title: Atypical fracture of the tibial diaphysis associated with bisphosphonate therapy: a case report.
abstract: Atypical subtrochanteric femoral shaft fractures (AFFs) have recently emerged as a potential long-term complication of bisphosphonate therapy. In 2010, the American Society for Bone and Mineral Research (ASBMR) Task Force published a definition for AFF consisting of 5 major and 7 minor features. Little attention has so far been paid to the possibility that bisphosphonate-associated atypical fractures may also involve the diaphysis of other long bones. We report here the case of a patient on long-term bisphosphonate therapy who presented a diaphyseal tibial insufficiency fracture fulfilling all the major criteria (except for the location), and a number of the minor criteria of an atypical fracture. Our case report suggests the need for greater awareness of the possibility of atypical fractures at other sites, particularly in weight-bearing long bones other than the femur, and suggests that long-term bisphosphonate therapy may also contribute to the occurrence of these atypical fractures.
authors.affiliation: Division of Rheumatology, Faculty of Medicine, University of Sherbrooke, 3001, 12th Avenue North, Sherbrooke, Quebec, Canada.
authors.forename: Lyne
authors.initials: L
authors.lastname: Bissonnette
authors.forename: Pierre-Marc
authors.initials: PM
authors.lastname: April
authors.forename: Réjean
authors.initials: R
authors.lastname: Dumais
authors.forename: Gilles
authors.initials: G
authors.lastname: Boire
authors.forename: Sophie
authors.initials: S
authors.lastname: Roux
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000139:chemically induced; D006801:Humans; D013978:Tibial Fractures / Q000139:chemically induced*
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Atypical fracture; Bisphosphonates; Tibial diaphyseal fracture