CASE REPORTS - Subtrochanteric femoral stress fractures after prolonged Fosamax therapy

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Clin Orthop Relat Res. 2009 Dec 18. [Epub ahead of print]

Case Reports: Subtrochanteric Femoral Stress Fractures after Prolonged

Alendronate Therapy.

Cermak K, Shumelinsky F, iou J, Gebhart MJ.

Department of Orthopedic Surgery, Institut Jules Bordet, Université

Libre de Bruxelles, 1 rue Heger-Bordet, 1000, Brussels, Belgium.

BACKGROUND: Alendronate is known for its ability to reduce bone loss

in osteoporotic and osseous metastatic conditions. Its long-term

effects remain unclear although several reports describe cases of

proximal femur stress fractures associated with long-term alendronate

use.

CASE DESCRIPTION: We report the cases of four women who sustained

low-energy subtrochanteric or femoral shaft stress fractures while

being on alendronate therapy for more than 5 years. All radiographs

showed typical patterns consisting of a transverse fracture line with

external cortical bone reaction and medial cortical spike. Alendronate

discontinuation along with nonoperative treatment was sufficient for

one patient, whereas surgical stabilization was required in three

patients.

LITERATURE REVIEW: The side effects of alendronate therapy include

osteonecrosis of the jaw, esophageal irritation, and musculoskeletal

pain. Several cases of insufficiency femoral fractures associated with

prolonged alendronate use have been reported. Their radiographic

pattern and clinical presentation are consistent with our

observations. Although various hypotheses have been suggested, the

physiopathogenesis of these stress fractures is not completely

understood.

PURPOSES AND CLINICAL RELEVANCE: Although bisphosphonates play an

important role in preventing pathologic fractures in patients with

cancer, these subtrochanteric stress fractures associated with

prolonged use of alendronate should not be ignored.

PMID: 20020334

http://www.ncbi.nlm.nih.gov/pubmed/20020334

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