Bisphosphonates-induced Atypical Subtrochanteric Fracture Femur: A Case Report

Abstract

A 71-year-old female came to our institute with a subtrochanteric left femur fracture following a fall from her bed. It was a low-energy trauma, and the X-rays were suggestive of an atypical fracture following bisphosphonate therapy for five years. The fracture was fixed with intramedullary nailing following which she was started on partial weight-bearing walking after three weeks. The fracture went on to a nonunion; after one year, the fracture site was opened and bone grafting with bone marrow injection, along with augmented plating, was done. The fracture showed signs of union three months postoperatively. Fractures associated with bisphosphonate therapy may be associated with delayed union or nonunion and should be explained to the patient.

Does the Nonunion Rate of Atypical Femoral Fractures Differ According to Fracture Site?: A Meta-Analysis

“…AFFs are known to heal poorly compared to typical femoral fractures and poor healing is partially attributed to the long-term use of bisphosphonates, which can suppress bone turnover. 37 38 39) In our meta-regression analysis, we did not find a clear-cut causality relationship between the duration of bisphosphonate use and nonunion rate in AFFs. Although bisphosphonates are known to have a relation to AFF, this may suggest that other factors play a greater role in the healing process of these fractures such as malreduction, which may decrease the contact area between the main fragments.…”