Asian Federation of Osteoporosis Societies 2025 consensus on atypical femoral fractures in patients with osteoporosis
Year: 2025
Type: article
Abstract: Atypical femoral fractures (AFFs) are a rare but serious complication of prolonged anti-resorptive therapy for osteoporosis. This study aimed to develop consensus-based recommendations for the clinical management of AFFs across the Asian Federation of Osteoporosis Societies (AFOS), for harmonizing practice and improving patient outcomes. A structured questionnaire covering ten key domains related to AFFs was distributed to expert representatives from the 10 AFOS member countries or regions. Responses were analyzed to identify areas of consensus and variation in regional practice. A concurrent narrative review of the literature was conducted to inform evidence-based recommendations. Survey responses were obtained from 8 of 10 participating AFOS member nations or regions. Among these, Thailand, Malaysia, South Korea, and Hong Kong reported established national guidelines or position statements on AFFs. Contributing risk factors include extended anti-resorptive therapy, femoral geometry, comorbidities, and specific pharmacologic exposures. Diagnosis depends on clinical suspicion and multimodal imaging, with high concordance in diagnostic criteria across regions. Screening emphasizes full-length femoral imaging in high-risk individuals. Incomplete AFFs are managed conservatively or with prophylactic fixation, while complete AFFs typically require intramedullary nailing, tailored to anatomic variations such as femoral bowing. Post-fracture care involves discontinuation of anti-resorptives, assessment for secondary osteoporosis, and potential initiation of anabolic therapy, including teriparatide, abaloparatide, and romosozumab. This AFOS-led initiative highlights the importance for early detection, individualized management, and region-specific strategies. A multidisciplinary, patient-centered approach-encompassing risk assessment, imaging surveillance, surgical intervention, and tailored pharmacologic treatment-is crucial to reduce AFFs impact and improve skeletal health outcomes across Asia.
Source: Osteoporosis and Sarcopenia
Authors: Thanut Valleenukul, Thawee Songpatanasilp, Unnop Jaisamrarn, Surapong Anuraklekha, Varalak Srinonprasert, Sumapa Chaiamnuay, Aasis Unnanuntana, Lalita Wattanachanya, Hataikarn Nimitphong, Noratep Kulachote, Ong-art Phruetthiphat, Rahat Jarayabhand, Tanawat Amphansap, Ekasame Vanitcharoenkul, Pojchong Chotiyarnwong, Satoshi Mori, Kwang-kyoun Kim, Swan Sim Yeap, Sharmila Sunita Paramasivam, Linsey Gani, Ching-Lung Cheung, Julie Li-Yu, Mark Anthony Sandoval, Chung-Hwan Chen, Natthinee Charatcharoenwitthaya
Institutions: Bhumibol Adulyadej Hospital, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Chulalongkorn University, Bumrungrad International Hospital, Siriraj Hospital, Mahidol University, Ramathibodi Hospital, Police General Hospital, Seirei Hamamatsu General Hospital, Konyang University, Konyang University Hospital, Subang Jaya Medical Centre, Mount Elizabeth Novena Hospital, University of Hong Kong, University of Santo Tomas Hospital, Philippine General Hospital, University of the Philippines Manila, Kaohsiung Medical University, Kaohsiung Medical University Chung-Ho Memorial Hospital, Thammasat University
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $500
OpenAlex ID: W7106532520