Bisphosphonate-related atypical femoral fracture

Case contributed by Dr Henry Knipe

Presentation

Left leg pain. No trauma. History of osteoporosis.

Patient Data

Age: 90 years
Gender: Female

Transverse proximal left femoral shaft fracture with medial "beaking". 

Thickening of the lateral shaft cortex on the right. 

99mTc MDP

Nuclear medicine

Increased uptake in the lateral cortex of the proximal femoral shafts bilaterally. 

Case Discussion

Typical appearances of an atypical femoral fracture related to bisphosphonate use on the left with a stress fracture on the right. This patient had a history of taking bisphosphonates for osteoporosis. Recognition of these types of fractures is important because changes are usually bilateral and prophylactic pinning is often performed. 

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