[Atypical fracture of the femur related to prolonged bisphosphonate use. The importance of saying 'enough's enough']. / Fractura atípica de fémur relacionada con el uso prolongado de bifosfonatos. La importancia de decir «basta¼.

Osteoporosis is a highly prevalent disease with important consequences. The most widely used drugs to control this disease are bisphosphonates but their prolonged use is associated with the risk of atypical fractures. We report the cases of two patients under bisphosphonate treatment with bilateral atypical femoral fractures. In one patient the fractures occurred simultaneously, unprovoked by trauma, and in the other, they occurred as delayed fractures after mild trauma. In both cases, the fractures were preceded by pain. The fractures were treated with intramedullary nailing and bisphosphonate withdrawal with good outcomes. Although bisphosphonates have demonstrated effectiveness in preventing frailty-related fractures, their prolonged use has paradoxically been associated with atypical fractures. These fractures are usually preceded by pain. Consequently, when faced with this clinical picture, physicians should request imaging studies that could show incomplete fractures that could benefit from prophylactic nailing before becoming complete fractures.

Fractura atípica de fémur relacionada con el uso prolongado de bifosfonatos. La importancia de decir "basta" / Atypical fracture of the femur related to prolonged bisphosphonate use. The importance of saying 'enough's enough'

La osteoporosis es una enfermedad con una alta prevalencia e importantes consecuencias. Los bifosfonatos son los fármacos más utilizados para controlarla, sin embargo, su uso durante periodos prolongados se asocia con el riesgo de fracturas atípicas. Se presentan los casos de 2 pacientes en tratamiento con bifosfonatos que presentaron fracturas femorales atípicas bilaterales; en un caso fueron simultáneas, sin traumatismo desencadenante, y en el otro fueron diferidas tras sendos traumatismos banales. En ambos casos la fractura fue precedida de clínica dolorosa. Fueron tratadas mediante enclavado intramedular y supresión de los bifosfonatos, con buenos resultados. Aunque los bifosfonatos han demostrado su eficacia en la prevención de fracturas por fragilidad, su uso prolongado se ha asociado paradójicamente a fracturas atípicas. Estas fracturas suelen estar precedidas de dolor, por lo que ante ello es necesario realizar estudios de imagen, en los que pueden evidenciarse fracturas incompletas que podrían beneficiarse de un enclavamiento profiláctico antes de que se produzca la fractura completa

Osteoporosis is a highly prevalent disease with important consequences. The most widely used drugs to control this disease are bisphosphonates but their prolonged use is associated with the risk of atypical fractures. We report the cases of two patients under bisphosphonate treatment with bilateral atypical femoral fractures. In one patient the fractures occurred simultaneously, unprovoked by trauma, and in the other, they occurred as delayed fractures after mild trauma. In both cases, the fractures were preceded by pain. The fractures were treated with intramedullary nailing and bisphosphonate withdrawal with good outcomes. Although bisphosphonates have demonstrated effectiveness in preventing frailty-related fractures, their prolonged use has paradoxically been associated with atypical fractures. These fractures are usually preceded by pain. Consequently, when faced with this clinical picture, physicians should request imaging studies that could show incomplete fractures that could benefit from prophylactic nailing before becoming complete fractures