Metabolic Bone Disease Center, State University of New York Upstate Medical University, Syracuse, New York.
Bone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, Michigan, USA.
Curr Opin Endocrinol Diabetes Obes. 2019 Dec;26(6):283-290. doi: 10.1097/MED.0000000000000505.
This article summarizes the risk factors for atypical femur fractures (AFF), discusses current and emerging imaging modalities for early identification of AFF, and offers recommendations for prevention and management of AFFs based on the current concepts.
Antiresorptive therapies are widely recommended for prevention and treatment of osteoporosis. Despite their well established effectiveness to reduce fracture risk, emerging concerns related to potential adverse effects have led to a substantial decline in the use of bisphosphonates. Although, the pathogenesis of AFF has not yet been elucidated, the bulk of evidence supports that the well known therapeutic benefits of bisphosphonate far outweigh the relatively low risk of AFFs. Recommendations for early identification of patients at risk for AFF using radiographic imaging have been established. Consensus on the management of AFF and osteoporosis in patients with AFF needs to be formulated.
AFF is a rare event associated with long-term bisphosphonate therapy, which represents an apparent paradox in the management of osteoporosis. Improved understanding of pathogenetic mechanisms will be helpful in further refining of screening guidelines and standardization of management and treatment strategies.
本文总结了非典型股骨骨折（AFF）的风险因素，讨论了目前和新兴的影像学方法用于早期识别 AFF，并根据现有概念提供了预防和管理 AFF 的建议。
抗吸收疗法被广泛推荐用于预防和治疗骨质疏松症。尽管它们在降低骨折风险方面的有效性已得到充分证实，但与潜在不良反应相关的新出现的问题导致双磷酸盐的使用大幅下降。虽然 AFF 的发病机制尚未阐明，但大多数证据支持，双磷酸盐的良好治疗益处远远超过 AFF 的相对低风险。已经建立了使用影像学检查早期识别有 AFF 风险患者的建议。需要制定针对 AFF 患者的 AFF 和骨质疏松症的管理共识。
AFF 是一种与长期双磷酸盐治疗相关的罕见事件，这在骨质疏松症的管理中代表了一个明显的悖论。对发病机制的深入了解将有助于进一步完善筛查指南，并使管理和治疗策略标准化。
