Clinical vignette

doi:10.1093/rheumatology/keu465 Atypical femoral fractures as an incidental finding on dual X-ray absorptiometry Atypical femoral fractures (AFFs) have been associated with long-term bisphosphonate use [1]. We present a case of AFF first identified with dual X-ray absorptiometry (DXA). A 64-year-old female attended for DXA with over 10 years of bisphosphonate use. DXA of the left hip showed a focal thickening of the lateral cortex (Fig. 1). Image ap-pearances were drawn to the attention of the patient’s physician and bisphosphonates were discontinued. No further imaging studies were performed. The patient frac-tured her right proximal femur 95 days later, appearances consistent with AFF. Further imaging with X-rays and CT of the left femur showed focal cortical thickening with