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Published on: June 6, 2025
[Atypical femoral fractures associated with long-term treatment with bisphosphonates]
Francisco Flores Santos1, José Pinheiro da Silva2, Paulo Felicíssimo1
1Serviço de Ortopedia. Hospital Fernando Fonseca. Amadora. Portugal.
Introduction:
Long-term treatment with bisphosphonates has been associated to atypical femoral fractures whose features are now clearly defined.
Clinical Cases:
We present two cases of female patients under bisphosphonate treatment for over 10 years who were admitted to our institution for subtrochanteric and femoral shaft fractures after low-energy trauma. They presented, respectively, a transverse and a short oblique femoral fracture, with thickening of the lateral cortex. They underwent surgical treatment obtaining good functional and imaging result.
Discussion:
These cases fulfill the established criteria for atypical femoral fracture, thereby illustrating a serious adverse event of long-term treatment with bisphosphonates. Such relationship has still not been clearly established by scientific evidence. However, its effectiveness in preventing osteoporotic fractures is well proven.
Conclusion:
The atypical femoral fractures are possibly a serious adverse effect of the long-term treatment with bisphosphonates. Scientific evidence still supports its use, however, the physician must be aware of these events and closely follow-up these patients.
