Doctors widely prescribe osteoclast-inhibiting bisphosphonate drugs to treat osteoporosis, but long-term bisphosphonate use has been linked to an increased risk of atypical subtrochanteric femoral fractures. According to an updated task force report from the American Society for Bone and Mineral Research, the features that distinguish these atypical subtrochanteric fractures include transverse orientation, general lack of comminution, and localized cortical thickening at the fracture site. In addition, the prolonged healing times of these fractures challenge orthopaedists to obtain strong and stable fixation that outlasts the extended period required for fracture union. Intramedullary nailing is often used to treat these fractures, but related characteristics such as canal narrowing can make this fixation approach unfeasible. This month’s “Case Connections” looks at various techniques for repairing bisphosphonate-associated atypical femoral fractures. In the January 14, 2015, JBJS Case Connecto r , Yuasa et al. reported on the case of a sixty-nine-year-old woman who, one month prior to scheduled right hip arthroplasty to treat osteoarthritis, presented with severe right thigh pain after a low-trauma fall. History-taking revealed four-plus years of treatment with alendronate (Fosamax), and radiographs showed a noncomminuted transverse subtrochanteric fracture below an arthritic hip joint. During a single operation, the patient underwent cementless total hip arthroplasty using a modular stem/neck, followed by fracture reduction and fixation using a cable-and-plate system (Fig. 1). The patient was switched from alendronate to a …