Abstract
Bisphosphonates have been widely used in the treatment of osteoporosis with well-documented
long-term efficacy and safety, particularly in postmenopausal patients. But over the
past decade, low-energy atypical subtrochanteric and proximal diaphyseal femoral fractures
have emerged as an unexpected complication of prolonged bisphosphonate use. To the
radiologist unfamiliar with this entity, the findings may be subtle and often missed,
potentially evolving from an early incomplete fracture to a displaced complete fracture
with a delay in diagnosis.
In such instances where the radiographic findings are negative or equivocal and patients
present with prodromal symptoms of aching or dull groin or thigh pain, additional
work-up with advanced imaging techniques, such as magnetic resonance imaging, computed
tomography, or bone scintigraphy, may prove diagnostic owing to their multiplanar
capabilities and earlier detection of subtle periosteal changes. It is imperative
that radiologists develop a search pattern to help identify such fractures and consider
imaging evaluation of the contralateral extremity in suspected cases with prodromal
symptoms to assess for an incomplete asymptomatic or minimally symptomatic fracture.
Keywords
bisphosphonates - osteoporosis - atypical femur fractures
