Atypical Femur Fractures Associated with Diphosphonate Use

Osteoporosis-related fractures create a heavy economic and healthcare burden. Although diphosphonate medications have been successful at decreasing the risk of osteoporotic fragility fractures and have become staples in the treatment of osteoporosis, concerns have been raised about the association of diphosphonate therapy with spontaneous nonvertebral fractures. Diphosphonate fractures are characteristically transverse or slightly oblique in nature and occur in the lateral cortex, or tension side, of the subtrochanteric region of the femur where diffuse cortical thickening and fracture can be observed on radiographs. A multidisciplinary approach incorporating both medical and surgical teams should be used in the case of diphosphonate-associated fractures. Future medical and surgical developments that augment fracture fixation and counteract diphosphonate-associated osteoclast apoptosis may play a role in therapy. Although diphosphonate use has decreased the rate of osteoporosis-related fractures, increased awareness and association with atypical subtrochanteric fractures is an important concern for clinicians to keep in mind.