Atypical femur fractures in patients receiving bisphosphonate therapy: etiology and management

  • Laura Blum
  • Karen Cummings
  • James A. Goulet
  • Aaron M. Perdue
  • Cyril Mauffrey
  • Mark E. HakeEmail author
Original Article • HIP - FRACTURES


Osteoporosis is a growing problem that is projected to affect more than 50% of American adults by 2020. Bisphosphonate therapy is currently the primary mode of treating osteoporosis in this population. While bisphosphonate therapy has been successful in increasing bone mineral density, data has shown an increased risk of atypical femur fractures with prolonged therapy. Atypical femur fractures are characterized by low-energy or atraumatic injuries that occur in the subtrochanteric region. They originate on the medial cortex, travel transversely, and typically have little or no comminution. Conservative therapy is indicated for patients with incomplete fractures without prodromal symptoms. Patients with incomplete fractures and significant prodromal symptoms or visible fracture line on radiographs, those who have failed conservative management, and those with complete fractures should be treated with intramedullary nail fixation. Evaluation should involve imaging of the contralateral femur. Teriparatide therapy may be considered for patients without contraindications. While the incidence of these fractures is low, it is likely that these rates will increase with the aging population and increased prevalence of patients being treated with bisphosphonate therapy.


Atypical femur fracture Bisphosphonate therapy Stress fractures Osteoporosis 



No outside funding was required for this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag France 2016

Authors and Affiliations

  • Laura Blum
    • 1
  • Karen Cummings
    • 1
  • James A. Goulet
    • 1
  • Aaron M. Perdue
    • 1
  • Cyril Mauffrey
    • 2
  • Mark E. Hake
    • 1
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of MichiganAnn ArborUSA
  2. 2.Department of Orthopaedic SurgeryDenver Health Medical CenterDenverUSA

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