A rare case of a bisphosphonate-induced peri-prosthetic femoral fracture.
An 81-year-old woman presented with a fracture in the left femur. She had well-fixed bilateral hip replacements and had received long-term bisphosphonate treatment. Prolonged bisphosphonate use has been recently linked with atypical subtrochanteric and diaphyseal femoral fractures. While the current definition of an atypical fracture of the femur excludes peri-prosthetic fractures, this case suggests that they do occur and should be considered in patients with severe osteopenia. Union of the fracture followed cessation of bisphosphonates and treatment with teriparatide. Thus, this case calls into question whether prophylactic intramedullary nailing is sufficient alone to treat early or completed atypical femoral fractures.
Hospital for Special Surgery, 535 E 70th Street, New York, New York 10021, USA. crossm@hss.edu
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Cross
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van der Meulen
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Bostrom
D000369:Aged, 80 and over; D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005264:Femoral Fractures / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy; D057068:Periprosthetic Fractures / Q000139:chemically induced* / Q000000981:diagnostic imaging; D011859:Radiography; D019379:Teriparatide / Q000627:therapeutic use
D050071:Bone Density Conservation Agents; D019379:Teriparatide; D019386:Alendronate