With the prevalence of osteoporosis expected to rise in the coming years, early recognition and management of bisphosphonate-related atypical femur fractures will become increasingly important. Edward J. Fox, M.D., explains, “In many cases, osteoporosis is treated with long-term bisphosphonate therapy, which suppresses osteoclastmediated bone turnover. With prolonged bisphosphonate use (more than five years), some patients (about one in 1,000) develop atypical femur fractures.” Atypical femur fractures are stress fractures that usually occur in the proximal one-third of the diaphyseal bone, but can occur more distally, too; beginning in the lateral cortex and gradually progressing medially (see figure below).
Fox adds, “With atypical fractures, a small ‘beak’ of bone forms on the lateral femur surface and this is where the fracture begins.” This contrasts with more typical stress fractures that occur in the medial portion of bone and progress laterally. “Clinically, when a patient with osteoporosis presents complaining of thigh and hip pain that’s unrelated to any acute injury, I always ask about history of bisphosphonate treatment. It’s important to obtain X-rays not only of the hip joint but also the femur shaft; otherwise the problem may go undetected or misdiagnosed,” advises Fox. In most cases, conservative treatment is effective. Continue reading