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Case Reports: Subtrochanteric Femoral Stress Fractures after Prolonged Alendronate Therapy

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  • Trauma
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Clinical Orthopaedics and Related Research®

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.

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Acknowledgments

We thank Martine Piccart, PhD, and Thierry Gil, MD, for assistance in reviewing this manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1 rue Heger-Bordet, 1000, Brussels, Belgium

    Katerina Cermak MD, Felix Shumelinsky MD & Michael J. Gebhart MD

  2. Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium

    Jean Alexiou MD

Authors
  1. Katerina Cermak MD
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  2. Felix Shumelinsky MD
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  3. Jean Alexiou MD
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  4. Michael J. Gebhart MD
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Corresponding author

Correspondence to Katerina Cermak MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the reporting of this case report, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Cermak, K., Shumelinsky, F., Alexiou, J. et al. Case Reports: Subtrochanteric Femoral Stress Fractures after Prolonged Alendronate Therapy. Clin Orthop Relat Res 468, 1991–1996 (2010). https://doi.org/10.1007/s11999-009-1192-0

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  • DOI: https://doi.org/10.1007/s11999-009-1192-0

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