Incomplete Atypical Femoral Fractures: Assessing the Diagnostic Utility of DXA by Extending Femur Length |
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| Authors: | Malachi J McKenna Susan van der Kamp Eric Heffernan Conor Hurson |
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| Institution: | 1. DXA Unit, St. Vincent''s University Hospital, Dublin, Ireland;2. School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland;3. Department of Diagnostic Imaging, St. Vincent''s University Hospital, Dublin, Ireland;4. Department of Orthopaedic Surgery, St. Vincent''s University Hospital, Dublin, Ireland;1. School of Medicine, J.J.Strossmayer University, Osijek, Croatia;2. University Hospital “Sisters of Mercy”, Clinic for Traumatology, Zagreb, Croatia;3. Department of Mathematics, J.J.Strossmayer University, Osijek, Croatia;1. Nuclear Engineering Program, Federal University of Rio de Janeiro, Brazil;2. Physics Institute, State University of Rio de Janeiro, Brazil;3. Radiological Science Laboratory, State University of Rio de Janeiro, Brazil;1. NorthWest Academic Centre, The University of Melbourne, Western Health, St Albans, Victoria, Australia;2. School of Medicine, Deakin University, Geelong, Australia;3. Barwon Health, Geelong, Victoria, Australia;4. Rural Clinical School, School of Medicine, The University of Queensland, Toowoomba, Queensland, Australia;1. Department of Anatomy, Histology and Embryology, Medical University of Plovdiv, Bulgaria;2. Department of Pathology, Medical University of Plovdiv, Bulgaria;3. Medical University of Plovdiv, Bulgaria;1. Division of Clinical Immunology and Rheumatology, Department of Medicine, UAB Osteoporosis Prevention and Treatment Clinic, University of Alabama at Birmingham, Birmingham, AL, USA;2. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA;3. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and Endocrinology and Metabolism Institute, Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA |
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| Abstract: | 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%). |
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| Keywords: | Atypical femoral fracture bisphosphonate DXA |
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