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The prescribing information for bisphosphonates now includes a warning about the potential complication of atypical low-energy femur fractures (AFFs) involving the shaft below the trochanteric region. This case series of 81 patients (78 women) with AFFs has an unusual genesis: The lead author (a physician) began an online support group for patients with AFFs, collected detailed information from them, and verified reported cases by reviewing radiographs.
Seventy-one patients had complete fractures, and 10 had stress fractures. Mean duration of previous bisphosphonate therapy was 9 years. Two thirds of patients who received the drug had osteopenia, not osteoporosis. An astonishing 40% of patients suffered contralateral AFFs a mean 10 months af…