Femoral Fractures Following Long-term Bisphosphonate Use

Bisphosphonates are widely used for the prevention of osteoporosis-associated fractures. Femoral fractures associated with bisphosphonate use are increasingly being reported in the literature. Orthopedic surgeons should be aware of this potential association and related implications for patient treatment. Bisphosphonate-associated fractures are characteristically simple, transverse with beaking, and subtrochanteric. Diagnosis is based on a careful history, physical examination, and focused imaging. In the setting of either a complete or partial fracture, it is recommended that bisphosphonate therapy be halted and calcium and vitamin D brought into the therapeutic range. Orthopedic management of the completed fracture preferably uses a locked intramedullary nail. The recommendations for incomplete fractures are unresolved.