title: Pelvic fractures associated with long-term bisphosphonate therapy - case report.
abstract: Long term bisphosphonate use has been associated with "atypical" subtrochanteric and diaphyseal fractures of the femoral shaft. We are reporting a case of pelvic fractures in addition to atypical long bone fractures, in a patient with osteopenia treated with bisphosphonate for 8 years, and teriparatide for 2 years. After 5 years of bisphosphonate therapy the patient suffered an atraumatic fracture of the femoral shaft. With an additional 3 years of bisphosphonate use she fractured both the upper and lower pubic rami on the left side. Bone histomorphometry performed on a biopsy of right iliac crest was negative for malignancy and calcification defects. It showed normal to low/normal bone turnover which correlated well with a low NTX level. Post-surgical X-rays revealed cortical thickening of the femur and beaking at the femoral shaft fracture, the classic findings associated with alendronate-related fractures. The pelvic fractures also reveal beaking at the fracture sites. Spontaneous fracture of the pelvis with unusual characteristics, in a patient with an atypical fracture of the femur suggests that the pelvic fracture may be related to long term bisphosphonate therapy.
authors.affiliation: Kansas University Medical Center, USA.
authors.forename: V
authors.initials: V
authors.lastname: Patel
authors.forename: L
authors.initials: L
authors.lastname: Graves
authors.forename: B
authors.initials: B
authors.lastname: Lukert
mesh_terms: D019386:Alendronate / Q000009:adverse effects / Q000627:therapeutic use; D015519:Bone Density / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D010388:Pelvis / Q000293:injuries*; D012307:Risk Factors; D019379:Teriparatide / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D019379:Teriparatide; D019386:Alendronate