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Case Reports
. 2025 Aug;15(8):116-120.
doi: 10.13107/jocr.2025.v15.i08.5906.

Fracture Occurrence following Prophylactic Nailing in a Case of Bisphosphonate-induced Atypical Femoral Fracture - A Rare Case Report

Kumardev Arvind Rajamanya  1 , Tushar Nayak  1 , Rahul Shah  1
Affiliations
Case Reports

Fracture Occurrence following Prophylactic Nailing in a Case of Bisphosphonate-induced Atypical Femoral Fracture - A Rare Case Report

Kumardev Arvind Rajamanya et al. J Orthop Case Rep. 2025 Aug.

Abstract

Introduction: Bisphosphonates are effective in osteoporosis management but have been linked to atypical femoral fractures (AFFs) with prolonged use. The management of incomplete AFF remains controversial, particularly regarding the role of prophylactic fixation.

Case report: A 67-year-old female on long-term bisphosphonate therapy presented with a left subtrochanteric fracture following a minor fall. Imaging revealed an impending AFF in the contralateral right femur, leading to prophylactic intramedullary nailing. Six weeks postoperatively, she developed a minimally displaced fracture on the right femur, which was managed conservatively due to the minimal displacement of the fracture as a result of prophylactic nailing. She achieved full fracture healing and unaided mobility without additional surgical intervention.

Conclusion: Prophylactic intramedullary nailing can effectively mitigate fracture displacement and the need for re-surgery in patients with impending AFF. However, further studies are needed to establish standardized management protocols.

Keywords: Atypical femoral fracture; bisphosphonate; bisphosphonate therapy; prophylactic nailing.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Radiograph confirming the presence of subtrochanteric fracture of the left femur.
Figure 2
Figure 2
Screengrab of magnetic resonance imaging the right thigh. Please note the marrow edema in the subtrochanteric region.
Figure 3
Figure 3
Post-operative radiograph of the right thigh with intramedullary nail in situ (a) anteroposterior view. (b) Lateral view.
Figure 4
Figure 4
Post-operative radiograph of left thigh with intramedullary nail in situ (a) anteroposterior view. (b) Lateral view.
Figure 5
Figure 5
Post-operative X-ray of pelvis with both hips – anteroposterior view, with implants in situ.
Figure 6
Figure 6
Radiograph taken 6-week post-surgery. Please note minimally displaced fracture in the proximal right femur.
Figure 7
Figure 7
Radiograph taken 1-year post-surgery showing satisfactory union with implants in situ bilateral femur.
See this image and copyright information in PMC

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