| Osteoporosis (OP) is a systemic multiple bone disease. It is mainly characterized by decreased bone mineral density and bone mineral loss, thereby destroying the fine structure of bone tissue, resulting in decreased mechanical strength of the bone and increased fragility, thus increased risk of related pathological fracture. Osteoporotic fracture (OPF, also known as brittle fracture) is one of the most serious complications of OP. It occurs more frequently in older people and has a high incidence. Due to the characteristics of the OP, the OPF is mostly crushed and slowly healed. Because low bone strength and high bone fragility could easily lead to internal fixation loosening and re-fracture, the incidence of disability and mortality is relatively high. At the current status of research, bisphosphonates is the first-line drugs for the prevention and treatment of OPF. Its therapeutic goal is to prevent further bone loss to reduce the risk of initial or subsequent fractures. The use of these drugs can significantly reduce the occurrence of OPF: the incidence of spinal fractures decreased by 40%-70%, and the incidence of hip fractures decreased by 40%-50%. However, considering the main mechanism of action of BPs is the inhibition of osteoclast activity and subsequent inhibition of bone formation, there is concern about whether they would delay or impair the ability of fracture healing, and even cause new fractures, i.e. atypical fractures, which is a rare type of non-traumatic or minimally invasive femoral fracture. Therefore, this question has caused people to think: whether the long-term use of BPs to prevent secondary fractures masks the risk of fracture healing disorders associated with the use of BPs, and ultimately leads to the emergence of atypical fractures. This article reviews the progress of research on the prevention and treatment of OPF using bisphosphonates and provides a basis for the subsequent study of bisphosphonates and clinical application. |