Skip to main content
Log in

Atypical forearm fractures associated with long-term use of bisphosphonate

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Recent reports on atypical femoral fracture have raised concerns about the long-term use of bisphosphonate. More recent case series focus specifically on the subtrochanteric fractures. But, there is relatively rarity and unawareness of atypical fracture in upper extremity. We report forearm fracture in two women receiving long-term bisphosphonate therapy. First woman presented with pain in the forearm and both thighs and radiographs showed incomplete fractures in a proximal ulnar shaft and bilateral femoral shaft. The other woman had a fracture in the radial shaft. This report suggests atypical fractures associated long-term use of bisphosphonate could occur in bones other than femur. More study is required to identify the magnitude of clinical features of this emerging concern.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Birkbeck DP, Failla JM, Hoshaw SJ, Fyhrie DP, Schaffler M (1997) The interosseous membrane affects load distribution in the forearm. J Hand Surg Am 22(6):975–980

    Article  PubMed  CAS  Google Scholar 

  2. Bjorgul K, Reigstad A (2011) Atypical fracture of the ulna associated with alendronate use. Acta Orthop 82(6):761–763

    Article  PubMed  Google Scholar 

  3. Breglia MD, Carter JD (2010) Atypical insufficiency fracture of the tibia associated with long-term bisphosphonate therapy. J Clin Rheumatol 16(2):76–78

    Article  PubMed  Google Scholar 

  4. Goh SK, Yang KY, Koh JS et al (2007) Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br 89(3):349–353

    PubMed  Google Scholar 

  5. Halls AA, Travill A (1964) Transmission of pressures across the elbow joint. Anat Rec 150:243–247

    Article  PubMed  CAS  Google Scholar 

  6. Hamilton BH, Colsen E, Brukner P (1999) Stress fracture of the ulna in a baseball pitcher. Clin J Sport Med 9(4):231–232

    Article  PubMed  CAS  Google Scholar 

  7. Imai K, Yamamoto S, Anamizu Y, Horiuchi T (2007) Pelvic insufficiency fracture associated with severe suppression of bone turnover by alendronate therapy. J Bone Miner Metab 25(5):333–336

    Article  PubMed  Google Scholar 

  8. Koeppen VA, Schilcher J, Aspenberg P (2012) Atypical fractures do not have a thicker cortex. Osteoporos Int 23(12):2893–2896

    Article  PubMed  CAS  Google Scholar 

  9. Koskinen SK, Mattila KT, Alanen AM, Aro HT (1997) Stress fracture of the ulnar diaphysis in a recreational golfer. Clin J Sport Med 7(1):63–65

    Article  PubMed  CAS  Google Scholar 

  10. Mashiba T, Hirano T, Turner CH, Forwood MR, Johnston CC, Burr DB (2000) Suppressed bone turnover by bisphosphonates increases microdamage accumulation and reduces some biomechanical properties in dog rib. J Bone Miner Res 15(4):613–620

    Article  PubMed  CAS  Google Scholar 

  11. Neviaser AS, Lane JM, Lenart BA, Edobor-Osula F, Lorich DG (2008) Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma 22(5):346–350

    Article  PubMed  Google Scholar 

  12. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY (2005) Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 90(3):1294–1301

    Article  PubMed  CAS  Google Scholar 

  13. Schilcher J, Koeppen V, Ranstam J, Skripitz R, Michaelsson K, Aspenberg P (2013) Atypical femoral fractures are a separate entity, characterized by highly specific radiographic features. A comparison of 59 cases and 218 controls. Bone 52(1):389–392

    Article  PubMed  Google Scholar 

  14. Thompson RN, Phillips JR, McCauley SH, Elliott JR, Moran CG (2012) Atypical femoral fractures and bisphosphonate treatment: experience in two large United Kingdom teaching hospitals. J Bone Joint Surg Br 94(3):385–390

    PubMed  CAS  Google Scholar 

  15. Unnanuntana A, Saleh A, Mensah KA, Kleimeyer JP, Lane JM (2013) Atypical femoral fractures: what do we know about them? J Bone Joint Surg Am 95(2):e8 1–e8 13

    Article  Google Scholar 

  16. Weaver MJ, Miller MA, Vrahas MS (2010) The orthopaedic implications of diphosphonate therapy. J Am Acad Orthop Surg 18(6):367–374

    PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jungyu Moon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moon, J., Bither, N. & Lee, T. Atypical forearm fractures associated with long-term use of bisphosphonate. Arch Orthop Trauma Surg 133, 889–892 (2013). https://doi.org/10.1007/s00402-013-1760-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-013-1760-3

Keywords

Navigation