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Fractures: Bone Repair

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
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[Subtrochanteric pathological fracture on bisphosphonates].

P Y Mathonet¹, S Willems¹, J F Ciornohac¹

¹Service de Chirurgie orthopédique, CHC Liège, Belgique.

Revue Medicale De Liege

|March 9, 2018

Summary

Long-term bisphosphonate use, like alendronate and ibandronate, can lead to atypical femoral fractures. This case highlights a subtrochanteric fracture in a patient with prolonged bisphosphonate therapy.

Keywords:

Osteoporosis Pathological fracture Bisphosphonates

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Area of Science:

Orthopedics
Pharmacology
Geriatric Medicine

Background:

Bisphosphonates are primary treatments for osteoporosis, with ibandronate and alendronate being commonly prescribed.
Long-term bisphosphonate therapy is increasingly associated with adverse skeletal events in the literature.
Atypical femoral fractures are a known, though rare, complication of these medications.

Observation:

A 73-year-old patient presented with a subtrochanteric pathological fracture.
The patient had a history of prolonged treatment with alendronate, followed by ibandronate.
This fracture occurred after extended use of these bisphosphonate medications.

Findings:

The patient's subtrochanteric fracture is consistent with atypical femoral fractures linked to long-term bisphosphonate use.
The specific fracture location (subtrochanteric) is a recognized pattern of these medication-related complications.
This case underscores the potential risk of atypical fractures even with sequential bisphosphonate use.

Implications:

Clinicians should maintain awareness of atypical femoral fracture risks in patients on long-term bisphosphonates.
Careful patient selection and monitoring are crucial for individuals undergoing extended bisphosphonate therapy.
Further research may be needed to elucidate the precise mechanisms and optimal management strategies for these fractures.