{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:09:54Z","timestamp":1791306594108,"version":"4.3.1"},"reference-count":68,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,10,2]]},"abstract":"<jats:p>\n                    <jats:list list-type=\"plain\">\n                      <jats:list-item>\n                        <jats:p>\u27a4 Atypical femoral fractures (AFFs) are stress fractures between the lesser trochanter and the metaphyseal flare that are most commonly related to prolonged (3 to 5 years) antiresorptive medication use.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 An important finding is a visible transverse line in the lateral cortex, known as the \u201cdreaded black line.\u201d Complete fractures are transverse and have minimal comminution.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 Prodromal symptoms including hip, groin, thigh, and knee pain are present in more than one-half of cases and are usually misdiagnosed.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 Nonoperative treatment for all patients with AFF includes withdrawal of bisphosphonates, assessment for secondary causes of osteoporosis, and optimization of vitamin D and calcium.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 Incomplete fractures without a visible line can initially be treated nonoperatively with protected weight-bearing.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 Intramedullary nailing is indicated for complete fractures and incomplete fractures with a visible fracture line. Delayed healing after fixation should be anticipated.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u27a4 Treatment with parathyroid hormone (PTH) analogs (teriparatide and abaloparatide) after AFF prevents other fractures in high-risk patients, but the effect on healing of the fracture is unclear.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:p>","DOI":"10.2106\/jbjs.23.01439","type":"journal-article","created":{"date-parts":[[2024,8,23]],"date-time":"2024-08-23T00:03:10Z","timestamp":1724371390000},"page":"1819-1828","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":14,"title":["Update on Atypical Femoral Fractures"],"prefix":"10.2106","volume":"106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5833-9179","authenticated-orcid":false,"given":"Paul A.","family":"Anderson","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0005-8694","authenticated-orcid":false,"given":"Stephen L.","family":"Kates","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0719-9801","authenticated-orcid":false,"given":"Nelson B.","family":"Watts","sequence":"additional","affiliation":[{"name":"Osteoporosis and Bone Health Services, Mercy Health, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"issue":"1","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/jbmr.1998","article-title":"Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research","volume":"29","author":"Shane","year":"2014","journal-title":"J Bone Miner Res."},{"issue":"6","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1007\/s00198-018-4506-9","article-title":"A proposal for an atypical femur fracture treatment and prevention clinical practice guideline","volume":"29","author":"Dell","year":"2018","journal-title":"Osteoporos Int."},{"issue":"2","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1210\/er.2018-00001","article-title":"Atypical femur fractures: review of epidemiology, relationship to bisphosphonates, prevention, and clinical management","volume":"40","author":"Black","year":"2019","journal-title":"Endocr Rev."},{"issue":"3","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.2106\/JBJS.RVW.N.00062","article-title":"Atypical fractures of the femur: evaluation and treatment","volume":"3","author":"Blood","year":"2015","journal-title":"JBJS Rev."},{"issue":"1","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s00198-016-3809-y","article-title":"Sensitivity and specificity of radiographic characteristics in atypical femoral fractures","volume":"28","author":"Adams","year":"2017","journal-title":"Osteoporos Int."},{"issue":"6","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1007\/s00198-019-04869-z","article-title":"Radiological criteria for atypical features of femur fractures: what we can learn when applied in a clinical study setting","volume":"30","author":"LeBlanc","year":"2019","journal-title":"Osteoporos Int."},{"key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1097\/00003086-198809000-00033","article-title":"Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965-1984","volume":"234","author":"Arneson","year":"1988","journal-title":"Clin Orthop Relat Res."},{"issue":"3","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"251","DOI":"10.3109\/17453679008993511","article-title":"Incidence of femoral and tibial shaft fractures. 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