Bilateral atypical femoral fracture related to bisphosphonate therapy

Abstract

Introduction Although bisphosphonates represent the most commonly prescribed antiresorptive therapy for the treatment of osteoporosis and fracture prevention, paradoxically, their continuous use in some patients can lead to an atypical femoral fracture. This type of fracture is characterized by specific features regarding clinical presentation, mechanism of injury and radiological manifestations. The objective of this article was to present a case of a bilateral femoral fracture associated with bisphosphonate usage.

Case outline A 70-year-old female patient was admitted to the emergency department with a severe, throbbing pain in both thighs after a ground-level fall. Radiographs of both femurs verified bilateral complete fracture localized in the diaphyseal region. Prior to hospitalization, she had continuously been taking ibandronate for three years. The patient underwent percutaneous osteosynthesis with intramedullary nailing with interlocking screws of both femurs. Six weeks after the surgical treatment, radiographic findings indicated the presence of early signs of healing on both femurs. At the four-month follow-up, the complete union of the bone fragments was achieved and she managed to walk without any pain and walking aids.

Conclusion Physicians still face doubts regarding optimal duration of bisphosphonate therapy. Although atypical femoral fracture represents a rare adverse event related to bisphosphonate use, all patients receiving this antiresorptive treatment who are complaining of new-onset unexplained pain in the thighs for more than two weeks should be completely diagnostically evaluated in term of atypical femoral fracture. Patients with confirmed atypical femoral fracture should undergo surgical treatment.

Keywords: osteoporosis; antiresorptive treatment; intramedullary nailing