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Atypical femoral fracture — SCE Rheumatology MCQ

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HardMetabolic bone diseaseAtypical femoral fractureSCE Rheumatology

A 69-year-old woman taking alendronate for nine years reports prodromal thigh pain. X-ray shows lateral cortical thickening and a transverse incomplete fracture line in the subtrochanteric femur. Calcium, phosphate and ALP are normal. What is the most likely diagnosis?

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Correct answer: B — Atypical femoral fracture

Long-term bisphosphonate exposure with prodromal thigh pain and lateral cortical beaking/transverse subtrochanteric fracture is typical of atypical femoral fracture. The opposite femur should be assessed and antiresorptive therapy reviewed. Osteonecrosis affects the femoral head and presents with different imaging.

Reference: NOGG osteoporosis guideline; BNF