Incomplete atypical femoral fractures: assessing the diagnostic utility of DXA by extending femur length.
Atypical femoral fractures (AFFs) are associated with prolonged bisphosphonate therapy. A feature of incomplete AFF is a localized periosteal reaction. It has been suggested that extending the length of the femur image at the time of dual-energy X-ray absorptiometry (DXA) may diagnose an incomplete AFF. In patients older than 50 yr on bisphosphonate therapy for more than 5 yr, we extended femur length at the time of routine DXA. Abnormal DXA images were suggested in 19 of 257 patients (7.4%). On X-ray, 7 patients (2.7%) showed no abnormality, 7 patients (2.7%) showed evidence of AFF, and 5 patients (2.0%) showed an unrelated radiographic abnormality. Of the 7 cases with X-ray evidence of AFF, 5 had a periosteal flare and 2 had a visible fracture line, both of whom needed insertion of an intramedullary nail. We demonstrated that it is feasible to detect incomplete AFF early using extended femur length imaging with a prevalence in our sample of 2.7% (95% confidence interval: 1.7%-3.7%).
['McKenna|Malachi J|MJ|', 'van der Kamp|Susan|S|', 'Heffernan|Eric|E|', 'Hurson|Conor|C|']
D015502:Absorptiometry, Photon D000368:Aged D015519:Bone Density D005260:Female D005264:Femoral Fractures D005269:Femur D006801:Humans D008297:Male D008875:Middle Aged D015203:Reproducibility of Results D012189:Retrospective Studies
Atypical femoral fracture DXA bisphosphonate