title: [What do we know about atypical fractures in patients on biphosphonates treatment? A literature review using a case series].
abstract: OBJECTIVE
  Retrospective review of long term biphosphonates treated patients who sustained a subtrochanteric or diaphyseal femoral fracture with an atypical pattern. A literature review is presented as an update of the topic.
  
  
  METHODS
  A retrospective study was conducted on 13 subtrochanteric or diaphyseal fractures in female patients treated with biphosphonates at our institution from September 2007 to March 2011.
  
  
  RESULTS
  Four cases of subtrochanteric fractures and 13 diaphyseal fractures were detected. Four patients had bilateral fractures. All cases but one (that affected only the lateral cortex) were complete fractures. Surgically, these kinds of fractures are demanding due to the hardness of the bones.
  
  
  CONCLUSIONS
  It is difficult to know if there is any relationship between bisphosphonates treatment and atypical femoral fractures. Nevertheless, current literature supports a greater benefit of their use in preventing vertebral and non-vertebral fractures. For this reason, biphosphonates continue being considered as a first choice in the prevention of osteoporotic fractures.
  
  
  CONCLUSIONS
  Patients on long-term treatment with bisphosphonates may present atypical femoral fractures as a complication. It is considered that the maximum period for biphosphonates treatment should not exceed 5 years.
authors.affiliation: Sección de Traumatología, Servicio de Cirugía Ortopédica y Traumatología, Institut Clínic d'Especialitats Mèdiques i Quirúrgiques (ICEMEQ), Hospital Clínic de Barcelona, Barcelona, España. amendezgil@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Méndez-Gil
authors.forename: S
authors.initials: S
authors.lastname: Prat-Fabregat
authors.forename: A
authors.initials: A
authors.lastname: Domingo-Trepat
authors.forename: M
authors.initials: M
authors.lastname: Navarro-López
authors.forename: P
authors.initials: P
authors.lastname: Camacho-Carrasco
authors.forename: A
authors.initials: A
authors.lastname: Carreño-Delgado
authors.forename: J A
authors.initials: JA
authors.lastname: Zumbado-Dijeres
authors.forename: R
authors.initials: R
authors.lastname: García-Elvira
authors.forename: M
authors.initials: M
authors.lastname: Ríos-Martín
authors.forename: R
authors.initials: R
authors.lastname: García-Tarriño
authors.forename: O
authors.initials: O
authors.lastname: Ares-Rodríguez
authors.forename: J R
authors.initials: JR
authors.lastname: Ballesteros-Betancourt
authors.forename: S
authors.initials: S
authors.lastname: Suso-Vergara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000139:chemically induced*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates