Endocrine Abstracts

One of the clinical complications associated with the long term use of bisphosphonates treatment in osteoporosis is the atypical femoral fracture (AFF).Even the absolute risk is low and acceptable compared with the number of fractures prevented, there are still reasonable concerns due to the wide prescription of bisphosphonates and the existence of several case series proving that bisphosphonates have a strong association with this unique fracture type. We present a case of a 81 year old woman who was admitted in our clinic two and a half years ago right after she was treated for left femoral fracture in the orthopedic department.She had no history of recent trauma or low energy trauma,no corticotherapy, smoking or alcohol intake,no previous fractures.For the past 13 years she was continously treated with various type of bisphosphonates without any therapeutical pause or medical control.At that moment an association between bisphosphonates long term use and the occurence of atypical femoral fracture has been suggested.This diagnostic has also been supported by the X-ray with all the major features of AFF.Therapy with strontium ranelate and vitamin D supplements was initiated right after surgery with fully recover of the mobility and an increase in the quality of life. While concrete evidence based recommandations canot be provided, strict surveillance,overall awareness of prodromal thigh pain,radiological findings and bisphosphonates usage records are recomanded for prevention.For most people with osteoporosis the proven fragility-fracture risk-reduction benefits of bisphosphonates outweigh the risks of AFF.