Twenty Years of Continuous Bisphosphonate Use Leading to Atypical Bilateral Femoral Fractures: A Case Report

BACKGROUND Osteoporosis is a skeletal disorder characterized by an impairment of bone strength that predisposes people to an increased risk of fracture. It is a major public health problem as one of the causes of fragility fractures in older people, placing a significant burden on healthcare systems. Bisphosphonates (BPs) have historically been the cornerstone of osteoporosis therapy and remain the most widely used drug today. Prolonged use of bisphosphonates has been demonstrated to be associated with atypical femoral fractures (AFFs). CASE REPORT Our case report presents a rare case in terms of duration of continuous treatment with osteoporosis drugs (approximately 20 years) in a woman who developed an atypical bilateral femoral fracture. She was treated surgically with bilateral long-nailing of the femurs in one-stage surgery. Surgical treatment resulted in osteosynthesis of the fracture and improvement of pain-related symptoms. One month after the treatment, she was able to walk with full weight bearing. At 6 months, her femoral fractures showed radiographic signs of healing. CONCLUSIONS This case highlights a rare complication of the widespread use of BPs, which remain the cornerstone of osteoporosis treatment and prevention of fragility fractures. It focuses on the necessity of a correct and prompt diagnosis for management of AFFs, including adherence to the proper dosing schedule of BPs.