Format

Send to

Choose Destination
See comment in PubMed Commons below
Clin Orthop Relat Res. 2010 Jul;468(7):1991-6. doi: 10.1007/s11999-009-1192-0. Epub 2009 Dec 18.

Case reports: subtrochanteric femoral stress fractures after prolonged alendronate therapy.

Author information

1
Department of Orthopedic Surgery, Institut Jules Bordet, Université Libre de Bruxelles, 1 rue Heger-Bordet, 1000, Brussels, Belgium. katia.cermak@hotmail.com

Abstract

BACKGROUND:

Alendronate is known for its ability to reduce bone loss in osteoporotic and osseous metastatic conditions. Its long-term effects remain unclear although several reports describe cases of proximal femur stress fractures associated with long-term alendronate use.

CASE DESCRIPTION:

We report the cases of four women who sustained low-energy subtrochanteric or femoral shaft stress fractures while being on alendronate therapy for more than 5 years. All radiographs showed typical patterns consisting of a transverse fracture line with external cortical bone reaction and medial cortical spike. Alendronate discontinuation along with nonoperative treatment was sufficient for one patient, whereas surgical stabilization was required in three patients.

LITERATURE REVIEW:

The side effects of alendronate therapy include osteonecrosis of the jaw, esophageal irritation, and musculoskeletal pain. Several cases of insufficiency femoral fractures associated with prolonged alendronate use have been reported. Their radiographic pattern and clinical presentation are consistent with our observations. Although various hypotheses have been suggested, the physiopathogenesis of these stress fractures is not completely understood.

PURPOSES AND CLINICAL RELEVANCE:

Although bisphosphonates play an important role in preventing pathologic fractures in patients with cancer, these subtrochanteric stress fractures associated with prolonged use of alendronate should not be ignored.

PMID:
20020334
PMCID:
PMC2881993
DOI:
10.1007/s11999-009-1192-0
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Springer Icon for PubMed Central
    Loading ...
    Support Center