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Peri-prosthetic atypical femur fractures are rare. Most are associated with the use of long-term bisphosphonates and other anti-resorptive medications. This case highlights a 74-year-old female treated with approximately 13 years of bisphosphonate therapy followed by a short course of denosumab, who suffered an atraumatic peri-prosthetic fracture after a several month prodrome. This case report's objectives are to show how the prodrome presents, increase recognition of the condition and work up prior to fracture, and emphasize the need to consider drug holidays.


This case report was submitted to the Journal of Family Practice, peer-reviewed, and accepted for publication on 11/9/22. The authors were notified on 11/11/23 that the journal would cease publication before the article could be published.