Discontinuation of alendronate and administration of bone-forming agents after surgical nailing may promote union of atypical femoral fractures in patients on long-term alendronate therapy

Table 1 Patient demographics, postoperative treatment, and union time

Case	Age (y)	Sex	Side	Fracture mechanism	Fracture location	Duration of ALN therapy (m)	BMD (T-score)	Surgery	Postoperative treatment	Union time (m)
1	84	F	R	Sprain	FS	36	−2.4	IMN	ALN	24
			L*	Sprain	FS	62	NA	IMN	ALN	31
2	88	F	R	Slipping fall	FS	94	−2.8	IMN	ALN	20
3	80	F	R	Sprain	FS	65	−4.2	IMN	ALN	18
			L*	Sprain	FS	112	NA	IMN	ALN	18
4	83	F	R	Slipping fall	FS	50	−1.0	IMN	ALN	30
5	77	F	L	Sprain	FS	63	−3.0	IMN	TPTD	5
			R**	Sprain	FS	63	NA	IMN	SR	4
6	78	F	R	Slipping fall	FS	52	−1.8	IMN	SR	4
7	74	F	R	Slipping fall	ST	64	−1.7	CMN	SR	5

ALN, alendronate; BMD, bone mineral density; FS, femoral shaft; ST, subtrochanteric; NA, not available; IMN, intramedullary nail; CMN, cephalomedullary nail; TPTD, teriparatide; SR, strontium ranelate.
*Sequential contralateral fractures occurred in the patient continued alendronate after surgery.
**Discontinued bone-forming agent after union of the initial fracture, and sequential contralateral femoral fracture noted 24 months later.

ISSN: 1756-0500