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Angela Man-Wei Cheung,
Director, Osteoporosis Program
University Health Network
Mount Sinai
Director, Centre of Excellence
     in Skeletal Health Assessment
Professor of Medicine, University of Toronto
Toronto General Research Institute


Robert Bleakney, MD, FRCPC
Staff Radiologist
University Health Network
Mount Sinai Hospital
Assistant Professor,
 - Dept. of Medical Imaging
University of Toronto


Equipment Requirements
PC: Win7/Win8, Pentium processor or faster, at least 2GB RAM,
Internet Explorer version 10/11, Mozilla FireFox version 33.0.

MAC: OS version 10.8/10.9, Intel processor, at least 2GB RAM,
Safari version 6.2, FireFox 33.0



Emerging Concepts in Atypical Femoral Fracture
Causes, Characteristics, and Imaging

Recording of a live webinar presented on December 10, 2013

A certified one-hour prerecorded webinar for radiologists
and other healthcare providers who treat osteoporotic patients

If you want credit, the course(s) must be completed (i.e. view the recording, pass the posttest, AND print the certificate) BEFORE  February 1st, 2018.

Format: Archived Webinar
Credit:  1.0 AMA PRA Category 1

Credit:  1.0 ARRT Category A
Fee for Credit Certificate: $0


Course Overview
Although there is strong evidence that bisphosphonates prevent certain types of osteoporotic fractures, there are concerns that these medications may be associated with rare atypical femoral fractures (AFF).1

Since many physicians including radiologists are not aware of this entity, the incidence is likely underreported. These fractures usually occur in the subtrochanteric and mid-diaphyseal regions of the femur in the setting of low-energy trauma. Awareness of these atypical fractures and their radiological appearance should enable their early and accurate detection and thus lead to specific management.2

This lecture will review current research on atypical femoral fractures, followed by case studies that focus on early radiological appearance for accurate detection of changes associated with the spectrum of AFF using plain film, DXA, and CT.

1. Gedmintas L, Solomon DH, Kim SC. Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: A systematic review and meta-analysis. J Bone Miner Res. 2013;28(8):1729-1737.

2. Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: Second report of a task force of the American society for bone and mineral research. J Bone Miner Res. 2013 May 28. doi: 10.1002/jbmr.1998. [Epub ahead of print]

Educational Objectives
At the conclusion of this activity, participants should be better able to:

  • Discuss the potential relationship between long-term bisphosphonate (BP) therapy and atypical femoral fracture (AFF)
  • Recognize the radiographic features that distinguish AFFs from ordinary osteoporotic femoral fracture
  • Use appropriate imaging techniques, including the use of plain film, dual-energy x-ray absorptiometry (DXA) and CT, for identifying early radiographic signs of AFF.

ACCME Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine and International Center for Postgraduate Medical Education. The Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

The Postgraduate Institute for Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

SA-CME: This activity meets the criteria for self-assessment toward the purpose of fulfilling requirements in the American Board of Radiology (ABR) Maintenance of Certification Program.

The European Accreditation Council for CME (EACCME®)
The UEMS-EACCME® has mutual recognition agreements with the American Medical Association (AMA) for live events and e-learning materials. For more information go to

Radiologic Technologists
This program has been approved by the American Society of Radiologic Technologists (ASRT) for 1.0 hour of ARRT Category A continuing education credit.

How to Enroll and Participate
There are no fees or prerequisites to participate in this program. Estimated time to complete this activity is one hour.

  • Click on the blue link. Complete the precourse questions and SUBMIT.
  • Click on the blue link again to view the recording.

How to Receive a Credit Certificate
Your certificate of credit will remain in your account at as a permanent record of your participation.

  • Log-in to your account at
  • View the entire educational activity session. At the conclusion of the lecture, close the Vimeo window.
  • Return to the course in your account at
  • From the COURSE HOME page, click the button for POSTTEST and for EVALUATION.
  • A passing grade of at least 75% is required to receive credit. You may take the test up to three times.
  • Upon receipt of a passing grade, you will be able to print a certificate of credit from your account at

Faculty Biographies

Angela M. Cheung, MD, PhD, FRCPC, CCD
Dr. Cheung is the Founding Director of University Health Network Osteoporosis Program; Founding Director of Centre of Excellence in Skeletal Health Assessment; Lillian Love Chair in Women’s Health, Senior Scientist at the Toronto General Research Institute; and Professor of Medicine, Medical Imaging, Health Policy, Management, and Evaluation Public Health Sciences, Institute of Biomedical, Biomaterial and Mechanical Engineering, and Institute of Medical Sciences at the University of Toronto.

Dr. Cheung received her MD from Johns Hopkins University School of Medicine and her PhD from Harvard University.  She is a fellow of the Royal College of Physicians of Canada.  Dr. Cheung is also a board-certified internist in the United States and has been in clinical practice for more than 25 years.

Dr. Cheung’s research interests are in the area of postmenopausal osteoporosis, especially in prevention and early diagnosis, and the evaluation of new technologies and therapies. She is well-published in peer-reviewed journals and a frequent speaker at national and international scientific meetings. Dr. Cheung is currently the chair of both the Scientific Advisory Council of Osteoporosis Canada and Canadian Bone Strength Working Group. As well, she has been the organizer of the American Society of Bone and Mineral Research Bone Strength Working Group.

Robert Bleakney, MD, FRCPC
Dr. Bleakney attended medical school at Queens University in Belfast, Northern Ireland and completed his radiology residency at Aberdeen Royal Infirmary in Aberdeen, Scotland. His fellowship in musculoskeletal radiology was completed in Toronto, Canada.

Currently Dr. Bleakney is a staff musculoskeletal radiologist at Mt. Sinai Hospital and University Network in Toronto, one of the largest academic radiology groups in Canada.  As well, he is Musculoskeletal Division Head, Musculoskeletal Fellowship Supervisor, and Assistant Professor of Medical Imaging at the University of Toronto.

Dr. Bleakney’s clinical and research interests are in clinician education, sports imaging, musculoskeletal tumors, bone density, and atypical femoral fractures.

Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy.  PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Angela M. Cheung, MD, PhD, FRCPC, CCD has received consulting fees from Amgen, Inc., Eli Lilly and Co., and Merck & Co., Inc. and has performed contracted research for Amgen, Inc. and Eli Lilly and Co.

Robert Bleakney, MD, FRCPC has no conflicts to report.

The following planners and managers have reported NO financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Sharon Cancino
Laura Excell, ND, NP, MS, MA, LPC, NCC
Trace Hutchison, PharmD
Samantha Mattiucci, PharmD, CCMEP
Linda McLean, MS
Victoria Phoenix,BS
Jan Schultz, RN, MSN, CCMEP

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners.  Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

For questions regarding this program, please contact ICPME:
Phone: 607-257-5860 x10

Jointly Provided by

This activity is supported by an independent educational grant from Hologic, Inc.