Successful conservative treatment: multiple atypical fractures in osteoporotic patients after bisphosphate medication: a unique case report

Abstract

Bisphosphonates have been commonly used for the treatment of osteoporosis. However, there have been recent case reports of atypical fractures citing their long-term use, which inhibits the turnover of bone components. A 64-year-old woman visited the outpatient clinic with pain in her right thigh and ambulation difficulty. We found fractures at both pedicles of L4 vertebra. subtrochanteric region of right femur, and left femoral shaft upon a radiologic examination. She had taken intravenous ibandronic sodium for osteoporosis over 3 years. We changed the bishophonates to a parathyroid hormone because it was suspected that the multiple fractures were caused by the medication. Further, rehabilitation, including progressive weight bearing, was started. After 3 months of the conservative treatment, she was able to walk independently. In conclusion, it is necessary to evaluate the possibility of atypical fractures in osteoporotic patients when they complain of lower extremity pain and to consider alternative treatments instead of bisphosphonates.

FIGURE 1

Hip MRI reveals a right femur subtrochanteric fracture (arrows). MRI = magnetic resonance imaging.

FIGURE 2

Hybrid SPECT–CT scan was conducted. (A) The SPECT-CT demonstrates the bilateral pedicle fracture through L4 (arrows). (B) The SPECT-CT parasagittal reconstruction image confirms L4 pedicle fractures (arrows). SPECT–CT = single-photon emission computed tomography–computed tomography.

FIGURE 3

(A) Bone scan taken in 2011 shows no fractures. (B) Bone scan in 2013 shows multiple fractures including both a femur fracture and a bilateral pedicle (arrows).

FIGURE 4

(A) Femur x-ray was conducted at the time of diagnosis (arrows). (B) Femur x-ray was conducted after conservative management (arrows).