Atypical fractures of the femur related to prolonged treatment with bisphosphonates for osteoporosis.

BACKGROUND Bisphosphonates reduce the overall risk of fractures among patients with osteoporosis, and this beneficial effect is long-lasting. However, since bisphosphonates inhibit bone remodeling, they may enhance the formation and propagation of micro-cracks over time and patients may therefore be prone to atypical fatigue fractures, mainly in the subtrochanteric region and femoral shaft. OBJECTIVES To present two cases of subtrochanteric fractures related to bisphosphonate treatment, and review the current literature. CONCLUSIONS Despite the overall beneficial effect of bisphosphonates, further research is required to prevent this significant complication.