title: Signs of Insufficiency Fractures Overlooked in a Patient Receiving Chronic Bisphosphonate Therapy.
abstract: Chronic bisphosphonate therapy is associated with atypical fractures of the subtrochanteric and proximal femoral diaphyseal regions. Various radiologic imaging signs can identify bisphosphonate-associated stress fractures before they progress to complete fractures. Identifying patients who are at risk and modifying treatment can prevent these fractures from occurring. We present a case study of a patient taking bisphosphonate with 2 years of chronic pain, and characteristic clinical signs of bisphosphonate-associated incomplete stress fractures that went untreated until the patient suffered from a right subtrochanteric complete fracture. Our goal is to make physicians aware of the signs of insufficiency fractures associated with chronic bisphosphonate therapy such that appropriate clinical decisions are made to optimize the quality of patient care.
authors.affiliation: From Wayne State University School of Medicine (WS), Detroit, MI; Department of Orthopedic Surgery (DM), St John Providence Health System, Southfield, MI; School of Medicine (SM), Mercer University, Macon, GA. wshaikh@med.wayne.edu.
authors.forename: Wassi
authors.initials: W
authors.lastname: Shaikh
authors.affiliation: From Wayne State University School of Medicine (WS), Detroit, MI; Department of Orthopedic Surgery (DM), St John Providence Health System, Southfield, MI; School of Medicine (SM), Mercer University, Macon, GA.
authors.forename: Dan
authors.initials: D
authors.lastname: Morris
authors.affiliation: From Wayne State University School of Medicine (WS), Detroit, MI; Department of Orthopedic Surgery (DM), St John Providence Health System, Southfield, MI; School of Medicine (SM), Mercer University, Macon, GA.
authors.forename: Sean
authors.initials: S
authors.lastname: Morris
mesh_terms: D000368:Aged; D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D015775:Fractures, Stress / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000517:prevention & control / Q000601:surgery; D006620:Hip Fractures / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000517:prevention & control / Q000601:surgery; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy; D019637:Orthopedic Procedures; D010024:Osteoporosis / Q000517:prevention & control*; D010146:Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D010147:Pain Measurement; D065286:Prophylactic Surgical Procedures; D011859:Radiography; D011877:Radionuclide Imaging; D019821:Simvastatin / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000924:Anticholesteremic Agents; D050071:Bone Density Conservation Agents; D019821:Simvastatin; D019386:Alendronate
keywords: Bisphosphonates; Case Reports; Orthopedics; Radiology; Subtrochanteric Fractures