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

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 bisphosphonateassociated 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.

Lateral fixation: an alternative surgical approach in the prevention of complete atypical femoral fractures

“…However, recognizing that a large proportion of incomplete AFFs will progress to complete fractures without surgical fixation mandates prophylactic surgical intervention [ 7 , 8 ]. Prophylactic treatment offers several benefits, including shorter operation time, reduced bleeding and shorter postoperative hospitalization [ 7 , 31 ].…”