Bisphosphonate-induced femoral stress fractures

Discussion:

This patient not only had a history of breast cancer but one of osteoporosis treated with bisphosphonates. While there are uptake on the bone scan (sternum, ribs) consistent with metastatic disease the symmetrical bilateral femoral uptake is not typical. The changes on the x-ray are typical of bisphosphonate-related stress fractures, which can go onto complete fractures. 

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