Perspective: The misleading label of atypical femur fracture: a call for diagnostic clarity amid biological diversity

Odvina C V, Zerwekh J E, Rao D S, Maalouf N, Gottschalk F A, Pak C Y. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 2005; 90: 1294-301. doi: 10.1210/jc.2004-0952. DOI: https://doi.org/10.1210/jc.2004-0952

Andersen J D, Bünger M H, Rahbek O, Hald J D, Harsløf T, Langdahl B L. Do femoral fractures in adult patients with osteogenesis imperfecta imitate atypical femoral fractures? A case series. Osteoporos Int 2019; 30: 513-17. doi: 10.1007/s00198-018-4769-1. DOI: https://doi.org/10.1007/s00198-018-4769-1

Charoenngam N, Thongpiya J, Yingchoncharoen P, Ponvilawan B, Marangoz M S, Chenbhanich J, et al. Atypical femoral fracture in hypophosphatasia: a systematic review. Int J Endocrinol 2023; 2023: 5544148. doi: 10.1155/2023/5544148. DOI: https://doi.org/10.1155/2023/5544148

Schilcher J, Koeppen V, Ranstam J, Skripitz R, Michaelsson K, Aspenberg P. Atypical femoral fractures are a separate entity, characterized by highly specific radiographic features: a comparison of 59 cases and 218 controls. Bone 2013; 52: 389-92. doi: 10.1016/j.bone.2012.10.016. DOI: https://doi.org/10.1016/j.bone.2012.10.016

Shane E, Burr D, Abrahamsen B, Adler R A, Brown T D, Cheung A M, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2014; 29: 1-23. doi: 10.1002/jbmr.1998. DOI: https://doi.org/10.1002/jbmr.1998

Ettinger B, Burr D B, Ritchie R O. Proposed pathogenesis for atypical femoral fractures: lessons from materials research. Bone 2013; 55: 495-500. doi: 10.1016/j.bone.2013.02.004. DOI: https://doi.org/10.1016/j.bone.2013.02.004

Schilcher J, Michaelsson K, Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 2011; 364: 1728-37. doi: 10.1056/NEJMoa1010650. DOI: https://doi.org/10.1056/NEJMoa1010650

Schaffler M B, Choi K, Milgrom C. Aging and matrix microdamage accumulation in human compact bone. Bone 1995; 17: 521-5. doi: 10.1016/8756-3282(95)00370-3. DOI: https://doi.org/10.1016/8756-3282(95)00370-3

Zdolsek G, Bögl H P, Sand R, Liszka A, Fahlgren A, Schilcher J. Comparing incomplete atypical femur fractures in patients with or without bisphosphonate treatment: radiography and bone morphology in a retrospective study of 19 cases. Acta Orthop 2025; 96: 421-8. doi: 10.2340/17453674.2025.43899. DOI: https://doi.org/10.2340/17453674.2025.43899

Schilcher J, Bernhardsson M, Aspenberg P. Chronic anterior tibial stress fractures in athletes: no crack but intense remodeling. Scand J Med Sci Sports 2019; 29: 1521-8. doi: 10.1111/sms.13466. DOI: https://doi.org/10.1111/sms.13466