Atypical Femoral Fractures Can Happen Even With Short Duration Bisphosphonate Treatment

Bisphosphonates remain the mainstay of the pharmacological approach to reduce the risk of fractures. Clinical trials have demonstrated their efficacy in reducing the frequency of osteoporosis-related vertebral and nonvertebral fractures. In the last few years, there have been several reports of increased risk of subtrochanteric and femoral shaft fractures also known as "atypical femoral fractures" (AFF) among patients receiving long-term bisphosphonate treatment. Most of these reports have been on alendronate, the most extensively used bisphosphonate. There is paucity of data to link ibandronate to AFF. We report a 66-year-old female presenting with AFF within three years of starting ibandronate and after receiving a total of 27 doses. Prescribers should be aware that AFF can happen even during the early course of bisphosphonate treatment and not necessarily only after prolonged treatment for several years.