Atypical subtrochanteric femur fracture following bisphosphonates: A grey area of diagnosis and management

Background and objective: Osteoporosis is a common orthopaedic problem of the geriatric population. Bisphosphonates have been effectively used to control osteoporosis and improve the bone strength. Bisphosphonates has particularly been used in glucocorticoid induced osteoporosis. However, there are emerging concerns over the risk of atypical femoral pathological fractures consequent to prolonged use of BPN therapy. This study was designed to report the diagnosis and treatment of atypical subtrochanteric femur fractures after bisphosphonate treatment. Subject and methods: We report a rare case of atypical femur fracture in a 70-year-old female patient who has been taking bisphosphonates for glucocorticoid-induced osteoporosis for 5 years. She suffered a subtrochanteric fracture after tripping on the doorstep. The fracture was fixed using a titanium proximal femur nail. The patient was followed up by X-ray examination 1 year after operation. This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Jagadguru Sri Shivarathreeshwara Hospital, India. Written informed consent was obtained from the patient. Results: The postoperative period was uneventful, and the patient recovered well. The patient was independently ambulatory with good function of her left hip. Conclusion: Atypical femoral fractures are defined clearly by the American Society of Bone and Mineral Research (ASBMR) criteria. Many reports in the literature have reported atypical femoral fractures after bisphosphonates therapy but do not meet the ASBMR criteria. The risk ratio of atypical femoral fractures after bisphosphonates use is high. Regular monitoring and screening of patients on bisphosphonates therapy by radiographs allow us to diagnose these fractures early and treat them successfully.