We present a rare case of femoral head indentation fracture without associated hip dislocation in an elderly female secondary to a low-energy trauma. She was managed with primary total hip arthroplasty and achieved an excellent functional outcome. We have proposed the mechanism of injury and discussed shortcomings in the present classification systems. A review of literature of such cases is presented along with the rationale for our management decision and the various other treatment modalities available for the surgeon.

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<p class="keywords"><span lang="EN-US">Bisphosphonates are mainstay of anti-resorptive therapies for osteoporosis. They prevent osteoporotic fractures by 40 to 70 % in women and men with osteoporosis.<span> Use of these medications is not free from complications. A case of 62 year old female who presented with left thigh pain after trivial fall at home. X-ray diagnosed as atypical femur fracture of left femur which was fixed internally with interlock nailing. On 1^st postoperative day, she complained of pain in right thigh. X-ray revealed an atypical femur fracture of left femur shaft which was also fixed internally with nailing. Biochemical investigations were suggestive of effectiveness of zoledronic therapy. We report this first case of bilateral sequential atypical femur fractures that was treated with zoledronate for 2 years. To our knowledge there are reports of oral alendronate therapy with atypical femoral fractures but none on zoledronic acid.</span></span></p><p class="keywords"><span lang="EN-US"> </span></p>