What condition is associated with atypical stress fractures due to long-term bisphosphonate use?

Long-term use of bisphosphonates, which are medications commonly prescribed to treat osteoporosis, can lead to atypical stress fractures. These fractures are most often seen in the femoral neck and can occur in patients without a significant history of trauma, distinguishing them from typical stress fractures that usually occur in active individuals or athletes. The mechanism behind these atypical fractures is thought to be related to the suppression of bone remodeling caused by bisphosphonates, which can lead to brittle bones over time. In osteoporosis, where bone density is decreased and bone quality is impaired, patients are particularly at risk for these types of fractures when using bisphosphonates continuously for prolonged periods. Bone health management in these patients typically involves monitoring treatment duration and assessing the need for periodic drug holidays to mitigate this risk.

Other conditions such as bone marrow cancer, Paget's disease, and osteogenesis imperfecta do not have established links with atypical stress fractures induced specifically by bisphosphonate therapy. Thus, the association with osteoporosis highlights the need for careful management of patients on these medications to prevent complications.