Subtrochanteric Femoral Insufficiency Fracture in Woman on Bisphosphonate Therapy for Glucocorticoid-Induced Osteoporosis
نویسندگان
چکیده
We present the case of an 85-year-old woman who sustained a subtrochanteric femoral shaft insufficiency fracture after receiving bisphosphonate therapy for osteoporosis. After more than 6 years of taking risedronate sodium (Actonel) and daily supplemental calcium carbonate and vitamin D, the patient developed right anterior thigh pain that was worse with weight-bearing. A small, pyramidal ridge of cortical bone was demonstrated by radiographs and CT along the antero-lateral subtrochanteric region of the right femoral shaft. On MRI, there was focally increased T2 signal in the adjacent bone marrow. Radionuclide bone scan showed moderately-intense, focally-increased uptake. The lesion was recognized as a potential stress riser for fracture; however, before a prophylactic intramedullary rod could be placed, the patient suffered a low-energy insufficiency fracture through the lesion. In the setting of bisphosphonate therapy for osteoporosis, a painful pyramidal projection of cortical bone in the subtrochanteric femoral shaft should be recognized as an impending insufficiency fracture and treated expeditiously.
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Prophylactic intramedullary fixation for bisphosphonate-related subtrochanteric stress fracture.
Bisphosphonates are the most widely used medication to treat osteoporosis. Recent reports have documented an association between chronic bisphosphonate use and femoral insufficiency fractures. This article describes an 84-year-old woman with a diagnosis of osteoporosis treated with bisphosphonate medications for 9 years. She presented with left groin pain, and magnetic resonance imaging reveale...
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