Bilateral atypical insufficiency fractures of the proximal tibia and unilateral distal femoral fracture associated with long-term intravenous bisphosphonate therapy: a case report

IntroductionAtypical insufficiency fractures of the femur in patients on long-term bisphosphonate therapy have been well described in recent literature. The majority of cases are associated with minimal or no trauma and occur in the subtrochanteric or diaphyseal region.Case presentationWe describe the case of a 76-year-old British Caucasian woman who presented initially to an emergency department and then to her primary care physician with a long-standing history of bilateral knee pain after minor trauma.

Plain radiographs showed subtle linear areas of sclerosis bilaterally in her proximal tibiae. Magnetic resonance imaging confirmed the presence of insufficiency fractures inthese areas along with her left distal femur.

There are very few reports of atypical insufficiency fractures involving the tibia in patients on long-term bisphosphonate therapy and this appears to be the only documented bilateral case involving themetaphyseal regions of the proximal tibia and distal femur.

Conclusion: In addition to existing literature describing atypical fractures in the proximal femur and femoral shaft, there is a need for increased awareness that these fractures can also occur in other weight-bearing areas of the skeleton. All clinicians involved in the care of patients taking long-term bisphosphonates need to be aware of the growing association between new onset lower limb pain and atypical insufficiencyfractures.

Author: Arjuna MAHINDA ImbuldeniyaNatasha JiwaJohn PAUL Murphy
Credits/Source: Journal of Medical Case Reports 2012, 6:50

Published on: 2012-02-06

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