Atypical femoral fracture — SCE Rheumatology MCQ

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ModerateMetabolic Bone DiseaseAtypical femoral fractureSCE Rheumatology

A 69-year-old woman taking alendronic acid for 9 years reports dull right thigh pain for 2 months. Radiograph shows lateral cortical thickening and a transverse incomplete subtrochanteric fracture line. There has been no trauma. What is the most likely diagnosis?

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Correct answer: D — Atypical femoral fracture

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

Atypical femoral fracture is best because long-term bisphosphonate exposure with prodromal thigh pain and lateral subtrochanteric transverse fracture suggests atypical femoral fracture. A is less suitable because Paget disease causes bone expansion and coarsened trabeculae; B is less suitable because hip OA causes groin pain and joint-space narrowing; C is less suitable because metastatic fractures are usually lytic/blastic lesions rather than classic lateral beaking; E is less suitable because trochanteric bursitis causes lateral tenderness without cortical fracture line. Clinical pearl: prodromal thigh pain on bisphosphonates warrants femoral imaging.

Reference: NOGG osteoporosis guideline; MHRA bisphosphonate safety advice