Atypical Fracture With Use of Ibandronate and the Role of Bone Scintigraphy on its Early Diagnosis

Abstract

We report a case of a 49 year-old woman with osteoporosis in treatment with sodium ibandronate 150 mg per week for 5 years that presented leg and knees pain, causing her to stop physical activities. There were no alterations on the physical examination or on plain radiography of legs. A bone scintigraphy with technetium-99m (99mTc) methylene diphosphonate showed a high uptake on the medial third of both femurs and 20 days later, while walking on the street, she fractured her right femur on the position listed above. Even though it is uncommon, bisphosphonates can predispose atypical fractures after a long time of use. It is difficult, though, to predict which patients are going to develop it. This case brings up the question whether bone scintigraphy could be useful as an exam to the early diagnose of atypical fractures on patients using bisphosphonates for a long period of time. doi: http://dx.doi.org/10.4021/jem166w