Bisphosphonates are used for treatment of postmenopausal osteoporosis. Long terms effects remain unclear although several reports describe cases of proximal femur stress fractures or low energy fractures associated with long term alendronate use. However, it is unclear the treatment that require this kind of fractures, and there are discussions about the best decision between medical or surgical care strategy. We describe a case of a 61 years old woman with 2 years bilateral femoral pain and alendronate therapy for more than 15 years. Radiographs and MRI images showed bilateral femoral stress fractures and cortical bone reaction. In this case we decide surgical treatment whit bilateral intramedullary nailing.

Bisphosphonates are used for treatment of postmenopausal osteoporosis. Long terms effects remain unclear although several reports describe cases of proximal femur stress fractures or low energy fractures associated with long term alendronate use. However, it is unclear the treatment that require this kind of fractures, and there are discussions about the best decision between medical or surgical care strategy. We describe a case of a 61 years old woman with 2 years bilateral femoral pain and alendronate therapy for more than 15 years. Radiographs and MRI images showed bilateral femoral stress fractures and cortical bone reaction. In this case we decide surgical treatment whit bilateral intramedullary nailing.