title: Atraumatic intracapsular neck of femur fractures after prolonged bisphosphonate treatment: a new atypical variant?
abstract: We present 2 cases of elderly females presenting with atraumatic, near-vertical (Pauwells grade 3), intracapsular neck of femur fractures. Following diagnosis of osteoporosis on DEXA scans, they had received alendronic acid for 7 and 10 years respectively. Routine blood tests and serum estimations of calcium, vitamin-D and thyroid-stimulating hormone, done at admission, were within the normal ranges. These patients were managed with a hemiarthroplasty and a dynamic hip screw (DHS) respectively, following discontinuation of bisphosphonates. We present these 2 cases in light of emerging evidence that associates long-term bisphosphonate use with atypical low energy femoral fractures. Only subtrochanteric/diaphyseal fractures have been reported to date. We present a new variant of atypical femoral neck fractures in metaphyseal bone related to prolonged bisphosphonate therapy.
authors.affiliation: Orthopaedic Registrar, Northumbria Healthcare NHS Trust, Ashington, UK.
authors.forename: Sameer Khalid
authors.initials: SK
authors.lastname: Khan
authors.affiliation: Upper Limb and Trauma Fellow, Sir Charles Gairdner Hospital, Perth, Australia.
authors.forename: Terence
authors.initials: T
authors.lastname: Savaridas
authors.affiliation: Specialty Trainee in Obstetrics and Gynaecology, Wrightington, Wigan and Leigh NHS Foundation Trust, UK.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Hemers
authors.affiliation: Consultant Histopathologist, North Cumbria University Hospitals, Carlisle, UK.
authors.forename: Zouheir
authors.initials: Z
authors.lastname: Maarouf
authors.affiliation: Consultant Geriatrician, North Cumbria University Hospitals, Carlisle, UK.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Orgee
authors.affiliation: Consultant Orthopaedic Surgeon, North Cumbria University Hospitals, Carlisle, UK.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Orr
keywords: atypical hip fractures; bisphosphonates; intracapsular fractures