Early Detected Femoral Neck Insufficiency Fracture in a Patient Treated with Long-term Bisphosphonate Therapy for Osteoporosis: A Need for MRI

Overview

Journal Int J Surg Case Rep

Specialty General Surgery

Date 2020 May 18

PMID 32417741

Citations 3

Authors

Yoon Jae Seong

Jong Ki Shin

Won Ro Park

Affiliations

Soon will be listed here.

Abstract

Introduction: Atypical femoral fracture is an uncommon complication of prolonged use of bisphosphonates, mainly occurring in the femoral shaft. We report a case of an atraumatic insufficiency fracture of femoral neck after four years of treatment with a bisphosphonate.

Presentation Of Case: A 71-year-old female presented with history of pain on Lt. hip and difficulty in walking. Although there was no fracture on the radiographs, diagnosis could be made early using magnetic resonance imaging (MRI) scans. She was treated by internal fixation using cannulated screws.

Discussion: Because bisphosphonate prevents bone healing and remodeling, it is difficult to accomplish the bony union despite of proper treatment in patients who have fractured after long-term use of bisphosphonate.

Conclusion: A high suspicion index and early diagnosis through the use of MRI are essential for the successful treatment of these fractures.

Citing Articles

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References

Whyte M, Wenkert D, Clements K, McAlister W, Mumm S . Bisphosphonate-induced osteopetrosis. N Engl J Med. 2003; 349(5):457-63. DOI: 10.1056/NEJMoa023110. View

Odvina C, Zerwekh J, Rao D, Maalouf N, Gottschalk F, Pak C . Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab. 2004; 90(3):1294-301. DOI: 10.1210/jc.2004-0952. View

Khan S, Savaridas T, Hemers J, Maarouf Z, Orgee J, Orr M . Atraumatic intracapsular neck of femur fractures after prolonged bisphosphonate treatment: a new atypical variant?. Clin Cases Miner Bone Metab. 2016; 13(1):38-41. PMC: 4869952. DOI: 10.11138/ccmbm/2016.13.1.038. View

Kim D, Lee E, Kang S . Insufficiency fracture of ipsilateral femur neck in patient treated with long term bisphosphonate treatment - a case report -. J Bone Metab. 2014; 19(2):159-62. PMC: 3780924. DOI: 10.11005/jbm.2012.19.2.159. View

Rivadeneira F, Zillikens M, De Laet C, Hofman A, Uitterlinden A, Beck T . Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam Study. J Bone Miner Res. 2007; 22(11):1781-90. DOI: 10.1359/jbmr.070712. View

Ahn D, Kim J, Lee J, Kim J . Bilateral Femoral Neck Insufficiency Fractures after Use of a Long-term Anti-resorptive Drug Therapy for Osteoporosis: A Case Report. Hip Pelvis. 2016; 27(2):115-9. PMC: 4972626. DOI: 10.5371/hp.2015.27.2.115. View

Russell R, Watts N, Ebetino F, Rogers M . Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int. 2008; 19(6):733-59. DOI: 10.1007/s00198-007-0540-8. View

McClung M, Harris S, Miller P, Bauer D, Davison K, Dian L . Bisphosphonate therapy for osteoporosis: benefits, risks, and drug holiday. Am J Med. 2012; 126(1):13-20. DOI: 10.1016/j.amjmed.2012.06.023. View

Suh Y, Jang B, Nho J, Won S, Lee W . Atypical incomplete femoral neck fracture in patients taking long-term bisphosphonate: Case report, a report of 2 cases. Medicine (Baltimore). 2019; 98(9):e14701. PMC: 6831339. DOI: 10.1097/MD.0000000000014701. View

10.

Turek J, Ebetino F, Lundy M, Sun S, Kashemirov B, McKenna C . Bisphosphonate binding affinity affects drug distribution in both intracortical and trabecular bone of rabbits. Calcif Tissue Int. 2012; 90(3):202-10. PMC: 10132775. DOI: 10.1007/s00223-012-9570-0. View

11.

Pentecost R, Murray R, Brindley H . FATIGUE, INSUFFICIENCY, AND PATHOLOGIC FRACTURES. JAMA. 1964; 187:1001-4. DOI: 10.1001/jama.1964.03060260029006. View

12.

Bone H, Hosking D, Devogelaer J, Tucci J, Emkey R, Tonino R . Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004; 350(12):1189-99. DOI: 10.1056/NEJMoa030897. View

13.

Reid I . Short-term and long-term effects of osteoporosis therapies. Nat Rev Endocrinol. 2015; 11(7):418-28. DOI: 10.1038/nrendo.2015.71. View

14.

McClung M . The relationship between bone mineral density and fracture risk. Curr Osteoporos Rep. 2005; 3(2):57-63. DOI: 10.1007/s11914-005-0005-y. View

15.

Schileo E, Balistreri L, Grassi L, Cristofolini L, Taddei F . To what extent can linear finite element models of human femora predict failure under stance and fall loading configurations?. J Biomech. 2014; 47(14):3531-8. DOI: 10.1016/j.jbiomech.2014.08.024. View

16.

Agha R, Borrelli M, Farwana R, Koshy K, Fowler A, Orgill D . The SCARE 2018 statement: Updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg. 2018; 60:132-136. DOI: 10.1016/j.ijsu.2018.10.028. View

17.

Paparodis R, Buehring B, Pelley E, Binkley N . A case of an unusual subtrochanteric fracture in a patient receiving denosumab. Endocr Pract. 2013; 19(3):e64-8. DOI: 10.4158/EP12367.CR. View

18.

Poole K, Mayhew P, Rose C, Brown J, Bearcroft P, Loveridge N . Changing structure of the femoral neck across the adult female lifespan. J Bone Miner Res. 2009; 25(3):482-91. DOI: 10.1359/jbmr.090734. View