Detection of Atypical Femur Fractures |
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| Institution: | 1. Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, Ontario, Canada;2. Osteoporosis Program, University Health Network and Sinai Health System, Toronto, Ontario, Canada;3. DXA Unit, St. Vincent''s University Hospital, Dublin, Ireland;4. School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland;5. Bone Centre, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands;6. Osteoporosis and Metabolic Bone Disease Program, Department of Medicine, NYU Langone Health, New York, NY, USA;7. New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA;1. Division of Endocrinology and Diabetes, Golisano Children''s Hospital, University of Rochester Medical Center, Rochester, NY, USA;2. Skeletal Disorders and Mineral Homeostasis Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA;3. Divisions of Adolescent/Young Adult Medicine and Endocrinology, Boston Children''s Hospital, Harvard Medical School, Boston, MA, USA;4. Institute of Metabolism and Systems Research, Birmingham Women''s and Children''s NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, UK;5. Departments of Biomedical Research & Medical Imaging, Nemours/Alfred I. duPont Hospital for Children Wilmington, DE, USA;6. Division of Pediatric Endocrinology, MassGeneral Hospital for Children, Harvard Medical School, Boston, MA, USA;7. Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Region Västra Götaland, Sahlgrenska University Hospital, The Queen Silvia Children''s Hospital, Department of Pediatrics, Gothenburg, Sweden;8. Division of Pediatric Endocrinology, Department of Pediatrics and Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA;9. Division of Endocrinology and Metabolism; Children''s Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada;10. Division of Endocrinology, Department of Pediatrics, Cincinnati Children''s Hospital Medical Center, Cincinnati, OH, USA;11. Swedish Medical Group, Seattle, WA, USA;12. Division of GI, Hepatology and Nutrition, The Children''s Hospital of Philadelphia, Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA;1. Centro de Pesquisa Católica do Brasil, Brasilia, Brazil;2. Tufts Medical Center, Boston, MA, USA;3. Washington University School of Medicine, St. Louis, MO, USA;4. Subang Jaya Medical Centre, Selangor, Malaysia;5. New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA;1. Division of Endocrinology and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA;2. Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women''s Hospital, Boston, MA, USA;3. Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;4. Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, Center for Transgender Medicine and Surgery, New York, NY, USA;5. Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA;6. Atlanta VA Medical Center, Decatur, GA, USA;7. Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;8. Excellence Center for Diabetes, Hormone, and Metabolism, King Chulalongkorn Memorial Hospital, Bangkok, Thailand;9. Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia |
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| Abstract: | The 2019 International Society for Clinical Densitometry (ISCD) Position Development Conference Task Force for monitoring with dual-energy X-ray absorptiometry (DXA) identified detection of atypical femur fractures (AFFs) as an important topic and established this working group to answer key questions in this area. The authors conducted a systematic review of the literature and deliberated on proposed ISCD positions, which were then reviewed by an external expert panel and vetted at the 2019 ISCD Position Development Conference in Kuala Lumpur on March 23, 2019. This paper summarizes the final ISCD positions and the rationale for supporting these positions. Default-length femur imaging or extended-length femur imaging as well as full-length femur imaging (FFI), both single-energy and dual-energy scans, by DXA can detect abnormalities in the spectrum of AFF. It is important to visually inspect all DXA scans of the hip and femur, and report on findings of focal periosteal and endosteal thickening at the lateral cortex (grade: Good, A, W). FFI is the preferred DXA scan mode for detecting abnormalities in the spectrum of AFF. The FFI report should state the absence or presence of abnormalities in the spectrum of AFF. If focal thickening is present on the lateral cortex, the report should state whether a lucent line is seen (grade: Fair, C, W). The ISCD recommends considering the use of bilateral FFI in patients who are currently or have been in the past year on potent antiresorptive therapy (ie, oral or intravenous bisphosphonate or subcutaneous denosumab therapy) for a cumulative period of 3 or more years, especially those on long-term glucocorticoid therapy (grade: Fair, B, W). More research is needed to determine the role of repeat testing and the optimal time interval for follow-up DXA scans, whether an automated measuring tool would perform better than visual inspection, whether FFI would change patient management and outcomes, and the cost-effectiveness of FFI. |
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