Clinical Case Database / Category: Case Based Discussion

Osteoporosis, fractures & bisphosphonates

Publication details

Dr. Indunil Gunawardena
Foundation Years Journal, volume 6, issue 1, p.14 (123Doc Education, London, January 2012)

Abstract

Ms MA presented with bilateral, sequential bisphosphonate-related subtrochanteric fractures. Unique clinical and radiographic features surrounding these atypical fractures that have been illustrated in the literature are identified in this case.

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Authors

Dr. Indunil Gunawardena

SpR General and Geriatric Medicine
Royal Bournemouth Hospital

References

1. Gunawardena I, Baxter M, Rasekh Y. Bisphosphonate-Related Subtrochanteric Femoral Fractures. AJGP 2011: (9) 3: 194-198.
2. Cummings SR, Melton III LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet 2002;359:1761-7.
3. WHO Study Group. Assessment of fracture risk and its application to postmenopausal osteoporosis. World Health Organ Tech Ser 1984;(843).
4. Kanis JA on behalf of the World Health Organization Scientific Group (2008) Assessment of osteoporosis at the primary health-care level. Technical Report. WHO Collaborating Centre, University of Sheffield, UK.
5. Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX® and the assessment of fracture probability in men and women from the UK Osteoporos Int 19: 385-397
6. Compston JE. Sex steroids and bone. Physiol Rev 2001;81:419-47.
7. Kanis JA, Compston J, Cooper A, et al: Guideline for the diagnosis and management of osteoporosis. National Osteoporosis Guideline Group (NOGG) 2010.
8. Shane E. Evolving data about subtrochanteric fractures and bisphosphonates. N Engl J Med 2010; 362;19: 1825-27.
9. Bilezikian JP. Efficacy of bisphosphonates in reducing fracture risk in postmenopausal osteoporosis. Am J Med 2009;122: Suppl:S14-S21.
10. Goh SK, Yang KY, Koh JS, et al.: Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br 2007, 89:349–353.
11. Kwek EB, Goh SK, Koh JS, et al.: An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury 2008, 39:224–231.
12. Neviaser AS, Lane JM, Lenart BA, et al.: Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma 2008, 22:346–350.
13. Odvina CV, Levy S, Rao S, et al.: Unusual mid-shaft fractures during long-term bisphosphonate therapy. Clin Endocrinol (Oxf) 2009 Mar 19 [Epub ahead of print].
14. Visekruna M, Wilson D, McKiernan FE: Severely suppressed bone turnover and atypical skeletal fragility. J Clin Endocrinol Metab 2008, 93:2948–2952.
15. Shane E, Burr D, Ebeling PR, et al, for American Society for Bone and Mineral Research. Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010;25:2267–2294.
16. Nieves JW, Cosman F. Atypical subtrochanteric and femoral shaft fractures and possible association with bisphosphonates. Curr Osteoporos Rep 2010, 8:34-39.
17. Schilcher J, Michaeisson K, Aspenberg P, Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 2011;364:1728-1737.

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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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