Periprosthetic Femoral Insufficiency Fracture in a Patient on Long-term Bisphosphonate Therapy

Recent literature shows an association between long-term bisphosphonate therapy and low-energy fractures of the subtrochanteric femur. It is thought that the pharmacology of bisphosphonates and stress characteristics of the subtrochanteric femur predispose patients on long-term therapy to fracture. There are few reports in the literature of bisphosphonate-associated periprosthetic fractures with the characteristic fracture pattern. We report a case in a patient with a 10year history of sustained bisphosphonate use. The patient is a 79-year-old female that developed new thigh pain 9 years following a cemented total hip arthroplasty. Radiographs revealed lateral cortical thickening and a transverse periprosthetic stress fracture of the lateral femoral cortex at the level of the distal stem. This fracture appears consistent with a bisphosphonate-associated insufficiency fracture, demonstrating that this pattern is not isolated to nonarthroplasty patients.