title: Spontaneous Bilateral Femoral Fractures After High-Dose Zoledronic Acid.
abstract: The authors report a case of spontaneous bilateral diaphyseal femoral fractures believed to be caused by oversuppression of bone remodeling as a result of long-term, high-dose treatment with bisphosphonate. The patient reported pain in both thighs before the fractures. Typical pathologic changes appeared on both femoral radiograph and bone scan before the fractures. Several hours after admission to the emergency department of the authors' institution, the patient underwent closed reduction and internal fixation with intramedullary nails for the bilateral femoral diaphyseal fractures. Treatment with zoledronic acid was immediately discontinued. In recent years, low-energy femoral diaphyseal fractures in patients undergoing long-term bisphosphonate treatment have been reported. It is believed that the prolonged treatment causes long-term suppression of bone remodeling and accumulation of microdamage. It is important to observe patients who are undergoing bisphosphonate treatment carefully. In this case study, the authors report the patient's unique medical history.
authors.forename: Yaron S
authors.initials: YS
authors.lastname: Brin
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Palmanovich
authors.forename: Ziv
authors.initials: Z
authors.lastname: Heler
authors.forename: Benyamin Josef
authors.initials: BJ
authors.lastname: Kish
authors.forename: Meir
authors.initials: M
authors.lastname: Nyska
authors.forename: Henry
authors.initials: H
authors.lastname: Bismuth
authors.forename: Ryan
authors.initials: R
authors.lastname: Coughlin
authors.forename: Tanya
authors.initials: T
authors.lastname: Zehavi
authors.forename: Pnina
authors.initials: P
authors.lastname: Rotman
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D018483:Diaphyses / Q000293:injuries / Q000601:surgery; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000139:chemically induced* / Q000601:surgery; D005598:Fractures, Spontaneous / Q000139:chemically induced* / Q000601:surgery; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid