Research Article
Volume 11 Issue 7 - 2020
Bisphosphonate-Related Atypical Femoral Fracture: A Case Series
Mauricio Povoa Barbosa*, Alexandre Povoa Barbosa and Jader Joel Machado Junqueira
Orthobone Clinic - Orthopedic Surgery and Rehabilitation Center, Associacao Benifecente Siria HCor, Sao Paulo-SP, Brazil
*Corresponding Author: Mauricio Povoa Barbosa, Orthobone Clinic - Orthopedic Surgery and Rehabilitation Center, Associacao Benifecente Siria HCor, Sao Paulo-SP, Brazil.
Received: May 26, 2020; Published: June 20, 2020


Aim: The present study reported a case series of atypical femoral fractures related to chronic bisphosphonate use and review the main topics of the disease.

Methods: Our case series were comprised to 8 patients, all female, mean age 74.7 ± 10.8 years (ranging from 57 to 89 years) and 11 femur fractures (3 patients had bilateral fractures) followed between January 2012 and December 2019. All patients were a preceding 6.1 ± 1.1 years history of bisphosphonate use for reported osteoporosis.

Results: Four patients presented with a displaced femoral fracture following minimal or no trauma and reported prodromal symptoms previously to fractures. The other four patients presented with incomplete femoral fracture on radiographs and reported the same symptoms. The average duration of prodromal symptoms was 7.3 ± 4.2 months (range 1 - 12 months). Bisphosphonate therapy was discontinued at the time of admission and administration of calcium and vitamin D were initiated to all patients with incomplete femur fracture and oriented to use crutches and partial weight bearing for three months. Patients complete fractures were conducted to surgery. Intramedullary nailing fixation was the surgical treatment of choice for patients with complete fracture plane (average healing fracture time: 9.1 months). None of the patients with conservative treatment healed in three months and all of them underwent prophylactically Surgery with Nail without distal fixation. For symptomatic incomplete fractures (average healing fracture time: 3.4 months). There were three cases of non-union in patients with complete fracture.

Conclusion: Atypical femoral fractures secondary to chronic use of bisphosphonates represents a spectrum of a disease with a slow evolution that can be insidious in onset and hard to diagnose. Early proactive treatment, with both medical and surgical interventions, may be the key to a good functional outcome.

Keywords: Bisphosphonates; Femoral Fracture; Osteoporosis; Spontaneous Fracture; Stress Fracture


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Citation: Mauricio Povoa Barbosa., et al. “Bisphosphonate-Related Atypical Femoral Fracture: A Case Series”. EC Orthopaedics 11.7 (2020): 51-60.

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