title: Atypical bisphosphonate-associated subtrochanteric and femoral shaft stress fractures: diagnostic features on bone scan.
abstract: A 69-year-old woman presented with a spontaneous right subtrochanteric hip fracture. Pan-imaging following orthopedic repair failed to identify a primary malignancy to explain the presumed pathologic basis for this fracture. The patient then underwent bone scintigraphy and SPECT/CT which showed mild uptake in multifocal endosteal thickening of the lateral left femoral diaphysis, diagnostic of bisphosphonate-associated femoral shaft stress fractures, but no evidence of metastatic bone disease. Atypical bisphosphonate-associated subtrochanteric and femoral shaft stress fractures have a fairly specific appearance on bone scintigraphy, and nuclear medicine physicians should be aware of this relatively infrequent emerging pathology.
authors.affiliation: Division of Nuclear Medicine, Jewish General Hospital, Montreal, QC, Canada. nukesmd@hotmail.com
authors.forename: Stephan
authors.initials: S
authors.lastname: Probst
authors.forename: Rajan
authors.initials: R
authors.lastname: Rakheja
authors.forename: Jerry
authors.initials: J
authors.lastname: Stern
mesh_terms: D000368:Aged; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging* / Q000187:drug effects; D015775:Fractures, Stress / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D006615:Hip / Q000000981:diagnostic imaging*; D006620:Hip Fractures / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D006801:Humans; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D004164:Diphosphonates