Impending atypical femoral fractures associated with bisphosphonates: postoperative diagnosis after hip prosthesis. Clinical cases presentation.

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Vanna Bottai
Nicola Piolanti
Giuseppe Digrandi
Agnese Menconi
Damiano Antognetti
Michele Di Lonardo
Michelangelo Scaglione
Gloria Raffaetà


Osteoporosis, Atypical femoral fractures, Hip Prosthesis, Periprosthetic Atypical Femoral Fractures, Bisphosphonates


Background and aim: Number of hip prosthesis implants in arthritis, number of patients treated with bisphosphonates to prevent fragility fractures and, together, number of atypical femoral fracture’s cases are increasing.

Case series: This article describes two cases of hip arthritis, treated with hip replacement, in patients using bisphosphonates for a long time; in both cases an incomplete atypical femoral fracture was misdiagnosed before the surgery. Authors describe the importance to carry out a complete osteometabolic and radiographic pre-operative examination of patients in treatment with bisphosphonates going to hip replacement, to check the possible presence of incomplete atypical femoral fracture and to optimize surgical and pharmacological treatment.

Conclusions: In hip prosthesis surgery, prior diagnosis of incomplete atypical femoral fractures can indicate the choice of a different kind of prosthesis stem to optimize surgical results. This can also positively impact to rehabilitation in term of duration and daily activities recovery.  


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