J Korean Orthop Assoc.  2010 Apr;45(2):146-150. 10.4055/jkoa.2010.45.2.146.

Bilateral Femoral Subtrochanteric Insufficiency Fractures after Long-term Bisphosphonate Therapy

• Park JG
• Song KS
• Jung HJ
• Lee JS
• Lee TJ
• Kim KS

• KMID: 2185583
• DOI: http://doi.org/10.4055/jkoa.2010.45.2.146

Abstract

Bisphosphonates are widely used for the treatment of osteoporosis to prevent fractures. Although their safety and efficacy have been well documented, some recent reports have drawn attention to a possible correlation between long term bisphosphonate therapy and the occurrence of insufficiency fractures owing to prolonged bone turnover suppression. A 71-year-old woman presented to our emergency room with pain and deformity of the left thigh with low energy injury. Radiographs showed a left femur subtrochanteric fracture and a transverse sclerotic fracture line in the right femur subtrochanteric area with cortical thickening, which indicate insufficiency fractures. She had been treated with sodium alendronate 70 mg per week for 6 years and was suffering from prodromal symptoms in both thighs from 3 months ago. After surgery and intraoperative bone biopsy for a left subtrochanteric fracture, her osteoporosis medication was changed with a bone forming agent. We have analyzed the characteristics of insufficiency fractures related to long term bisphosphonate therapy. Physicians should keep in mind the possibility of insufficiency fracture in cases such as ours, especially with prodromal thigh pain.

Keyword

femur; subtrochanteric insufficiency fracture; bisphosphonate; alendronate

MeSH Terms

Aged
Alendronate
Biopsy
Congenital Abnormalities
Diphosphonates
Emergencies
Female
Femur
Fractures, Stress
Humans
Osteoporosis
Prodromal Symptoms
Sodium
Stress, Psychological
Thigh
Alendronate
Diphosphonates
Sodium

Figure

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  Figure 1 (A) Plain radiograph shows sclerotic change in the distal end of proximal fracture fragment (blanked arrow) and thickening of the femoral cortex with a localized lateral cortical reaction at the level of fracture on the opposite side (white arrow). (B) CT scan of patient at fracture site shows the characteristic fracture configuration of (a) lateral cortical thickening (blanked arrow), (b) transverse fracture, and (c) beak-like medial cortical spike (white arrow).

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  Figure 2 Postoperative radiograph shows a well fixed nail device inside the medullary canal.

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  Figure 3 Histological findings of fractured fragmented bone (H&E Stain, ×200). The dead bone which showing empty lacunas (arrows) without osteocytes and no osteoclasts are observed.

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  Figure 4 Post-operative bone scintigraphy of patient shows increased uptake (arrow) in the contralateral right femur.

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