The Role of Lower-Limb Geometry in the Pathophysiology of Atypical Femoral Fracture

Curr Osteoporos Rep. 2019 Oct;17(5):281-290. doi: 10.1007/s11914-019-00525-x.


Purposeof review: The etiology of atypical femoral fracture (AFF) is likely multifactorial. In this review, we examined the recent literature investigating the role of lower-limb geometry in the pathophysiology of AFF.

Recent findings: Increased femoral bowing was associated with prevalent AFF and a greater likelihood of a diaphyseal versus a subtrochanteric AFF location. Femoral neck geometry or hip alignment may also be related to AFF, but findings remain equivocal. Differences in femoral geometry may, in part, be responsible for the high rate of AFF in Asian compared with Caucasian populations. Finally, simulation studies suggest that lower-limb geometry influences AFF risk via its effects on mechanical strain of the lateral femoral cortex. Femoral geometry, and bowing in particular, is related to prevalent AFF, but more prospective investigation is needed to determine whether measurements of geometry can be used for clinical risk stratification.

Keywords: Bisphophonates; Femoral bowing; Femoral strain; Fracture risk; Hip geometry; Osteoporosis.

Publication types

  • Review

MeSH terms

  • Bone Density
  • Femoral Fractures / physiopathology*
  • Femur / physiopathology*
  • Humans
  • Lower Extremity / anatomy & histology*
  • Lower Extremity / physiopathology*
  • Risk Factors