# Non-union after bisphosphonate-associated atypical femoral fractures: a review of the current literature

## TL;DR

This paper reviews the challenges of non-union in atypical femoral fractures linked to bisphosphonate use, impacting patient quality of life.

## Contribution

The paper compiles current literature to address knowledge gaps and serve as a revision tool for clinical practice.

## Key findings

- Non-union after bisphosphonate-associated atypical femoral fractures leads to severe pain and mobility issues.
- Persistent knowledge gaps exist despite the topic's prominence in surgical and academic settings.
- A comprehensive review is provided to guide clinical management and improve patient outcomes.

## Abstract

This article explores the mechanism of action of atypical femoral fractures (AFF), specifically focussing on osteoporosis, management challenges, and the implications for clinical practice. Non-union of AFF can result in severe pain, deformity and restricted mobility—all of which will have a detrimental impact on the patients’ quality of life.

This review consolidates the current literature regarding non-union after bisphosphonate-associated atypical femoral fractures, providing a revision tool for higher examinations.

An extensive search strategy was conducted for relevant studies up to April 2025 using several online databases including Cochrane Library, Embase, National Library of Medicine and PubMed.

Although this topic is prominent among surgical colleagues and in higher level examinations, we identified that persistent gaps in knowledge exist in this area. Our review compiles the available knowledge as a revision tool for our colleagues.