Osteoporosis International

, Volume 24, Issue 11, pp 2893–2895 | Cite as

Pseudoarthrosis in atypical femoral fracture: case report

  • S. Giannotti
  • V. Bottai
  • G. Dell’Osso
  • G. De Paola
  • M. Ghilardi
  • G. Guido
Case Report


Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment; they have a high frequency of delayed healing. The authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy. Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment even if, in the literature, there is no clarity on the exact pathogenetic mechanism. The Task Force of the American Society for Bone and Mineral Research described the major and minor features to define atypical fractures and recommends that all the five major features must be present while minor features are not necessary. Another controversial aspect regarding the atypical femoral fractures is the higher frequency of the delayed healing that can be probably related to a suppressed bone turnover caused by a prolonged period of bisphosphonates treatment. This concept could be corroborated by the Spet Tc exam. In the case of a pseudoarthrosis, there is not a standardization of the treatment. In this report, the authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy; the patient was studied with clinical, bioumoral end SPECT-Tc exam of both femurs. Many studies show the relationship between bisphosphonates and the presence of atypical fractures. These fractures should be monitored more closely due to the risk of nonunion and they require considering an initial treatment with pharmacological augmentation to reduce the complications for the patient and the health care costs.


Atypical femoral fracture Biphosphonates Pseudoarthrosis 


Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • S. Giannotti
    • 1
  • V. Bottai
    • 1
  • G. Dell’Osso
    • 1
  • G. De Paola
    • 1
  • M. Ghilardi
    • 1
  • G. Guido
    • 1
  1. 1.Clinica Ortopedica e Traumatologica IIUniversita’ Di PisaPisaItaly

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