RN, Phillips JR, McCauley SH, Elliott JR, Moran CG. Atypical femoral fractures and bisphosphonate treatment: experience in two large United Kingdom teaching hospitals. J Bone Joint Surg Br. 2012;94:385–90.

    Article  CAS  PubMed  Google Scholar 

  32. Feldstein AC, Black D, Perrin N, Rosales AG, Friess D, Boardman D, et al. Incidence and demography of femur fractures with and without atypical features. J Bone Miner Res. 2012;27:977–86.

    Article  PubMed  Google Scholar 

  33. Lo JC, Huang SY, Lee GA, Khandelwal S, Provus J, Ettinger B, et al. Clinical correlates of atypical femoral fracture. Bone. 2012;51:181–4.

    Article  PubMed  Google Scholar 

  34. Dell RM, Adams AL, Greene DF, Funahashi TT, Silverman SL, Eisemon EO, et al. Incidence of atypical nontraumatic diaphyseal fractures of the femur. J Bone Miner Res. 2012;27:2544–50.

    Article  PubMed  Google Scholar 

  35. Meier RP, Perneger TV, Stern R, Rizzoli R, Peter RE. Increasing occurrence of atypical femoral fractures associated with bisphosphonate use. Arch Int Med. 2012;172:930–6.

    Google Scholar 

  36. Warren C, Gilchrist N, Coates M, Frampton C, Helmore J, McKie J, et al. Atypical subtrochanteric fractures, bisphosphonates, blinded radiological review. ANZ J Surg. 2012;82:908–12.

    Article  PubMed  Google Scholar 

  37. Shkolnikova J, Flynn J, Choong P. Burden of bisphosphonate-associated femoral fractures. ANZ J Surg. 2013;83:175–81.

    Article  PubMed  Google Scholar 

  38. Allen MR, Gineyts E, Leeming DJ, Burr DB, Delmas PD. Bisphosphonates alter trabecular bone collagen cross-linking and isomerization in beagle dog vertebra. Osteoporos Int. 2008;19:329–37.

    Article  CAS  PubMed  Google Scholar 

  39. Tang SY, Zeenath U, Vashishth D. Effects of nonenzymatic glycation on cancellous bone fragility. Bone. 2007;40:1144–51.

    Article  CAS  PubMed  Google Scholar 

  40. Donnelly E, Meredith DS, Nguyen JT, Gladnick BP, Rebolledo BJ, Shaffer AD, et al. Reduced cortical bone compositional heterogeneity with bisphosphonate treatment in postmenopausal women with intertrochanteric and subtrochanteric fractures. J Bone Miner Res. 2012;27:672–8.

    Article  CAS  PubMed  Google Scholar 

  41. Li J, Mashiba T, Burr DB. Bisphosphonate treatment suppresses not only stochastic remodeling but also the targeted repair of microdamage. Calcif Tissue Int. 2001;69:281–6.

    Article  CAS  PubMed  Google Scholar 

  42. Stepan JJ, Burr DB, Pavo I, Sipos A, Michalska D, Li J, et al. Low bone mineral density is associated with bone microdamage accumulation in postmenopausal women with osteoporosis. Bone. 2007;41:378–85.

    Article  PubMed  Google Scholar 

  43. Chapurlat RD, Arlot M, Burt-Pichat B, Chavassieux P, Roux JP, Portero-Muzy N, et al. Microcrack frequency and bone remodeling in postmenopausal osteoporotic women on long-term bisphosphonates: a bone biopsy study. J Bone Miner Res. 2007;22:1502–9.

    Article  CAS  PubMed  Google Scholar 

  44. Li J, Miller MA, Hutchins GD, Burr DB. Imaging bone microdamage in vivo with positron emission tomography. Bone. 2005;37:819–24.

    Article  PubMed  Google Scholar 

  45. Wood J, Bonjean K, Ruetz S, Bellahcene A, Devy L, Foidart JM, et al. Novel antiangiogenic effects of the bisphosphonate compound zoledronic acid. J Pharmacol Exp Ther. 2002;302:1055–61.

    Article  CAS  PubMed  Google Scholar 

  46. Howe TS, Erlich G, Koh JS, Ng AC, Costerton W. A case of an atypical femoral fracture associated with bacterial biofilm—pathogen or bystander? Osteoporos Int. 2013;24:1765–6.

    Article  CAS  PubMed  Google Scholar 

  47. Lin JH. Bisphosphonates: a review of their pharmacokinetic properties. Bone. 1996;18:75–85.

    Article  CAS  PubMed  Google Scholar 

  48. Chavassieux PM, Arlot ME, Reda C, Wei L, Yates AJ, Meunier PJ. Histomorphometric assessment of the long-term effects of alendronate on bone quality and remodeling in patients with osteoporosis. J Clin Invest. 1997;100:1475–80.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Eriksen EF, Melsen F, Sod E, Barton I, Chines A. Effects of long-term risedronate on bone quality and bone turnover in women with postmenopausal osteoporosis. Bone. 2002;31:620–5.

    Article  CAS  PubMed  Google Scholar 

  50. Whyte MP, Bergfeld MA, Murphy WA, Avioli LV, Teitelbaum SL. Postmenopausal osteoporosis. A heterogeneous disorder as assessed by histomorphometric analysis of iliac crest bone from untreated patients. Am J Med. 1982;72:193–202.

    Article  CAS  PubMed  Google Scholar 

  51. Hauge E, Mosekilde L, Melsen F. Missing observations in bone histomorphometry on osteoporosis: implications and suggestions for an approach. Bone. 1999;25:389–95.

    Article  CAS  PubMed  Google Scholar 

  52. Tan SC, Koh SB, Goh SK, Howe TS. Atypical femoral stress fractures in bisphosphonate-free patients. Osteoporos Int. 2011;22:2211–2.

    Article  PubMed  Google Scholar 

  53. Whyte MP. Atypical femoral fractures, bisphosphonates, and adult hypophosphatasia. J Bone Miner Res. 2009;24:1132–4.

    Article  PubMed  Google Scholar 

  54. Schilcher J, Koeppen V, Ranstam J, Skripitz R, Michaelsson K, Aspenberg P. Atypical femoral fractures are a separate entity, characterized by highly specific radiographic features. A comparison of 59 cases and 218 controls. Bone. 2013;52:389–92.

    Article  PubMed  Google Scholar 

  55. Mohan PC, Howe TS, Koh JS, Png MA. Radiographic features of multifocal endosteal thickening of the femur in patients on long-term bisphosphonate therapy. Eur Radiol. 2013;23:222–7.

    Article  PubMed  Google Scholar 

  56. Koeppen VA, Schilcher J, Aspenberg P. Atypical fractures do not have a thicker cortex. Osteoporos Int. 2012;23:2893–6.

    Article  CAS  PubMed  Google Scholar 

  57. Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, et al. Atypical subtrochanteric and diaphyseal femoral fractures: Second report of a task force of the American society for bone and mineral research. J Bone Miner Res. 2014. This is the second report from the ASBMR Task Force, which proposes revisions to the case definition of AFFs, as well as provides comprehensive updates in the area of epidemiology and risk factors, pathogenesis, and medical management.

  58. Ng AC, Png MA, Mohan PC, Koh JS, Howe TS. Atypical femoral fractures—transverse morphology at lateral cortex is a critical feature. J Bone Miner Res. 2013.

  59. Ha YC, Cho MR, Park KH, Kim SY, Koo KH. Is surgery necessary for femoral insufficiency fractures after long-term bisphosphonate therapy? Clin Orthop Relat Res. 2010;468:3393–8.

    Article  PubMed  Google Scholar 

  60. Allison MB, Markman L, Rosenberg Z, Vieira RL, Babb J, Tejwani N, et al. Atypical incomplete femoral fractures in asymptomatic patients on long term bisphosphonate therapy. Bone. 2013;55:113–8.

    Article  CAS  PubMed  Google Scholar 

  61. Koh JS, Goh SK, Png MA, Ng AC, Howe TS. Distribution of atypical fractures and cortical stress lesions in the femur: implications on pathophysiology. Singap Med J. 2011;52:77–80.

    CAS  Google Scholar 

  62. Png MA, Koh JS, Goh SK, Fook-Chong S, Howe TS. Bisphosphonate-related femoral periosteal stress reactions: scoring system based on radiographic and MRI findings. Am J Roentgenol. 2012;198:869–77.

    Article  Google Scholar 

  63. Saleh A, Hegde VV, Potty AG, Schneider R, Cornell CN, Lane JM. Management strategy for symptomatic bisphosphonate-associated incomplete atypical femoral fractures. HSS J. 2012;8:103–10.

    Article  PubMed Central  PubMed  Google Scholar 

  64. Koh JS, Goh SK, Png MA, Kwek EB, Howe TS. Femoral cortical stress lesions in long-term bisphosphonate therapy: a herald of impending fracture? J Orthop Trauma. 2010;24:75–81.

    Article  PubMed  Google Scholar 

  65. Chan SS, Rosenberg ZS, Chan K, Capeci C. Subtrochanteric femoral fractures in patients receiving long-term alendronate therapy: imaging features. Am J Roentgenol. 2010;194:1581–6.

    Article  Google Scholar 

  66. de Limaa JG, da Costa Fernandesa F, de Souzaa AB, dos Santos Juniora AC, Reboucasa BM, de Limaa NN, et al. Atypical fracture with use of ibandronate and the role of bone scintigraphy on its early diagnosis. J Endocrinol Metabol. 2013;3:67–9.

    Google Scholar 

  67. Crossley K, Bennell KL, Wrigley T, Oakes BW. Ground reaction forces, bone characteristics, and tibial stress fracture in male runners. Med Sci Sports Exerc. 1999;31:1088–93.

    Article  CAS  PubMed  Google Scholar 

  68. Oh Y, Wakabayashi Y, Kurosa Y, Ishizuki M, Okawa A. A stress fractures of bowing femoral shaft in the elderly—another cause of atypical femoral fractures. Bone Joint J Orthopaed Proc. 2013;(Suppl 95-B):9.

  69. Ikeda S, Sakai A, Tanaka H, Takeuchi Y, Ohnishi H, Murakami H, et al. Atypical femoral fractures were associated with deterioration of bone quality and curvature of femoral shaft. Bone Joint J Orthopaed Proc. 2013;(Suppl 95-B):67.

  70. Ettinger B, Burr DB, Ritchie RO. Proposed pathogenesis for atypical femoral fractures: lessons from materials research. Bone. 2013;55:495–500.

    Article  CAS  PubMed  Google Scholar 

  71. Karakas HM, Harma A. Femoral shaft bowing with age: a digital radiological study of Anatolian Caucasian adults. Diagn Interv Radiol. 2008;14:29–32.

    PubMed  Google Scholar 

  72. Saita Y, Ishijima M, Mogami A, Kubota M, Kaketa T, Miyagawa K, et al. Association between the fracture site and the mechanical axis of lower extremities in patients with atypical femoral fracture. J Bone Miner Res. 2012;27 (Suppl 1). Available at http://www.asbmr.org/Meetings/AnnualMeeting/AbstractDetail.aspx?aid=3a44dce8-4774-4995-9be3-151791ddca7a. Accessed February 11, 2014.

  73. Morin SN GB, Wall M, Belzile EL, Michou L, Ste-Marie LG, Karaplis AC, et al. Femur geometrical parameters in the pathogenesis of atypical femur fractures. 2013. Available at http://wwwbone-abstractsorg/ba/0001/ba0001OC16htm Accessed October 5, 2013.

  74. Nakamura T, Turner CH, Yoshikawa T, Slemenda CW, Peacock M, Burr DB, et al. Do variations in hip geometry explain differences in hip fracture risk between Japanese and White Americans? J Bone Miner Res. 1994;9:1071–6.

    Article  CAS  PubMed  Google Scholar 

  75. Brownbill RA, Ilich JZ. Hip geometry and its role in fracture: what do we know so far? Curr Osteoporos Rep. 2003;1:25–31.

    Article  PubMed  Google Scholar 

  76. Novotny R, Daida YG, Grove JS, Le Marchand L, Vijayadeva V. Asian adolescents have a higher trunk: peripheral fat ratio than Whites. J Nutr. 2006;136:642–7.

    CAS  PubMed Central  PubMed  Google Scholar 

  77. Black DM, Kelly MP, Genant HK, Palermo L, Eastell R, Bucci-Rechtweg C, et al. Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med. 2010;362:1761–71.

    Article  CAS  PubMed  Google Scholar 

  78. Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA, et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA. 2006;296:2927–38.

    Article  CAS  PubMed  Google Scholar 

  79. Black DM, Thompson DE, Bauer DC, Ensrud K, Musliner T, Hochberg MC, et al. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial; FIT Research Group. J Clin Endocrinol Metab. 2000;85:4118–24.

    Article  CAS  PubMed  Google Scholar 

  80. Mashiba T, Turner CH, Hirano T, Forwood MR, Jacob DS, Johnston CC, et al. Effects of high-dose etidronate treatment on microdamage accumulation and biomechanical properties in beagle bone before occurrence of spontaneous fractures. Bone. 2001;29:271–8.

    Article  CAS  PubMed  Google Scholar 

  81. Khosla S, Burr D, Cauley J, Dempster DW, Ebeling PR, Felsenberg D, et al. Bisphosphonate-associated osteonecrosis of the jaw: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2007;22:1479–91.

    Article  PubMed  Google Scholar 

  82. Schneider JP, Hinshaw WB, Su C, Solow P. Atypical femur fractures: 81 individual personal histories. J Clin Endocrinol Metab. 2012;97:4324–8.

    Article  CAS  PubMed  Google Scholar 

  83. Imai K, Yamamoto S, Anamizu Y, Horiuchi T. Pelvic insufficiency fracture associated with severe suppression of bone turnover by alendronate therapy. J Bone Miner Metabol. 2007;25:333–6.

    Article  Google Scholar 

  84. Ang BF, Koh JS, Ng AC, Howe TS. Bilateral ulna fractures associated with bisphosphonate therapy. Osteoporos Int. 2013;24:1523–5.

    Article  CAS  PubMed  Google Scholar 

  85. Bjorgul K, Reigstad A. Atypical fracture of the ulna associated with alendronate use. Acta Orthop. 2011;82:761–3.

    Article  PubMed  Google Scholar 

  86. Bissonnette L, April PM, Dumais R, Boire G, Roux S. Atypical fracture of the tibial diaphysis associated with bisphosphonate therapy: a case report. Bone. 2013;56:406–9.

    Article  PubMed  Google Scholar 

  87. Imbuldeniya AM, Jiwa N, Murphy JP. Bilateral atypical insufficiency fractures of the proximal tibia and a unilateral distal femoral fracture associated with long-term intravenous bisphosphonate therapy: a case report. J Med Case Rep. 2012;6:50.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

A.C. Ng has received speaker honorariums from GSK and Servier. M. A. Png declares that he has no conflicts of interest. D. T. Chua declares that he has no conflicts of interest. J. S. Koh declares that she has no conflicts of interest. T. S. Howe declares that he has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Endocrinology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

    Alvin C. Ng

  2. Department of Radiology, Singapore General Hospital, Singapore, Singapore

    Meng Ai Png

  3. Department of Orthopedic Surgery, Changi General Hospital, Singapore, Singapore

    David T. Chua

  4. Department of Orthopedic Surgery, Singapore General Hospital, Singapore, Singapore

    Joyce S. B. Koh & Tet Sen Howe

Authors
  1. Alvin C. Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meng Ai Png
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David T. Chua
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joyce S. B. Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tet Sen Howe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alvin C. Ng.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ng, A.C., Png, M.A., Chua, D.T. et al. Review: Epidemiology and Pathophysiology of Atypical Femur Fractures. Curr Osteoporos Rep 12, 65–73 (2014). https://doi.org/10.1007/s11914-014-0198-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11914-014-0198-z

Keywords

Search

Navigation