Metabolic bone disease: atypical femoral fracture management: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Metabolic bone disease: atypical femoral fracture management

Sample item

A 70-year-old woman who has taken alendronate for eight years has two weeks of dull thigh pain. A radiograph shows thickening and beaking of the lateral cortex of the subtrochanteric femur. What is the best next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Stop the drug and image both femora

Prodromal thigh pain with lateral cortical thickening suggests an incomplete atypical femoral fracture. The bisphosphonate should be stopped, calcium and vitamin D optimised, and the opposite femur imaged because involvement is often bilateral. Prophylactic nailing is considered for symptomatic incomplete fractures.

Option by option

  • A. Switch to intravenous zoledronic acid

    Switching to another bisphosphonate maintains the same risk.

  • B. Stop the drug and image both femora (correct)

    Correct. Stopping the antiresorptive and imaging both femora is the recommended first step.

  • C. Reassure that the pain is muscular

    Reassurance would miss an impending complete fracture.

  • D. Continue alendronate and add an NSAID

    Continuing the drug risks completion of the fracture.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is B, Stop the drug and image both femora. Prodromal thigh pain with lateral cortical thickening suggests an incomplete atypical femoral fracture.

Why is "Switch to intravenous zoledronic acid" not the answer?

Switching to another bisphosphonate maintains the same risk.

Why is "Reassure that the pain is muscular" not the answer?

Reassurance would miss an impending complete fracture.

Why is "Continue alendronate and add an NSAID" not the answer?

Continuing the drug risks completion of the fracture.

What concept does this question test?

It tests Metabolic bone disease: atypical femoral fracture management in Orthopaedics. The bisphosphonate should be stopped, calcium and vitamin D optimised, and the opposite femur imaged because involvement is often bilateral. Prophylactic nailing is considered for symptomatic incomplete fractures.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Metabolic bone disease: atypical femoral fracture management?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.