Bisphosphonate-Related Atypical Femoral Fractures: A Comprehensive Review

Bisphosphonates have become a cornerstone in the management of osteoporosis and other bone-related conditions over the past few decades. While these medications have proven highly effective in reducing the risk of typical osteoporotic fractures, a concerning paradox has emerged: long-term use may be associated with a rare but serious complication known as atypical femoral fractures (AFFs). These unusual breaks occur in the shaft of the femur and differ significantly from common osteoporotic fractures in terms of location, appearance, and mechanism. This review explores the nature of these fractures by examining their characteristics, underlying mechanisms, risk factors, clinical presentation, diagnostic approaches, and management strategies. Understanding this complication is essential for clinicians who prescribe bisphosphonates and for patients who take them, as it highlights the importance of balancing the substantial benefits of these medications with their potential risks - particularly with prolonged use.