Mid-diaphyseal Periprosthetic Femur Fracture Secondary to Bisphosphonate Use: A case report

Jun Kim, DO and Jacqueline Krumrey, MD
Good Samaritan Regional Medical Center
Corvallis, OR

Over the last decade, atypical femoral fractures have been demonstrated as an uncommon but emerging complication with the use of bisphosphonates. This emergence led to a task force report by the American Society for Bone and Mineral Research to provide insight into its pathogenesis.

While periprosthetic fractures were excluded from the task force report, periprosthetic atypical femoral fractures have now been shown to be a subset of periprosthetic fractures that display atypical femoral fracture characteristics. We present a case of a 74 year old female who sustained an atraumatic mid-diaphyseal periprosthetic femur fracture with features typically seen with atypical femur fractures associated with bisphosphonate use.

Not only was the fracture located along the femoral mid-diaphysis and at the proximal tip of a distal femur locking plate, but the medullary canal was entirely occluded by sclerotic bone at the fracture site. She underwent successful treatment with removal of the distal femur locking plate and conversion into a retrograde intramedullary femoral nail with subsequent healing of the fracture.

Long-term bisphosphonate therapy for osteoporosis places patients at risk for atypical femoral fractures and providers will need to be vigilant in identifying these atypical characteristics in a subset of periprosthetic fractures.

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