Early detected femoral neck insufficiency fracture in a patient treated with long-term bisphosphonate therapy for osteoporosis: A need for MRI

Yoon Jae Seong; Jong Ki Shin; Won Ro Park

doi:10.1016/j.ijscr.2020.04.003

Early detected femoral neck insufficiency fracture in a patient treated with long-term bisphosphonate therapy for osteoporosis: A need for MRI

Int J Surg Case Rep. 2020:70:213-215. doi: 10.1016/j.ijscr.2020.04.003. Epub 2020 May 7.

Authors

Yoon Jae Seong¹, Jong Ki Shin¹, Won Ro Park²

Affiliations

¹ Department of Orthopaedic Surgery, Dongeui Medical Center, 62 Yangjung-ro, Jin-gu, Busan, 47227, South Korea.
² Department of Orthopaedic Surgery, Dongeui Medical Center, 62 Yangjung-ro, Jin-gu, Busan, 47227, South Korea. Electronic address: wonro@hanmail.net.

Abstract

Introduction: Atypical femoral fracture is an uncommon complication of prolonged use of bisphosphonates, mainly occurring in the femoral shaft. We report a case of an atraumatic insufficiency fracture of femoral neck after four years of treatment with a bisphosphonate.

Presentation of case: A 71-year-old female presented with history of pain on Lt. hip and difficulty in walking. Although there was no fracture on the radiographs, diagnosis could be made early using magnetic resonance imaging (MRI) scans. She was treated by internal fixation using cannulated screws.

Discussion: Because bisphosphonate prevents bone healing and remodeling, it is difficult to accomplish the bony union despite of proper treatment in patients who have fractured after long-term use of bisphosphonate.

Conclusion: A high suspicion index and early diagnosis through the use of MRI are essential for the successful treatment of these fractures.

Keywords: Bisphosphonate; Femoral neck; Insufficiency fracture; Magnetic resonance imaging.

Publication types

Case Reports