J Korean Fract Soc.  2017 Jul;30(3):137-141. 10.12671/jkfs.2017.30.3.137.

Atypical Fracture-Like Insufficiency Fracture of the Tibia with Prolonged Bisphosphonate Drug: A Case Report

Affiliations
  • 1Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea. hangugi@gmail.com
  • 2Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
  • 3Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Atypical femoral fracture related to a long-term bisphosphonate therapy has commonly been reported; however, a fracture at the site other than the femur has rarely been reported to date. Herein, we report a case of a patient on long-term bisphosphonate therapy who presented atypical tibial insufficiency fracture at the anterolateral aspect of diaphysis, without trauma. We, for the first time in Korea, present this case with a literature review.

Keyword

Tibial diaphysis; Atypical tibial insufficiency fracture; Bisphosphonate

MeSH Terms

Diaphyses
Femoral Fractures
Femur
Fractures, Stress*
Humans
Korea
Tibia*

Figure

  • Fig. 1 Preoperative radiograph shows atypical tibial diaphyseal fracture (white arrows), including periosteal reaction, endosteal thickening, and a radiolucent fracture line.

  • Fig. 2 Preoperative computed tomography shows periosteal reaction, cortical thickening, and transverse fracture line (white arrows).

  • Fig. 3 Bone scan of this patient shows increased uptake (arrow) at the anterolateral area of tibial diaphysis.

  • Fig. 4 Using intramedullary nailing, operation was performed.

  • Fig. 5 The radiographs of tibia taken eight months after the operation show callus formation at the fracture site, with a diminished gap of fracture.


Reference

1. Park JM, Sung KS. Stress fractures of the tibia. Arthrosc Orthop Sports Med. 2015; 2:95–102.
Article
2. Bone HG, Hosking D, Devogelaer JP, et al. Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004; 350:1189–1199.
Article
3. Shane E, Burr D, Abrahamsen B, et al. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2014; 29:1–23.
Article
4. Yang KH, Min BW, Ha YC. Atypical femoral fracture: 2015 position statement of the Korean Society for Bone and Mineral Research. J Bone Metab. 2015; 22:87–91.
Article
5. Rogers MJ, Crockett JC, Coxon FP, Mönkkönen J. Biochemical and molecular mechanisms of action of bisphosphonates. Bone. 2011; 49:34–41.
Article
6. Moon J, Bither N, Lee T. Atypical forearm fractures associated with long-term use of bisphosphonate. Arch Orthop Trauma Surg. 2013; 133:889–892.
Article
7. Beals RK, Cook RD. Stress fractures of the anterior tibial diaphysis. Orthopedics. 1991; 14:869–875.
Article
8. Bissonnette L, April PM, Dumais R, Boire G, Roux S. Atypical fracture of the tibial diaphysis associated with bisphosphonate therapy: a case report. Bone. 2013; 56:406–409.
Article
9. Odvina CV, Levy S, Rao S, Zerwekh JE, Rao DS. Unusual mid-shaft fractures during long-term bisphosphonate therapy. Clin Endocrinol (Oxf). 2010; 72:161–168.
Article
10. Breglia MD, Carter JD. Atypical insufficiency fracture of the tibia associated with long-term bisphosphonate therapy. J Clin Rheumatol. 2010; 16:76–78.
Article
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