Several recent reports have described "atypical" fractures of the subtrochanteric and diaphyseal femoral shaft that occur with minimal or no trauma, associated with the use of bisphosphonates. Physicians treating bone diseases with bisphosphonate need, therefore, to be aware of this potential risk and plan the prophylaxis, early diagnosis and prevention of potential consequences. We review the literature on this newly described complication, with particular focus on pathogenesis, preventive measures suggested before and during therapy with bisphosphonates, and the most frequent clinical presentation of these lesions. The recommendations for the management and care of patients who are on long-term use of alendronate (bisphosphonates) are summarized.