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Atypical femoral fracture — SCE Rheumatology MCQ

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HardMetabolic Bone DiseaseAtypical femoral fractureSCE Rheumatology

A patient taking alendronate for nine years has focal lateral cortical beaking and an incomplete atypical fracture of the right femur. The left thigh is asymptomatic. What imaging should follow?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: CImage both full femora, using MRI for an uncertain incomplete lesion

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · B = shown as D

A is correct. Atypical femoral fractures are frequently bilateral, so both full femora should be assessed even when symptoms are unilateral. MRI or isotope imaging can clarify an occult or incomplete lesion. B misses contralateral disease. C cannot localise a femoral cortical crack. D delays assessment and permits propagation. E provides systemic turnover information, not fracture anatomy.

Reference: NOGG: strategies for osteoporosis and fracture-risk management: https://www.nogg.org.uk/full-guideline/section-7-strategies-management-osteoporosis-and-fracture-risk