In acase of 64-year-old woman with osteoporosis, the authors demonstrate atextbook example of treatment failure of long-term bisphosphonate therapy which was the cause of atypical fracture of both femurs. The potential risk of long-term bisphosphonate therapy can be seen in their potent antiresorptive effect, which may be associated with deterioration of bone structure, atypical frac-tures or osteonecrosis of the jaws. Differentially diagnostic consideration should be given to similar radiological findings in congenital and acquired metabolic bone diseases where pseudofractures or fractures from fatigue can occur, e.g. hypophosphatemic rickets. The authors refer to the recom-mended approach for proper management of osteoporosis treatment in order to minimise the occurrence of atypical femoral fractures. The efficacy and safety of long-term administration of antiresorptive drugs and indication to intramedullary nailing of the femoral atypical fractures are discussed.
