我们假设患乳腺癌（BC）接受双膦酸盐治疗的大部分非典型股骨骨折（AFF）可以在乳腺外科医生已经进行的其他放射学检查中发现，而不是在简单的放射照片（SRs）中。我们仔细检查了2008年至2017年在我们机构接受治疗的BC患者的临床记录。总共，将228名患者根据SRs分为三组：至少一侧出现完全AFF（第一组）；至少一侧出现不完全骨折，但没有任何完全骨折（第二组）；两侧股骨上没有可疑病变（X组）。然后，我们检查了所有组别的全身放射显像（WBS）和正电子发射计算机断层扫描（PET-CT）图像。对于X组，通过至少一根股骨上的放射学线索，将患者最终分类为第三组，其余患者组成正常组。约35%的患者显示与双膦酸盐的副作用相关的AFF（完全或不完全）或可疑病变。在第一组中，SRs上双侧病变（完全或不完全骨折）的频率较单侧病变更高（p = 0.008）。第一组和第二组的SRs上已鉴定出的WBS和PET-CT结果，与前期SRs上的完全和不完全骨折相比，出现的时间平均提前了7个月。在WBS和PET-CT首次鉴定病变之后，SRs并未在第三组中显示出病变，直到5个月后。即使在SRs上不能检测到不完全AFFs之前，它们可以在乳腺外科医生和放射科医生进行的转移监测检查中通过WBS和PET-CT进行检测。对病变的认识为在出现完全骨折之前进行预防性手术提供了机会。 版权所有©2023年韩国骨科学会。

We hypothesized that most of the atypical femoral fractures (AFFs) associated with bisphosphonate treatment for breast cancer (BC) could be found before the fracture event in another radiological examination already performed by breast surgeons, rather than on simple radiographs (SRs).We thoroughly inspected the clinical charts of BC patients treated at our institute between 2008 and 2017. In total, 228 patients were categorized into three groups based on SRs: complete AFF on at least one side (group 1); incomplete fracture on at least one side, but not any complete fracture (group 2); and no suspicious lesion (group X) on either femur. Then, we inspected whole-body scintigraphy (WBS) and positron emission tomography (PET)-computed tomography (CT) images in all groups. For group X, patients with radiological clues from at least one femur were categorized, ultimately, into final group 3 and the rest made up the normal group.About 35% of the patients showed AFFs (complete or incomplete) or suspicious lesions as AFFs, associated with the side effect of Bisphosphonate. In group 1, bilateral lesions (complete or incomplete fractures) were more frequently seen on SRs than unilateral lesions (p = 0.008). The initially identified findings in WBS and PET-CT for the respective complete and incomplete fractures on SRs of groups 1 and 2 were seen at a mean of 7 months previously. SRs did not reveal the lesions in group 3 until 5 months after the initial identification of the lesions in WBS and PET-CT.Even before incomplete AFFs were detectable on SRs, they could be found at check-ups using WBS and PET-CT that had been previously examined by breast surgeons and radiologists for metastasis surveillance. Awareness of the lesions creates an opportunity for prophylactic surgery before complete fractures occur.Copyright © 2023 by The Korean Orthopaedic Association.