Bisphosphonate-related bilateral atypical femoral fractures : be aware and beware

Abstract

Although bisphosphonates have a well established therapeutic role in the prevention of osteoporosis-related fractures, several reports published over the past 5-6 years suggest a possible causative relationship between long-term use of bisphosphonates and development of ‘atypical’ subtrochanteric and femoral diaphyseal fractures. A high level of clinical suspicion and prompt imaging when these patients present with groin/thigh pain should lead to a timely diagnosis. Appropriate elective management to mitigate against the increased risks of these fractures becoming complete could then be instituted. We present a case of complete bilateral atypical subtrochanteric fractures in a patient on long-term bisphosphonates for osteoporosis. Our objective is to highlight the fracture risk of this patient population; present the current knowledge; and discuss the dilemmas in management of both femora.