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

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