1.Asian Federation of Osteoporosis Societies 2025 consensus on atypical femoral fractures in patients with osteoporosis
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
Osteoporosis and Sarcopenia 2025;11(4):111-120
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 evidencebased 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 highrisk 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 initia tion 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, im aging surveillance, surgical intervention, and tailored pharmacologic treatment—is crucial to reduce AFFs impact and improve skeletal health outcomes across Asia.
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