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Our case highlights a rare but serious complication of a commonly prescribed antiresorptive agent. It also shows that teriparatide, while helpful in increasing bone mass, does not fully prevent the development of atypical fractures. Careful investigation should be considered in patients on long-term antiresorptive therapy presenting with bony tenderness to exclude an atypical fracture.<\/jats:p>","DOI":"10.1136\/bcr-2019-229366","type":"journal-article","created":{"date-parts":[[2019,7,24]],"date-time":"2019-07-24T06:59:42Z","timestamp":1563951582000},"page":"e229366","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Antiresorptive-associated spontaneous fractures of both tibiae, followed by an atypical femur fracture during the sequential treatment with alendronate, denosumab then teriparatide"],"prefix":"10.1136","volume":"12","author":[{"given":"Juan","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshige","family":"Sano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cambridge University, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth","family":"Poole","sequence":"additional","affiliation":[{"name":"Metabolic Bone Disease Unit, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,7,23]]},"reference":[{"key":"2025082708293458000_12.7.e229366.1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/40.11.1313"},{"key":"2025082708293458000_12.7.e229366.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)07088-2"},{"key":"2025082708293458000_12.7.e229366.3","doi-asserted-by":"crossref","unstructured":"Papapoulos SE . 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