Atypical bisphosphonate-associated subtrochanteric and femoral shaft stress fractures: diagnostic features on bone scan

Clin Nucl Med. 2013 May;38(5):397-9. doi: 10.1097/RLU.0b013e318286bfb6.


A 69-year-old woman presented with a spontaneous right subtrochanteric hip fracture. Pan-imaging following orthopedic repair failed to identify a primary malignancy to explain the presumed pathologic basis for this fracture. The patient then underwent bone scintigraphy and SPECT/CT which showed mild uptake in multifocal endosteal thickening of the lateral left femoral diaphysis, diagnostic of bisphosphonate-associated femoral shaft stress fractures, but no evidence of metastatic bone disease. Atypical bisphosphonate-associated subtrochanteric and femoral shaft stress fractures have a fairly specific appearance on bone scintigraphy, and nuclear medicine physicians should be aware of this relatively infrequent emerging pathology.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Diphosphonates / adverse effects*
  • Female
  • Femur / diagnostic imaging*
  • Femur / drug effects
  • Fractures, Stress / chemically induced*
  • Fractures, Stress / diagnostic imaging*
  • Hip / diagnostic imaging*
  • Hip Fractures / chemically induced*
  • Hip Fractures / diagnostic imaging*
  • Humans
  • Multimodal Imaging
  • Positron-Emission Tomography
  • Tomography, X-Ray Computed


  • Diphosphonates