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We present a patient who presented to the emergency department with a bisphosphonate-induced femoral fracture (BIFF). Clinical presentation, pathogenesis and management of BIFF are discussed. We also highlight the importance of imaging the contralateral femur, as these patients may need prophylactic surgical fixation of the contralateral femur. © 2020 The Royal Australian and New Zealand College of Radiologists.INTRODUCTION Diabetic patients with peripheral arterial disease (PAD) are challenging to assess. Non-contrast magnetic resonance