Subtrochanteric femoral fracture - bisphosphonate related
78 year old female, thigh pain following a fall from a car
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Displaced subtrochanteric fracture of the left femur. The left hip is enlocated. Note is made of the widening of the lateral cortex proximal and distal to the fracture. Incompletely imaged right femoral gamma nail.
The subtrochanteric region is a less common site for fragility fractures but a more common site for fractures in those who have been on long term bisphosphonates (> 5 years). Thickening of the cortex is a feature seen in stress fractures. Involvement of the lateral cortex is more typical with bisphosphonate related fractures whereas stress fractures associated with osteomalacia tend to involve the medial cortex.
- 1. Porrino JA, Kohl CA, Taljanovic M et-al. Diagnosis of proximal femoral insufficiency fractures in patients receiving bisphosphonate therapy. AJR Am J Roentgenol. 2010;194 (4): 1061-4. doi:10.2214/AJR.09.3383 - Pubmed citation
- 2. Yoon RS, Hwang JS, Beebe KS. Long-term bisphosphonate usage and subtrochanteric insufficiency fractures: a cause for concern?. J Bone Joint Surg Br. 2011;93 (10): 1289-95. doi:10.1302/0301-620X.93B10.26924 - Pubmed citation