Bisphosphonate-related subtrochanteric femoral fractures

Hip fractures are important because they are associated with an increased rate of death, substantial morbidity, enormous costs, and devastating effects on independence and quality of life. Bisphosphonates have proven efficacy in reducing the incidence of spine and nonspine fractures. Several case series and multiple individual case reports from around the world suggest that some subtrochanteric fractures and those of the femoral shaft might occur in patients who have been treated with long-term bisphosphonate therapy.

We present a case in the United Kingdom, where a patient presented with bilateral, sequential bisphosphonate-related subtrochanteric fractures. Several unique clinical and radiographic features surrounding these atypical fractures that have been identified in the literature are illustrated in this case.

There is no rationale for withholding bisphosphonate therapy from patients with osteoporosis, although continued use of bisphosphonates beyond a treatment period of 3 to 5 years should be reevaluated annually. In patients who have been on long-term bisphosphonate therapy, physicians should specifically solicit information of unique clinical features and consider imaging, when appropriate.