Introduction:

Osteoporosis is the most common metabolic disease of bone. Bisphosphonates are the first-line pharmacological class used in its treatment. Despite its effectiveness in reducing the risk of osteoporotic fractures, reports of atypical femur fractures have emerged as potential complications of long-term treatment with these drugs.

Case report:

We present the case of a 78-year-old patient, medicated for 13 years with alendronic acid 70 mg + cholecalciferol 2800 IU, weekly, transported to the orthopedics emergency service following a low-energy trauma, resulting in a subtrochanteric fracture of the left femur.

Conclusion:

There is yet no established causal relationship between the occurrence of atypical femur fractures and prolonged treatment with bisphosphonates. However, this association should not be ignored, and it is essential to assess the risks and benefits before starting treatment, as well as to promote active surveillance of patients under long-term bisphosphonate therapy. Studies report that at least half of patients who suffer atypical fractures of the femur present prodromes of pain in the thigh or groin, which occurred in the case reported. Therefore, these symptoms should be valued and actively questioned, especially in patients receiving bisphosphonates. Regardless of this potential risk, bisphosphonates remain the first-line drugs for the prevention of osteoporotic fractures and the duration of treatment must be individualized.

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