To determine whether plain film radiographs demonstrating atypical femoral fractures (AFFs) are accurately being reported according to the American Society for Bone and Mineral Research (ASBMR) criteria To determine if radiological reports of AFFs comply with ASBMR recommendations for contralateral limb imaging

Bisphosphates are currently the mainstay of pharmacological therapy for prevention and treatment of osteoporosis.1 Their widespread use has resulted in several case series published describing an association between bisphosphate use and atypical femoral fractures (AFFs). 2,3 Although AFFs are typically associated with anti-resorptive therapy, they can occur in patients with no exposure to these drugs.5,6 Accurate identification and reporting of AFFs is crucial as there are implications for further investigation and management. In 2010, the American Society for Bone and Mineral Research (ASBMR) established major...

A total of 614 femoral shaft fractures were identified across the 2 centres. To satisfy the first major ASBMR criteria, those fractures related to significant trauma (defined as a fall from greater than standing height) were excluded. Fractures related to malignancy were also excluded. 65 total femoral shaft fractures were identified once the exclusion criteria had been applied. An MSK radiologist, who was blinded to the clinical data, then reviewed plain film radiographs from the 65 cases and identified 21 as AFFs. 3.4% (21/614) of...

Atypical femoral fractures, rare but important clinical entities, are not accurately reported in concordance with ASBMR criteria. Furthermore, recommendations for imaging of the contralateral limb are not included in the reports. We suggest further education for radiologists and radiology trainees in recognising features of atypical femoral fractures and when to recommend contralateral limb imaging.

Rudran B, Super J, Jandoo R, Babu V, Nathan S, Ibrahim E, et al. Current concepts in the management of bisphosphonate associated atypical femoral fractures. World J Orthop. 2021;12(9):660-71. DOI: 10.5312/wjo.v12.i9.660 Cheung RK, Leung KK, Lee KC, Chow TC. Sequential non-traumatic femoral shaft fractures in a patient on long-term alendronate. Hong Kong Med J. 2007;13(6):485-9. 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 Jt Surg Br vol....