Bisphosphonate-induced Atypical Femoral Shaft Fracture&#x0D;

Usman Baig,Awais Maqbool

doi:10.7759/cureus.1750

Abstract

Bisphosphonates are used to treat postmenopausal and glucocorticoid-induced osteoporosis, Paget's disease of bone, and malignant hypercalcemia. They have been related to atypical femur fractures. We describe an 83-year-old woman on long-term bisphosphonates presenting with an atypical femur fracture. She underwent a surgical procedure and, a few months later, she presented with a nonunion of the periprosthetic femoral fracture. She underwent an additional surgical procedure and discontinued bisphosphonate treatment. As more atypical femur fractures associated with bisphosphonate use are being reported in the literature, the risk of an atypical femur fracture with bisphosphonate use should not be ignored.

Highlights

Osteoporosis is an important health challenge, and bisphosphonates provide the most benefit at the least cost
The bisphosphonates act by inhibiting the resorption of bone by osteoclasts; as a result, inhibiting bone mineralization and decreasing bone turnover
The medical literature reports that bisphosphonates are a potential cause of atypical femur fractures

Summary

Introduction

Osteoporosis is an important health challenge, and bisphosphonates provide the most benefit at the least cost. An 83-year-old woman presented to our hospital with low-energy trauma resulting in pain in the right thigh, causing an inability to bear weight She has a history of chronic obstructive pulmonary disease, type 2 diabetes mellitus, gastroesophageal reflux disease, and osteoporosis. Teriparatide is a synthetic parathyroid hormone that exists naturally in the body She was undergoing this treatment when, in April 2015, she had another low-energy fall and was brought to the hospital with pain in the right thigh and an inability to bear weight. On radiologic examination, she had DHS implant failure and nonunion of the subtrochanteric fracture (Figure 5 ). She is walking with a walking frame and continues to receive teriparatide injections

Discussion

Conclusions

Disclosures