In the FREEDOM trial open-label extension with denosumab, two participants developed AFF at three and seven years of treatment, which represents an incidence of 8 per 100,000 participant years. AFF is extremely uncommon in the first three years of BP however, the incidence increases with duration of treatment to 113 per 100,000 patient years after eight years. AFF have also been reported with denosumab and romosozumab therapy. The role of bisphosphonates in atypical femoral fracturesįirst reported in 2005, AFF were determined to be related to long-term therapy with bisphosphonates (BP). The pain resolved in two months in the right thigh and 12 months in the left thigh. She was treated with partial weight bearing and teriparatide for 24 months. The patient was seen in orthopedics and intramedullary rodding was recommended, which the patient refused. The left femur had an identified fracture line that did not extend to the endocortex, although she had both periosteal and endosteal elevation on x-ray. ![]() X-rays showed bilateral stress reactions in both femurs, on the lateral cortex, below the lesser trochanter consistent with atypical femur fractures (AFF). She had osteoporosis with a lumbar spine T-score of –3.2 and had been on alendronate for 11 years. JB, an 81-year-old, white female, presented with bilateral thigh pain of three months’ duration. We do not endorse non-Cleveland Clinic products or services Policy ![]() Advertising on our site helps support our mission. Cleveland Clinic is a non-profit academic medical center.
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