Alendronate-related femoral diaphysis fracture--what should be done to predict and prevent subsequent fracture of the contralateral side?

Abstract

Introduction: Atypical fractures of the femoral diaphysis have recently been associated with alendronate therapy (Neviaser et al. J Orthop Trauma 22(5):346-350, 2008; Kwek et al. Injury 39:224-231, 2008; Lenart et al. N Engl J Med 358:1304-1306, 2008).

Methods: In many cases, fractures have occurred bilaterally prompting debate regarding appropriate screening of the unaffected side (Kwek et al. N Engl J Med 359(3):316-317, 2008).

Case report: We report a case of sequential, bilateral, femoral diaphysis fractures associated with prolonged alendronate therapy and the failure to predict the subsequent fracture of the contralateral side despite radiological imaging.

Discussion: We review the current literature and discuss potential management strategies.