Presentation
Fall and pain. History of osteoporosis and chronic use of ibandronic acid (Boniva).
Patient Data
Right femur chalk stick fracture.
Left femur insufficiency fracture classic finding from chronic bisphosphonate use.
Case Discussion
This patient was diagnosed with a chalk stick like fracture of the proximal right femoral diaphysis, and an insufficiency fracture involving the lateral aspect of the left femoral diaphysis cortex. The fractures were fixed by open reduction and internal fixation with bilateral intramedullary nails. Ibandronate was discontinued.
The two uncommon adverse events of long term bisphosphonate use are osteonecrosis of jaw and atypical femur fractures. There is significant controversy regarding the optimal duration of therapy of bisphosphonates. Some authors have recommended the use of drug holidays. However, there is no consensus regarding this.
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