"Similar atypical fractures at sites other than the femur have also been recognised, most often the ulnar or tibial diaphyses16. Whereas the femur and tibia are subjected to high mechanical loads and repetitive stress during normal weight-bearing activity, the ulna can experience similar stresses in those who habitually use walking aids."
"T1: low signal fracture line; diffuse low marrow signal"
"T2 and STIR: low signal fracture line; diffuse high marrow signal"
"Postoperatively, teriparatide, a recombinant human parathyroid hormone (rhPTH) promotes bone healing and accelerates union 7,8. 80% regain pre-fracture ambulatory status after fixation. Mortality is similar compared to the general population and is lower compared to that of typical fragility fractures 25."
"While some sources apply the term AFF only to fractures that complicate antiresorptive medication for osteoporosis, this is not required per the 2013 consensus diagnostic criteria (see below)."
"70-80% of AFF are associated with antiresorptive therapy 18. Risk increases with treatment duration but decreases during drug holidays; a 1-3 year holiday reduces risk by 47% and a longer holiday reduces risk by 77% 18. Asian women have a higher risk than White patients 18 (age-adjusted relative hazard ratio 8.5), particularly those of Southeast Asian ethnicity 19."
"Risk factors for AFF, beyond antiresorptive therapy, include 16:"
"AFFs are defined by the American Society for Bone and Mineral Research (ASBMR) in 2013 by the following criteria 6,9:"
"Antiresorptive medications, primarily bisphosphonates and denosumab, inhibit osteoclast-mediated bone resorption. Bisphosphonates bind to hydroxyapatite in bone, are endocytosed by osteoclasts during bone resorption, inhibit the synthesis of GTPase signalling proteins (necessary for osteoclast function and survival) leading to apoptosis 20. Denosumab (monoclonal antibody) binds to and inhibits RANKL, preventing osteoclast differentiation, function and survival."
"obtain AP and lateral views of the entire diaphysis of both femora"
"T2 and STIR: low signal fracture line; diffuse high marrow signal"
Expected headings
"Bone mineral densitometry"
"Related pathology"
"70-80% of AFF are associated with antiresorptive therapy 18. Risk increases with treatment duration but decreases during drug holidays; a 1-3 year holiday reduces risk by 47% and a longer holiday reduces risk by 77% 18. Asian women have a higher risk than White patients 18 (age-adjusted relative hazard ratio 8.5), particularly those of Southeast Asian ethnicity 19."
"complete fractures extend through both cortices and may be associated with a medial spike; incomplete fractures involve only the lateral cortex"
"T1: low signal fracture line; diffuse low marrow signal"
"T2 and STIR: low signal fracture line; diffuse high marrow signal"
"evidence of malignant bone tumour (primary or metastatic) or other bone diseases (e.g. Paget disease, fibrous dysplasia)"
"Antiresorptive medications, primarily bisphosphonates and denosumab, inhibit osteoclast-mediated bone resorption. Bisphosphonates bind to hydroxyapatite in bone, are endocytosed by osteoclasts during bone resorption, inhibit the synthesis of GTPase signalling proteins (necessary for osteoclast function and survival) leading to apoptosis 20. Denosumab (monoclonal antibody) binds to and inhibits RANKL, preventing osteoclast differentiation, function and survival."