Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 2 2022 09 26 68 74 Salman Ghaffari Associate professor of orthopedic surgery, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Mehran Razavipour Associate professor of orthopedic surgery, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Soroosh Fateh Resident of orthopedic surgery, Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran. 2021 05 15 2021 05 30 We report a rare case of bilateral subtrochanteric femoral fracture related to prolonged treatment with Alendr onate. Bisphosphonates are the most common drugs used for treatment of osteoporosis and prevention of the risk of osteoporosis-related fractures. Atypical femoral fractures (AFF) have been reported in patients who have been on long term treatment with bisphosphona te especially Alendr onate. our case was a 68- year- old woman who sustained bilateral subtroc- hanteric femoral fracture after a simple falling down. She had a past medical history of osteoporosis and had been on treatment with alendronate for 5 years. Radiographs showed bilateral fractures in femur subtrochanteric area. We decided to use double plating technique and we used angled blade plate and locking plate (LCP). Alendronate was discontinued and Teriparatide was started. Careful evaluation of hip or thigh pain in patients who are on prolonged courses of bisphosphonates is essential. Our method of fixation with double plating can be used in pa tients with poor bone quality. https://crcp.tums.ac.ir/index.php/crcp/article/view/541