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)


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.

Access the Clinical Cases Database

A subscription is required to read the full article. Please subscribe using one of the options below.

Foundation Years Clinical Cases Database£29.006 months
Add to cart
Foundation Years Clinical Cases Database£39.0012 months
Add to cart


Dr. Indunil Gunawardena

SpR General and Geriatric Medicine
Royal Bournemouth Hospital


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.


Conflict Of Interest

The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (

Financial Statement

The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.

Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts ( The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

Animal & Human Rights

When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.

About the Clinical Cases Database

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.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.