<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2306-4102</journal-id>
<journal-title><![CDATA[Acta ortopédica mexicana]]></journal-title>
<abbrev-journal-title><![CDATA[Acta ortop. mex]]></abbrev-journal-title>
<issn>2306-4102</issn>
<publisher>
<publisher-name><![CDATA[Colegio Mexicano de Ortopedia y Traumatología A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2306-41022025000600401</article-id>
<article-id pub-id-type="doi">10.35366/121820</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Bilateral atypical femoral fractures caused by long-term use of bisphosphonate treatment in postmenopausal osteoporosis]]></article-title>
<article-title xml:lang="es"><![CDATA[Fracturas femorales atípicas bilaterales causadas por uso prolongado de tratamiento con bifosfonato en osteoporosis postmenopáusica]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Jasqui-Remba]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Grobeisen-Levin]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Jasqui-Romano]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez-Rejón]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Médico ABC  ]]></institution>
<addr-line><![CDATA[Mexico City ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad Autónoma Metropolitana - Xochimilco  ]]></institution>
<addr-line><![CDATA[Mexico City ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital Ángeles Lomas  ]]></institution>
<addr-line><![CDATA[Mexico City ]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<volume>39</volume>
<numero>6</numero>
<fpage>401</fpage>
<lpage>404</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2306-41022025000600401&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2306-41022025000600401&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2306-41022025000600401&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: This paper presents two cases of bilateral atypical femoral fractures in postmenopausal women who underwent prolonged bisphosphonate therapy for osteoporosis. Both patients, aged 83 and 76, experienced fractures after long-term bisphosphonate treatment, highlighting concerns about suppressed bone turnover. Each case was treated with intramedullary nailing, and bisphosphonates were discontinued in favor of alternative therapies. These cases underscore the risks of atypical femoral fractures linked to extended bisphosphonate use, emphasizing the need for careful patient monitoring and further research to optimize osteoporosis treatment strategies and prevent such complications.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: Este artículo presenta dos casos de fracturas femorales atípicas bilaterales en mujeres posmenopáusicas con tratamiento prolongado con bifosfonatos para la osteoporosis. Ambas pacientes, de 83 y 76 años, sufrieron fracturas tras un tratamiento prolongado con bifosfonatos, lo que pone de manifiesto la preocupación que suscita la supresión del recambio óseo. En ambos casos, la reducción de las fracturas fue mediante colocación de clavos intramedulares y se suspendió el tratamiento con bifosfonatos cambiando el manejo por terapias alternativas. Estos casos dan relevancia a los riesgos de fracturas femorales atípicas relacionadas con el uso prolongado de bifosfonatos, y subrayan la necesidad de un seguimiento cuidadoso de los pacientes y de más investigación para optimizar las estrategias de tratamiento de la osteoporosis y prevenir tales complicaciones.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[osteoporosis]]></kwd>
<kwd lng="en"><![CDATA[bisphosphonates]]></kwd>
<kwd lng="en"><![CDATA[atypical femoral fracture]]></kwd>
<kwd lng="en"><![CDATA[osteoporotic fracture]]></kwd>
<kwd lng="en"><![CDATA[intramedullary nailing]]></kwd>
<kwd lng="es"><![CDATA[osteoporosis]]></kwd>
<kwd lng="es"><![CDATA[bifosfonatos]]></kwd>
<kwd lng="es"><![CDATA[fractura femoral atípica]]></kwd>
<kwd lng="es"><![CDATA[fractura osteoporótica]]></kwd>
<kwd lng="es"><![CDATA[clavo intramedular]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Eastell]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[O&#8217;Neill]]></surname>
<given-names><![CDATA[TW]]></given-names>
</name>
<name>
<surname><![CDATA[Hofbauer]]></surname>
<given-names><![CDATA[LC]]></given-names>
</name>
<name>
<surname><![CDATA[Langdahl]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Reid]]></surname>
<given-names><![CDATA[IR]]></given-names>
</name>
<name>
<surname><![CDATA[Gold]]></surname>
<given-names><![CDATA[DT]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Postmenopausal osteoporosis]]></article-title>
<source><![CDATA[Nat Rev Dis Primers]]></source>
<year>2016</year>
<volume>2</volume>
<page-range>16069</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kanis]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
</person-group>
<collab>World Health Organization Scientific Group</collab>
<source><![CDATA[Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield]]></source>
<year>2007</year>
<publisher-loc><![CDATA[UK ]]></publisher-loc>
<publisher-name><![CDATA[Printed by the University of Sheffield]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Camacho]]></surname>
<given-names><![CDATA[PM]]></given-names>
</name>
<name>
<surname><![CDATA[Petak]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
<name>
<surname><![CDATA[Binkley]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Diab]]></surname>
<given-names><![CDATA[DL]]></given-names>
</name>
<name>
<surname><![CDATA[Eldeiry]]></surname>
<given-names><![CDATA[LS]]></given-names>
</name>
<name>
<surname><![CDATA[Farooki]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis - 2020 Update]]></article-title>
<source><![CDATA[Endocr Pract]]></source>
<year>2020</year>
<volume>26</volume>
<numero>^s1</numero>
<issue>^s1</issue>
<supplement>1</supplement>
<page-range>1-46</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rogers]]></surname>
<given-names><![CDATA[MJ]]></given-names>
</name>
<name>
<surname><![CDATA[Monkkonen]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Munoz]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Molecular mechanisms of action of bisphosphonates and new insights into their effects outside the skeleton]]></article-title>
<source><![CDATA[Bone]]></source>
<year>2020</year>
<volume>139</volume>
<page-range>115493</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Drake]]></surname>
<given-names><![CDATA[MT]]></given-names>
</name>
<name>
<surname><![CDATA[Clarke]]></surname>
<given-names><![CDATA[BL]]></given-names>
</name>
<name>
<surname><![CDATA[Khosla]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Bisphosphonates: mechanism of action and role in clinical practice]]></article-title>
<source><![CDATA[Mayo Clin Proc]]></source>
<year>2008</year>
<volume>83</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>1032-45</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Allgrove]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Bisphosphonates]]></article-title>
<source><![CDATA[Arch Dis Child]]></source>
<year>1997</year>
<volume>76</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>73-5</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Schilcher]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Koeppen]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Aspenberg]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Michaelsson]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Risk of atypical femoral fracture during and after bisphosphonate use]]></article-title>
<source><![CDATA[Acta Orthop]]></source>
<year>2015</year>
<volume>86</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>100-7</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hwang]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Seo]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Lim]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Choi]]></surname>
<given-names><![CDATA[MS]]></given-names>
</name>
<name>
<surname><![CDATA[Park]]></surname>
<given-names><![CDATA[JW]]></given-names>
</name>
<name>
<surname><![CDATA[Nam]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Bilateral atypical femoral fractures after bisphosphonate treatment for osteoporosis: a literature review]]></article-title>
<source><![CDATA[J Clin Med]]></source>
<year>2023</year>
<volume>12</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>1038</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sellmeyer]]></surname>
<given-names><![CDATA[DE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Atypical fractures as a potential complication of long-term bisphosphonate therapy]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2010</year>
<volume>304</volume>
<numero>13</numero>
<issue>13</issue>
<page-range>1480-4</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Yin]]></surname>
<given-names><![CDATA[RV]]></given-names>
</name>
<name>
<surname><![CDATA[Hirpara]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[NC]]></given-names>
</name>
<name>
<surname><![CDATA[Lee]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Llanos]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Increased risk for atypical fractures associated with bisphosphonate use]]></article-title>
<source><![CDATA[Fam Pract]]></source>
<year>2015</year>
<volume>32</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>276-81</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Odvina]]></surname>
<given-names><![CDATA[CV]]></given-names>
</name>
<name>
<surname><![CDATA[Zerwekh]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Rao]]></surname>
<given-names><![CDATA[DS]]></given-names>
</name>
<name>
<surname><![CDATA[Maalouf]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Gottschalk]]></surname>
<given-names><![CDATA[FA]]></given-names>
</name>
<name>
<surname><![CDATA[Pak]]></surname>
<given-names><![CDATA[CY]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Severely suppressed bone turnover: a potential complication of alendronate therapy]]></article-title>
<source><![CDATA[J Clin Endocrinol Metab]]></source>
<year>2005</year>
<volume>90</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>1294-301</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Edwards]]></surname>
<given-names><![CDATA[BJ]]></given-names>
</name>
<name>
<surname><![CDATA[Bunta]]></surname>
<given-names><![CDATA[AD]]></given-names>
</name>
<name>
<surname><![CDATA[Lane]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Odvina]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Rao]]></surname>
<given-names><![CDATA[DS]]></given-names>
</name>
<name>
<surname><![CDATA[Raisch]]></surname>
<given-names><![CDATA[DW]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Bisphosphonates and nonhealing femoral fractures: analysis of the FDA Adverse Event Reporting System (FAERS) and international safety efforts: a systematic review from the Research on Adverse Drug Events And Reports (RADAR) project]]></article-title>
<source><![CDATA[J Bone Joint Surg Am]]></source>
<year>2013</year>
<volume>95</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>297-307</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Balach]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Baldwin]]></surname>
<given-names><![CDATA[PC]]></given-names>
</name>
<name>
<surname><![CDATA[Intravia]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Atypical femur fractures associated with diphosphonate use]]></article-title>
<source><![CDATA[J Am Acad Orthop Surg]]></source>
<year>2015</year>
<volume>23</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>550-7</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Koh]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Guerado]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Giannoudis]]></surname>
<given-names><![CDATA[PV]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Atypical femoral fractures related to bisphosphonate treatment: issues and controversies related to their surgical management]]></article-title>
<source><![CDATA[Bone Joint J]]></source>
<year>2017</year>
<volume>99</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>295-302</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nayak]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Greenspan]]></surname>
<given-names><![CDATA[SL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A systematic review and meta-analysis of the effect of bisphosphonate drug holidays on bone mineral density and osteoporotic fracture risk]]></article-title>
<source><![CDATA[Osteoporos Int]]></source>
<year>2019</year>
<volume>30</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>705-20</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
