Current concepts in the management of bisphosphonate associated atypical femoral fractures

Table 1 Atypical femoral fractures are insufficiency fractures that can be related to bisphosphonate use and are identified by major and minor criteria

Major criteria (all must be met)	Minor criteria (none required)
Fracture line located anywhere between the distal border of the lesser trochanter of the femur to the proximal edge of the supracondylar flare	Localised periosteal reaction at lateral cortex – beaking, flaring
Lateral cortex must be involved (incomplete or complete – normally with medial cortical spike)	Generalised, diaphyseal cortical thickening
Transverse or short oblique fracture line No comminution	Prodromal groin/thigh pain
No or minimal precipitating trauma	Bilateral fracture and symptoms
	Delayed healing
	Co-morbidities (rheumatoid arthritis, vitamin and mineral deficiencies)
	Concomitant use of pharmacological agents (BP, corticosteroids, proton pump inhibitors)
Exclusions
Neck of femur fractures, fractures relating to primary or secondary bone tumours and peri-prosthetic fractures[11].