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Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

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I was standing in line at the grocery store minding my own business when my leg gave out from under me. The next thing I knew I was waking up in the hospital with a broken leg. The nurse told me I have something called an atypical femoral fracture. I get the general idea this is unusual but can you tell me more about it?

Atypical femoral fractures affect the long, shaft portion of the thigh bone (femur). The do not present or look like the more common osteoporotic bone fractures that older adults experience. But just exactly how to describe or define atypical femoral fractures has not been determined yet. At the present time, the major features of atypical femoral fractures include: 1) the location (the long shaft of the bone), 2) type of fracture (across the bone on a diagonal), and 3) the way the fracture occurred (no trauma or very low trauma, like falling down from a standing position). A visible spike at one end of the fracture seen on X-rays is a tell-tale sign of these types of fractures. The use of bisphosphonate medications for osteoporosis (brittle bones) has turned up as a possible risk factor for the atypical femoral fractures. These bone building drugs for osteoporosis stop the normal cycle of bone turnover. Over time, they can actually increase the risk of fracture. But studies with different results have been reported, so the debate and controversy over these drugs continues. Whether or not long-term use (defined as five years or more) is a cause of atypical femoral fractures is unknown. Collection of data on femoral fractures show that the fractures currently described as "atypical" are unusual, if not rare. Recently, surgeons from the Hospital for Special Surgery in New York City published their recommendations for the management of atypical femoral fractures. They said the first thing to do is stop the use of the bisphosphonates. This drug builds up in the bone and continues to be released for years after the patient has stopping taking them. And studies so far show no increase in fractures after discontinuing the medication compared to people of the same age group who never took the bisphosphonates. Next, calcium and vitamin D supplements to aid the bone building process are advised. Lab tests should be done to look for any reason the bone might not heal. This could be a thyroid problem, metabolic bone disease, or hormone deficiency (e.g., low testosterone). Other recommendations include surgical treatment for the fracture with a long nail down the center of the bone to stabilize the fracture. Other types of fixation may not be enough to hold the shape of the atypical fracture together until union takes place. Patients should be monitored closely for the same kind of fracture developing in the other leg. Up to 44 per cent of patients with the first atypical femoral fracture end up having the same thing happen to the other leg. They concluded their study by saying that more study is needed to clearly identify risk factors and primary and secondary features of these rare atypical femoral fractures. This type of information would help physicians find more effective ways to prevent and treat them when they do occur.


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