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Atypical Femoral Fracture — RACP Adult Medicine MCQ

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HardGeriatric MedicineAtypical Femoral FractureRACP Adult Medicine

An 82-year-old woman with osteoporosis (T-score -3.2 at the hip) has been on alendronate for 6 years. She sustains an atypical femoral fracture (transverse, beaking, periosteal thickening). What is the most appropriate management of her osteoporosis medication?

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Correct answer: D — Cease bisphosphonate and commence teriparatide

Atypical femoral fractures are associated with prolonged bisphosphonate use. The bisphosphonate should be ceased. Anabolic therapy with teriparatide (PTH analogue) is recommended to promote fracture healing and maintain bone density. Teriparatide improves bone formation and is used for 18–24 months. After cessation, an antiresorptive agent should be commenced to maintain gains.

Reference: eTG – 2025 – Rheumatology; ASBMR – 2022 – Atypical Femur Fracture Guidelines