Radiographic Evolution of Contralateral Asymptomatic Incomplete Atypical Femoral Fractures in Autoimmune Disease...

Area of Science:

• Orthopedics
• Rheumatology
• Radiology

Background:

• Atypical femoral fractures (AFF) pose challenges in autoimmune patients on long-term bisphosphonate (BP) and glucocorticoid (GC) therapy.
• The evolution of asymptomatic incomplete AFF lesions alongside complete fractures is not well-defined.

Purpose of the Study:

• To characterize the natural history of asymptomatic incomplete AFF.
• To identify imaging biomarkers predicting progression in high-risk autoimmune patients.

Main Methods:

• Retrospective evaluation of 10 female autoimmune patients with complete AFF and contralateral incomplete lesions.
• Serial radiograph assessment for cortical beaking, periosteal flaring, and transverse radiolucent lines.
• Discontinuation of BP therapy and administration of teriparatide when tolerated.

Main Results:

• Most incomplete lesions (6/10) regressed, 3 remained stable, and 1 progressed.
• The only progressing lesion had a baseline transverse radiolucent line.
• No contralateral complete fractures or new symptoms occurred.

Conclusions:

• Asymptomatic incomplete AFF in this population often stabilizes or improves with conservative management.
• A transverse radiolucent line is a key predictor of progression.
• Further research is needed to refine risk stratification and management strategies.