Bisphosphonates (BPs) have proven successful in reducing fragility fractures and are the most commonly used antiresorptive drugs. However, the reduced bone remodeling that is the source of their immense benefits also gives rise to side effects. The first reports linking atypical femoral fractures (AFFs) to BPs appeared around 15 years ago but, despite the known connection, the process leading to injury is still unclear. AFFs have characteristic radiographic features that must be detected in order to identify the lesion and establish appropriate treatment. Their unique factors make surgery challenging, and indeed the surgical approach is burdened by a higher rate of complications. With the purpose of raising awareness, we describe, in detail, 4 cases of atypical subtrochanteric/diaphyseal femoral fractures treated by our department and provide a review of the recent literature.
