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KMID : 0438420120190020129
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Korean Journal of Bone Metabolism
2012 Volume.19 No. 2 p.129 ~ p.132
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Is It a Simple Stress Fracture or Bisphosphonate-related Atypical Fracture?
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Kang Soo-Yong
Baek Ji-Hoon
Kang Bun-Jung
Kim Min-Kyu
Lee Han-Jun
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Abstract
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A number of reports regarding atypical fractures of the femur have raised questions concerning the possible correlation between long-term bisphosphonate treatment and the occurrence of insufficiency fractures in the proximal femur. However, clinically, it is often confused whether is it a fatigue fracture because of implant induced stress concentration or a bisphosphonate-related atypical fracture, especially in a patient with a subtrochanteric fracture who receive bisphosphonate therapy after open reduction and internal fixation, such as dynamic hip screw (DHS) fixation for previous ipsilateral femoral neck or intertrochanteric fracture. The authors experienced a case of a progressive femoral insufficiency fracture in a woman who had been on Fosamax (Alendronic acid with Vitamin D; Merck & Co. Inc, NJ, USA) therapy for four years after ipsilateral femoral neck fracture treated with a two hole DHS system. Despite a high suspicion of an insufficiency femoral subtrochanteric fracture by bone scan, the occult fracture progressed to a displaced femoral subtrochanteric fracture one year after. The fracture site was fixed with a 6 hole DHS plate, and six months after reoperation the patient had no symptoms and the fracture site had united without any complication.
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KEYWORD
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Bisphosphonate, Early diagnosis, Femoral fractures, Fractures stress, Osteoporosis
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