Early detected femoral neck insufficiency fracture in a patient treated with long-term bisphosphonate therapy for osteoporosis

INTRODUCTION: Atypical femoral fracture is an uncommon complication of prolonged use of bisphosphonates, mainly occurring in the femoral shaft. We report a case of an atraumatic insufficiency fracture of femoral neck after four years of treatment with a bisphosphonate. PRESENTATION OF CASE: A 71-year-old female presented with history of pain on Lt. hip and difficulty in walking. Although there was no fracture on the radiographs, diagnosis could be made early using magnetic resonance imaging (MRI) scans. She was treated by internal fixation using cannulated screws. DISCUSSION: Because bisphosphonate prevents bone healing and remodeling, it is difficult to accomplish the bony union despite of proper treatment in patients who have fractured after long-term use of bisphosphonate. CONCLUSION: A high suspicion index and early diagnosis through the use of MRI are essential for the successful treatment of these fractures.