Signs of Insufficiency Fractures Overlooked in a Patient Receiving Chronic Bisphosphonate Therapy

J Am Board Fam Med. 2016 May-Jun;29(3):404-7. doi: 10.3122/jabfm.2016.03.150242.

Abstract

Chronic bisphosphonate therapy is associated with atypical fractures of the subtrochanteric and proximal femoral diaphyseal regions. Various radiologic imaging signs can identify bisphosphonate-associated stress fractures before they progress to complete fractures. Identifying patients who are at risk and modifying treatment can prevent these fractures from occurring. We present a case study of a patient taking bisphosphonate with 2 years of chronic pain, and characteristic clinical signs of bisphosphonate-associated incomplete stress fractures that went untreated until the patient suffered from a right subtrochanteric complete fracture. Our goal is to make physicians aware of the signs of insufficiency fractures associated with chronic bisphosphonate therapy such that appropriate clinical decisions are made to optimize the quality of patient care.

Keywords: Bisphosphonates; Case Reports; Orthopedics; Radiology; Subtrochanteric Fractures.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Alendronate / administration & dosage
  • Alendronate / adverse effects*
  • Alendronate / therapeutic use
  • Anticholesteremic Agents / therapeutic use
  • Bone Density Conservation Agents / administration & dosage
  • Bone Density Conservation Agents / adverse effects*
  • Bone Density Conservation Agents / therapeutic use
  • Diagnosis, Differential
  • Female
  • Fractures, Stress / chemically induced
  • Fractures, Stress / diagnostic imaging*
  • Fractures, Stress / prevention & control
  • Fractures, Stress / surgery
  • Hip Fractures / chemically induced
  • Hip Fractures / diagnostic imaging*
  • Hip Fractures / prevention & control
  • Hip Fractures / surgery
  • Humans
  • Hypercholesterolemia / drug therapy
  • Orthopedic Procedures
  • Osteoporosis / prevention & control*
  • Pain / diagnostic imaging*
  • Pain / etiology
  • Pain Measurement
  • Prophylactic Surgical Procedures
  • Radiography
  • Radionuclide Imaging
  • Simvastatin / therapeutic use
  • Time Factors

Substances

  • Anticholesteremic Agents
  • Bone Density Conservation Agents
  • Simvastatin
  • Alendronate