Bilateral atypical femur fractures without bisphosphonate exposure

Atypical femur fractures have common radiographic features that set them apart from more typical higher-energy subtrochanteric femur fractures. They are noncomminuted, transverse fractures with medial spiking of the femoral cortex and increased lateral cortical thickness. These fractures have been associated in the literature with the use of bisphosphonate medications. This case describes bilateral atypical femur fractures in a patient with a medical history devoid of bisphosphonate use. We present his history, co-morbidities, and subsequent treatment. From this case, we call attention to bisphosphonate use as not the only cause of subtrochanteric femur fractures with atypical features and highlight that some patients may sustain these injuries even bilaterally without use of the medications. In addition, it is important to identify this fracture type and obtain imaging of the contralateral femur to facilitate prophylactic treatment if needed.