Clinical Orthopaedics and Related Research®

, Volume 472, Issue 9, pp 2728–2734

Healing Delayed But Generally Reliable After Bisphosphonate-associated Complete Femur Fractures Treated with IM Nails

  • Kenneth A. Egol
  • Ji Hae Park
  • Zehava Sadka Rosenberg
  • Valerie Peck
  • Nirmal C. Tejwani
Symposium: Femur Fractures: Contemporary Treatment Approaches

DOI: 10.1007/s11999-013-2963-1

Cite this article as:
Egol, K.A., Park, J.H., Rosenberg, Z.S. et al. Clin Orthop Relat Res (2014) 472: 2728. doi:10.1007/s11999-013-2963-1



Bisphosphonate therapy for osteoporosis has been associated with atypical femoral fractures. To date, there have been few reports in the literature regarding the preoperative and postoperative courses of patients who have sustained bisphosphonate-associated complete atypical femur fractures.


The purposes of this study were to (1) characterize the preoperative course of patients who eventually presented with bisphosphonate-associated complete atypical femur fractures (duration of bisphosphonate treatment, pain history, risk of converting a nondisplaced fracture to a complete fracture); (2) evaluate the percentage of patients who achieved radiographic union of those fractures after treatment; and (3) determine the patients’ recovery of function using the Short Musculoskeletal Functional Assessment.


Thirty-three patients with 41 atypical, low-energy femur fractures associated with ≥ 5 years of bisphosphonate use were treated with intramedullary nailing between 2004 and 2011 at one center. The main outcome measurements were Short Musculoskeletal Functional Assessment for function and radiographic evaluation for fracture healing. Patients had been treated with bisphosphonates for an average of 8.8 years (range, 5–20 years) before presentation.


Patients reported a mean of 6 months of pain before presentation (range, 1–8 months). Sixty-six percent of patients with surgically treated complete fractures became pain-free and 98% were radiographically healed by 12 months. Sixty-four percent of patients who underwent intramedullary nailing reported a functional return to baseline within 1 year. Patients who reported major functional limitations at latest followup listed pain and apprehension as the major causes of their limitation.


Patients with surgically treated bisphosphonate-associated complete femur fractures achieved generally reliable although delayed fracture healing if malaligned, and nearly two-thirds of patients returned to self-reported baseline function within 1 year.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Kenneth A. Egol
    • 1
    • 2
  • Ji Hae Park
    • 1
  • Zehava Sadka Rosenberg
    • 3
  • Valerie Peck
    • 4
  • Nirmal C. Tejwani
    • 1
  1. 1.Department of Orthopaedic SurgeryNew York University Hospital for Joint DiseasesNew YorkUSA
  2. 2.Jamaica Hospital Medical Center, JamaicaNew YorkUSA
  3. 3.Department of RadiologyNYU Langone Medical CenterNew YorkUSA
  4. 4.Department of MedicineNYU Langone Medical CenterNew YorkUSA

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