Spontaneous femoral shaft fracture after long-term alendronate

Alendronate is used as first-line treatment for osteoporosis in postmenopausal women worldwide. The evidence supporting its benefit in reducing the risk of fragility fracture among this high-risk group is well established. Due to its mechanism of action, there were concerns about potential reduction in bone turnover, repair of microdamage and hence reduced bone toughness and increased risk of fractures with long-term use. A number of cases have been reported from other countries describing a pattern of atraumatic mid-femoral fractures in women on long-term alendronate therapy. We present a case of an atraumatic femoral shaft fracture in an elderly woman on long-term alendronate therapy admitted to a UK Hospital.