Clinical Orthopaedics and Related Research®

, Volume 468, Issue 7, pp 1991–1996

Case Reports: Subtrochanteric Femoral Stress Fractures after Prolonged Alendronate Therapy

  • Katerina Cermak
  • Felix Shumelinsky
  • Jean Alexiou
  • Michael J. Gebhart
Case Reports Trauma

DOI: 10.1007/s11999-009-1192-0

Cite this article as:
Cermak, K., Shumelinsky, F., Alexiou, J. et al. Clin Orthop Relat Res (2010) 468: 1991. doi:10.1007/s11999-009-1192-0

Abstract

Background

Alendronate is known for its ability to reduce bone loss in osteoporotic and osseous metastatic conditions. Its long-term effects remain unclear although several reports describe cases of proximal femur stress fractures associated with long-term alendronate use.

Case Description

We report the cases of four women who sustained low-energy subtrochanteric or femoral shaft stress fractures while being on alendronate therapy for more than 5 years. All radiographs showed typical patterns consisting of a transverse fracture line with external cortical bone reaction and medial cortical spike. Alendronate discontinuation along with nonoperative treatment was sufficient for one patient, whereas surgical stabilization was required in three patients.

Literature Review

The side effects of alendronate therapy include osteonecrosis of the jaw, esophageal irritation, and musculoskeletal pain. Several cases of insufficiency femoral fractures associated with prolonged alendronate use have been reported. Their radiographic pattern and clinical presentation are consistent with our observations. Although various hypotheses have been suggested, the physiopathogenesis of these stress fractures is not completely understood.

Purposes and Clinical Relevance

Although bisphosphonates play an important role in preventing pathologic fractures in patients with cancer, these subtrochanteric stress fractures associated with prolonged use of alendronate should not be ignored.

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Katerina Cermak
    • 1
  • Felix Shumelinsky
    • 1
  • Jean Alexiou
    • 2
  • Michael J. Gebhart
    • 1
  1. 1.Department of Orthopedic SurgeryInstitut Jules Bordet, Université Libre de BruxellesBrusselsBelgium
  2. 2.Department of Radiology, Institut Jules Bordet Université Libre de BruxellesBrusselsBelgium