Julia Calatayud MD, Presenter: Nothing to Disclose

Daniel Castellon PhD, Abstract Co-Author: Nothing to Disclose

Maria Gonzalez Vazquez, Abstract Co-Author: Nothing to Disclose

Alex Grande, Abstract Co-Author: Nothing to Disclose

Gabriel C. Fernandez MD, Abstract Co-Author: Nothing to Disclose

Maria Velasco MD, Abstract Co-Author: Nothing to Disclose

Francisco Tardaguila Montero MD, Abstract Co-Author: Nothing to Disclose

Sandra Baleato Gonzalez MD, Abstract Co-Author: Nothing to Disclose

To describe the paradoxical effect between prolonged bisphosphonates use and femoral fractures. To analyze typical characteristics imaging features of these fractures by Rx, CT and MRI, asses the treatment and compared with those published in the literature.

Retrospective study was performed. We reviewed 15 fractures in 11 patients receiving prolonged treatment with bisphosphonates since March 2007 to July 2011. All of them were women. Age range 61-84 years (Mean 72). The patients received this treatment a minimum of 4 years and a maximum of 14 (Mean 9 years). The studies were reviewed by 2 radiologists with 4 and 10 years of experience. We recorded the following imaging features: Complete/Incomplete; Unilateral/Bilateral; Fracture orientation; Displacement pattern; Marrow edema; Cortical thickening association; Horizontal linear lucency.

All patients reported not or minimal trauma. A total of 15 fractures were collected, 10 subtrochanteric and 5 diaphyseal. In 4 patients (40%) were bilateral. 8 were complete fractures (55%) and 7 incomplete (45%). All of them showed focal thickening of the cortex. 5 patient showed an horizontal linear lucency visible on the RX and CT. MRI revealed marrow edema in the 3 patients studied. All incomplete fractures were treated with intramedullary prophylactic nail except two that were not treated and progressed to complete fracture.

It has been recently describe the paradoxical association between prolonged use of bisphosphonates and subtrochanteric insufficiency femur fractures. Our results are very similar to those reported in the literature. Knowledge of these fractures and their imaging features is essential for early diagnosis and proper patient management

Recognize imaging presentation of atypical femur fractures caused by prolongated biphosphonates therapy and early diagnosis is primordial to avoid complete fractures and guide appropriate treatment.

Calatayud, J, Castellon, D, Gonzalez Vazquez, M, Grande, A, Fernandez, G, Velasco, M, Tardaguila Montero, F, Baleato Gonzalez, S, Insufficiency Femur Fractures Associated with Prolonged Biphosphonate Therapy.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12026021.html