J Breast Cancer.  2012 Jun;15(2):261-264. 10.4048/jbc.2012.15.2.261.

Atypical Subtrochanteric Femur Fracture in Patient with Metastatic Breast Cancer Treated with Zoledronic Acid

• Kim YS
• Park WC

• KMID: 2242207
• DOI: http://doi.org/10.4048/jbc.2012.15.2.261

Abstract

Several case series have suggested an association exists between atypical femoral subtrochanteric fractures and long-term use of bisphosphonates. It is thought that prolonged use of bisphosphonates may lead to adynamic, fragile bone. The radiologic features of atypical fractures include diffuse cortical thickening, transverse fracture, and beaking at the lateral subtrochanteric area. Atypical subtrochanteric femur fractures have been reported after use of alendronate, but there have been rare reports of atypical femur fractures occurring after administration of zoledronic acid. A 56-year-old female with metastatic breast cancer treated with zoledronic acid presented with pain in the right hip. X-rays showed a right subtrochanteric fracture, and she underwent operation. Four months later after having undergone an operation, the patient struggled with walking and X-ray showed delayed union of the fracture site.

Keyword

Bisphophonate; Breast neoplasms; Femoral neck fracture

MeSH Terms

Alendronate
Animals
Beak
Breast
Breast Neoplasms
Diphosphonates
Female
Femoral Neck Fractures
Femur
Hip
Hip Fractures
Humans
Imidazoles
Middle Aged
Walking
Alendronate
Diphosphonates
Imidazoles

Figure

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  Figure 1 (A) Bone scan reveals metastasis to the left scapula. (B) A follow-up bone scan reveals exacerbation of the metastasis.

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  Figure 2 A mild, focal hot uptake is newly developed in right femur shaft.

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  Figure 3 X-ray shows no skeletal abnormalities.

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  Figure 4 Fracture of the right subtrochanteric femur with dorsal and ventral angulation in transverse orientation (A) AP view, (B) Right lateral view.

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  Figure 5 Postoperative state of the fracture site.

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  Figure 6 X-ray shows cortical beaking of the left femur (circle).

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