Question
A 74 year old woman who has taken alendronate for 8 years has had thigh ache for 2 months. She fractures her femur stepping off a kerb.
- What features define this fracture?
- How is it managed?
- What should be done about the other femur?
Answer
ASBMR major features
- Minimal or no trauma
- Located between the lesser trochanter and the supracondylar flare
- Transverse or short oblique, starting at the lateral cortex
- Little or no comminution
- Complete fractures have a medial spike, incomplete fractures involve only the lateral cortex
- Minor features include lateral cortical beaking, prodromal pain, bilateral fractures and delayed healing
Management
- Cephalomedullary nail spanning the femur
- Avoid varus malreduction and account for femoral bowing
- Stop the bisphosphonate, correct calcium and vitamin D, and consider teriparatide
- Healing is slower than for typical fractures
Contralateral femur
- Image the whole opposite femur
- Incomplete fracture with pain or a radiolucent line, prophylactic nailing
- Asymptomatic beaking, stop the bisphosphonate and monitor
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.