Bisphosphonate-induced femoral stress fractures

Case contributed by Henry Knipe


Bilateral leg pain. Past history of metastatic breast cancer.

Patient Data

Age: 50 years
Gender: Female

99mTc MDP

Nuclear medicine

Tracer uptake representing skeletal metastases in the anterior end of the right 2nd rib as well as in the sternum. 

Mild focal increase in tracer uptake at lateral mid-shaft cortex of both femora.

Lateral cortical thickening is seen bilaterally. No fracture line seen. 

Case Discussion

This patient not only had a history of breast cancer but one of osteoporosis treated with bisphosphonates. While there are uptake on the bone scan (sternum, ribs) consistent with metastatic disease the symmetrical bilateral femoral uptake is not typical. The changes on the x-ray are typical of bisphosphonate-related stress fractures, which can go onto complete fractures. 

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