Abstract

The effect of long-term use of alendronate for the treatment of patients with osteoporosis is widely known. However, side effects of this drug, such as its effect on atypical femoral fractures, may have received less attention. Alendronate is one of the bisphosphonates used to treat fractures caused by osteoporosis. Oral or injectable bisphosphonates are used to treat osteoporosis. Atypical femur fracture, a rare type of fracture that has been associated with the long-term use of alendronate, is a potentially devastating consequence of osteoporosis treatment. Several literatures have been reported the effects of longterm alendronate use (over a period of 5 years) and the occurrence of low-energy subtrochanteric/femoral fractures. However, its exact mechanism remains unknown and has not yet been proven. Recently, a relationship between low-energy femoral fracture, profound osteoclast inhibition, the suppression of bone turnover, bone remodeling, and femoral shaft fractures has been elucidated. Here, we provide an overview based on the latest findings from the pathophysiological mechanism, therapeutic management strategies, and the relationship between femoral fracture and short- and long-term use of alendronate. Despite the treatment recommendations of the literature, treating unusual femoral fractures with alendronate is still difficult, and more attention should be paid to the clinical trials of the therapeutic procedures.