Abstract
Case Presentation: A 24-year-old woman with a history of recurrent fractures and multiple bony pains was diagnosed with polyostotic fibrous dysplasia (FD) 3 years previously. There were no associated cutaneous or endocrine manifestations (hypophosphatemia, hormone excess state). She received optimal calcium and vitamin D supplementation. As the patient had persistent pain, she was treated with pamidronate intravenously 1 mg/kg/day for 3 days every 4 months, with serial monitoring of serum N-terminal telopeptide. After 2 years of bisphosphonate therapy, the patient presented with complaint of pain in the left leg, spontaneous in onset, and she underwent an X-ray. X-ray of the left tibia-fibula (Fig. 1) displayed a spiral, noncomminuted fracture of the tibial diaphysis, with beaking of the adjacent cortex and increased cortical bone density. Serum calcium, phosphorus, and vitamin D levels were normal. What is the diagnosis?
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