Bisphosphonate-associated atypical femur fracture

Abstract

Background: Bisphosphonate therapies have long been reported to decrease the risk of typical low trauma fractures in the elderly population and are commonly prescribed for this indication. In recent literature, case reports of atypical sub-trochanteric and femoral shaft fractures have been documented in patients treated with bisphosphonates. Clinical details: Herein we report on an 81-year-old woman with postmenopausal osteoporosis who presented with an atypical femoral sub-trochanteric fracture on plain film X-ray following approximately 5 months for query left hip bursitis after having received risedronate and alendronate therapy for >5 years. Outcomes: The patient was transferred to a hospital closer to home for further rehabilitation 10 days after surgery. Her bisphosphonate therapy was ceased with advice for her general practitioner (GP) to undertake annual bone mineral density testing, as well as regular calcium and vitamin D levels. It was also recommended that the patient be referred to a bone health clinic. Conclusion: The burden of atypical fractures is significant both for the healthcare system and, more importantly, patients. There are now clear radiological changes to bone scans that give rise to the possibility of bisphosphonate-associated atypical fractures; therefore, it is recommended that patients on long-term bisphosphonate therapy for osteoporosis be reviewed every 5 years. In addition, GPs should be informed of the need for surveillance for prodromal symptoms and the possibility of atypical and minimal trauma fractures associated with long-term bisphosphonate use.