Long term use of Alendronate (Bisphosphonates) results in following radiological changes in patients presenting with tigh pain: Earliest change would be thickening coex femur (predominantly the lateral coex) Later it results in subtrochanteric fracture through the thickened coex with medial spike. Hence in this scenario the next investigation would be X ray to see for coical thickening and atypical subtrochanteric fractures.