{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:57:52Z","timestamp":1785254272209,"version":"3.55.0"},"reference-count":23,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T00:00:00Z","timestamp":1737590400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100007687","name":"Svenska L\u00e4kares\u00e4llskapet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007687","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004063","name":"Knut och Alice Wallenbergs Stiftelse","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004063","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Centre for Research and Development, Region G\u00e4vleborg\/Uppsala University, G\u00e4vle, Sweden"},{"DOI":"10.13039\/100016670","name":"Region \u00d6sterg\u00f6tland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016670","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ALF Grants"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Acta Radiol"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bisphosphonate-associated stress fractures, atypical femur fractures (AFF), are a rare subgroup of femoral stress fractures. Their correct and early diagnosis is imperative for appropriate treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To investigate the sensitivity of written radiology reports to mention radiographic features of AFF, depending on the time period and academic level of the hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>We used 171 patients, aged 55 years or older, who sustained an AFF between 2008 and 2010 (early period) identified through the Swedish National Patient Register and radiographic review and 104 patients identified through the Swedish Fracture Register between 2015 and 2018 (late period). Plain radiographs were extracted from 72 radiology departments in Sweden and individually re-reviewed and classified based on the American Society for Bone and Mineral Research case definition for AFF. Radiology reports were viewed for mentioning AFF or stress\/insufficiency features (true positives). The number of true positives was compared with the number of false positives for both periods using non-parametric statistics and using the gold standard as reference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We obtained 98 of the possible 171 reports with 7% of true positives for the early period and 77 of the possible 104 reports with 27% true positives for the late period (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). The level of improvement over time was independent of the academic level of the hospital.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite improvements over time, written radiology reports seldom mention AFF features. Clinicians, specifically orthopedic surgeons, are encouraged to contribute to a correct and early diagnosis to tailor treatment, while awaiting improvements in radiology reports.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02841851241313026","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T06:20:37Z","timestamp":1737613237000},"page":"529-535","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Identification of subtrochanteric and femoral shaft fractures as atypical femur fractures on radiology reports"],"prefix":"10.1177","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9862-1064","authenticated-orcid":false,"given":"Hans Peter","family":"B\u00f6gl","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, G\u00e4vle Hospital, G\u00e4vle, Sweden"},{"name":"Centre for Research and Development, Region G\u00e4vleborg\/Uppsala University, G\u00e4vle, Sweden"},{"name":"Department of Orthopedics and Experimental and Clinical Medicine, Faculty of Health Science, Link\u00f6ping University, Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Schilcher","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Experimental and Clinical Medicine, Faculty of Health Science, Link\u00f6ping University, Link\u00f6ping, Sweden"},{"name":"Wallenberg Centre for Molecular Medicine, Link\u00f6ping University, Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Schilcher J Michaelsson K and Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 2011;364:1728\u20131737.","DOI":"10.1056\/NEJMoa1010650"},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","unstructured":"Schilcher J Koeppen V Aspenberg P et al. Risk of atypical femoral fracture during and after bisphosphonate use. Acta Orthop 2015;86:100\u2013107.","DOI":"10.3109\/17453674.2015.1004149"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","unstructured":"Khosla S Shane E. A crisis in the treatment of osteoporosis. J Bone Miner Res 2016;31:1485\u20131487.","DOI":"10.1002\/jbmr.2888"},{"key":"e_1_3_2_5_2","doi-asserted-by":"crossref","unstructured":"Bogl HP Zdolsek G Barnisin L et al. Surveillance of atypical femoral fractures in a nationwide fracture register. Acta Orthop 2022;93:229\u2013233.","DOI":"10.2340\/17453674.2022.1380"},{"key":"e_1_3_2_6_2","unstructured":"Zdolsek G Chen Y Bogl HP et al. Deep neural networks with promising diagnostic accuracy for the classification of atypical femoral fractures. Acta Orthop 2021:1\u20137."},{"key":"e_1_3_2_7_2","doi-asserted-by":"crossref","unstructured":"Willis BH. Empirical evidence that disease prevalence may affect the performance of diagnostic tests with an implicit threshold: a cross-sectional study. BMJ Open 2012;2:e000746.","DOI":"10.1136\/bmjopen-2011-000746"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.1998"},{"key":"e_1_3_2_9_2","doi-asserted-by":"crossref","unstructured":"Schilcher J Sandberg O Isaksson H et al. Histology of 8 atypical femoral fractures: remodeling but no healing. Acta Orthop 2014;85:280\u2013286.","DOI":"10.3109\/17453674.2014.916488"},{"key":"e_1_3_2_10_2","doi-asserted-by":"crossref","unstructured":"Schilcher J Koeppen V Ranstam J et al. Atypical femoral fractures are a separate entity characterized by highly specific radiographic features. A comparison of 59 cases and 218 controls. Bone 2013;52:389\u2013392.","DOI":"10.1016\/j.bone.2012.10.016"},{"key":"e_1_3_2_11_2","doi-asserted-by":"crossref","unstructured":"LeBlanc ES Rosales AG Black DM et al. Evaluating atypical features of femur fractures: how change in radiological criteria influenced incidence and demography of atypical femur fractures in a community setting. J Bone Miner Res 2017;32:2304\u20132314.","DOI":"10.1002\/jbmr.3221"},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","unstructured":"Bogl HP Zdolsek G Michaelsson K et al. Reduced risk of reoperation using intramedullary nailing with femoral neck protection in low-energy femoral shaft fractures. J Bone Joint Surg Am 2020;102:1486\u20131494.","DOI":"10.2106\/JBJS.20.00160"},{"key":"e_1_3_2_13_2","doi-asserted-by":"crossref","unstructured":"Starr J Tay YKD Shane E. Current understanding of epidemiology pathophysiology and management of atypical femur fractures. Curr Osteoporos Rep 2018;16:519\u2013529.","DOI":"10.1007\/s11914-018-0464-6"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2006.01.019"},{"key":"e_1_3_2_15_2","doi-asserted-by":"crossref","unstructured":"Bogl HP Michaelsson K Zdolsek G et al. Increased rate of reoperation in atypical femoral fractures is related to patient characteristics and not fracture type. A nationwide cohort study. Osteoporos Int 2020.","DOI":"10.1007\/s00198-019-05249-3"},{"key":"e_1_3_2_16_2","doi-asserted-by":"crossref","unstructured":"Schilcher J. Epidemiology radiology and histology of atypical femoral fractures. Acta Orthop Suppl 2013;84:1\u201326.","DOI":"10.3109\/17453674.2013.850008"},{"key":"e_1_3_2_17_2","doi-asserted-by":"crossref","unstructured":"Brady AP. Radiology reporting-from Hemingway to HAL? Insights Imaging 2018;9:237\u2013246.","DOI":"10.1007\/s13244-018-0596-3"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20150443"},{"key":"e_1_3_2_19_2","article-title":"Global, regional, and national burden of bone fractures in 204 countries and territories, 1990\u20132019: a systematic analysis from the Global Burden of Disease Study 2019","volume":"2","author":"Collaborators GBDF","year":"2021","unstructured":"Collaborators GBDF. Global, regional, and national burden of bone fractures in 204 countries and territories, 1990\u20132019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Healthy Longev 2021;2:e580\u2013e592.","journal-title":"Lancet Healthy Longev"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20150914"},{"key":"e_1_3_2_21_2","doi-asserted-by":"crossref","unstructured":"Nguyen HH Le DT Shore-Lorenti C et al. AFFnet - a deep convolutional neural network for the detection of atypical femur fractures from anteriorposterior radiographs. Bone 2024; 187: 117215.","DOI":"10.1016\/j.bone.2024.117215"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-020-07148-2"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.12111119"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/1754-9485.12871"}],"container-title":["Acta Radiologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02841851241313026","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02841851241313026","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02841851241313026","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:34:29Z","timestamp":1777390469000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02841851241313026"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,23]]},"references-count":23,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1177\/02841851241313026"],"URL":"https:\/\/doi.org\/10.1177\/02841851241313026","relation":{},"ISSN":["0284-1851","1600-0455"],"issn-type":[{"value":"0284-1851","type":"print"},{"value":"1600-0455","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,23]]}}}