Well-established clinically as frontline therapy in the management of osteoporosis, bisphosphonates have been shown in numerous trials to be highly effective in reducing the risk of both vertebral and hip fractures. More recently, however, in a multitude of exhaustive case reviews, attention has been raised to the small but by now well-established link between prolonged bisphosphonate usage and the risk for atypical subtrochanteric femoral stress fractures. We present herein a trio of illustrative cases highlighting both clinical presentation and characteristic radiological findings thereof, as well as a discussion of the background, management, and natural history of these oftentimes problematic injuries.
Bisphosphonate Femur Fracture
This is a preview of subscription content, log in to check access.
Conflict of interest
The authors declare that they have no conflicts of interest.
Kang J, Won Y, Kim J, Min B et al (2014) Atypical femoral fractures after anti-osteoporotic medication: a Korean multicenter study. Int Orthop. doi:10.1007/s00264-013Google Scholar
Odvina C, Zerwekh J, Rao D et al (2005) Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 90(3):1294–1301PubMedCrossRefGoogle Scholar
Abrahamsen B, Eiken P, Eastell R (2010) Cumulative alendronate dose and the long-term absolute risk of subtrochanteric and diaphyseal femur fractures: a register-based national cohort analysis. J Clin Endocinol Metab 95(12):5258–5265CrossRefGoogle Scholar
Kim S, Scheeweiss S, Katz J et al (2011) Oral bisphosphonates and risk of subtrochanteric or diaphyseal femur fractures in a population-based cohort. J Bone Miner Res 26(5):993–1001PubMedCrossRefPubMedCentralGoogle Scholar
Shane E, Burr D, Abrahamsen B et al (2010) 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. doi:10.1002/jbmr.1998Google Scholar
Bisonette L, April P, Dumais R et al (2013) Atypical fracture of the tibial diaphysis associated with bisphosphonate therapy: a case report. Bone 56(2):406–409CrossRefGoogle Scholar
Isaacs J, Shidiak L, Harris I et al (2010) Femoral insufficiency fractures associated with prolonged bisphosphonate therapy. Clin Orthop Relat Res 468(12):3384–3392PubMedCrossRefPubMedCentralGoogle Scholar
Edwards B, Bunta A, Lane J et al (2013) Bisphosphonates and nonhealing femoral fractures: analysis of the FDA Adverse Event Reporting System (FAERS) and international safety efforts: a systematic review from the Research on Adverse Drug Events and Reports (RADAR) project. J Bone Joint Surg Am 95(4):297–307PubMedCrossRefPubMedCentralGoogle Scholar
Rizzoli R, Akesson K, Kanis J et al (2011) Subtrochanteric fractures after long-term treatment with bisphosphonates: a European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and International Osteoporosis Foundation Working Group project. Osteoporos Int 22(2):373–390PubMedCrossRefPubMedCentralGoogle Scholar
Porrino J, Kohl C, Taljanovic M et al (2010) Clinical perspective. Diagnosis of proximal femoral insufficiency fractures in patients receiving bisphosphonate therapy. AJR 194:1061–1064PubMedCrossRefGoogle Scholar