Long-Term Alendronate Use Not without Consequences?

M P Somford, G F A E Geurts, J W A M den Teuling, B J W Thomassen, W F Draijer, M P Somford, G F A E Geurts, J W A M den Teuling, B J W Thomassen, W F Draijer

Abstract

A previously unknown side effect of biphosphonate use is emerging. In a specific patient group on long term biphosphonate therapy stress femur fractures seem to occur. The typical presentation consists of prodromal pain in the affected leg and/or a discrete cortical thickening on the lateral side of the femur in conventional radiological examination or the presentation with a spontaneous transverse subtrochanteric femur with typical features. We present three cases of this stress fracture in patients on bisphosphonate therapy. One of these patients suffered a bilateral femur fracture of the same type. In our opinion, in patients on bisphosphonate therapy who present with a spontaneous femur fracture, seizing therapy is advisable. In bilateral cases preventive nailing should be considered.

Figures

Figure 1
Figure 1
X-ray taken at first presentation of thigh pain on the right side. There is a sign of discrete lateral cortex thickening.
Figure 2
Figure 2
The subtrochanteric fracture through the lateral cortex thickening with a medial spike.
Figure 3
Figure 3
Cortical thickening (arrow) at the site of the pain in the left thigh.
Figure 4
Figure 4
The subtrochanteric fracture through the thickening of the lateral cortex with a medial spike.
Figure 5
Figure 5
Thickening of the lateral cortex (arrow) at the site of the pain in the left thigh.
Figure 6
Figure 6
SPECT of the lesion on the left femur showing bilaterally thickened cortices and both internally and externally intact cortices. On the left side the bone scan showing a hotspot on the lateral side of the left femur.
Figure 7
Figure 7
Fracture through the thickening of the lateral cortex with a medial spike.
Figure 8
Figure 8
Subtrochanteric fracture in the same patient as Figures 5 and 6 on the contra-lateral side. The fracture has the exact same pattern.

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