Dadrewalla Arshan J, Battle Joseph, Anakwe Raymond
Imperial College Healthcare Trust, St Mary's Hospital, Praed St, London W2 1NY.
J Orthop Case Rep. 2022 Oct;12(10):78-82. doi: 10.13107/jocr.2022.v12.i10.3376.
Long-term bisphosphonate use has been linked to an increased risk of pathological neck of femur fractures.
We write concerning a patient who presented with the left hip pain following a low impact fall, which was diagnosed as a pathological left neck of femur fracture. This was a subtrochanteric stress fracture most frequently seen in patients who take bisphosphonate medications. A key point of difference in our patient is the length of time of bisphosphonate use. A further interesting point was the method of imaging used to diagnose this fracture whereby plain radiographs and computerized tomography imaging both did not show any acute fracture whereas only a magnetic resonance imaging (MRI) hip demonstrated this fracture. Surgical insertion of a prophylactic intramedullary nail was done to stabilize the fracture and reduce the risk of progression to a complete fracture.
This case brings up multiple key points not reviewed previously such as the fact a fracture developed only 1 month after bisphosphonate use rather than months or years. These points suggest that there should be a low threshold for investigation (including MRI scanning) into potential pathological fractures and that bisphosphonate use should be a red flag to initiate these investigations regardless of length of use.
长期使用双膦酸盐与股骨颈病理性骨折风险增加有关。
我们撰写此病例是关于一名患者，其在一次低冲击力跌倒后出现左髋部疼痛，被诊断为左股骨颈病理性骨折。这是一种转子下应力性骨折，最常见于服用双膦酸盐药物的患者。我们这位患者的一个关键不同点在于双膦酸盐的使用时长。另一个有趣的点是用于诊断该骨折的成像方法，普通X线片和计算机断层扫描成像均未显示任何急性骨折，而仅髋关节磁共振成像（MRI）显示了该骨折。通过手术植入预防性髓内钉来稳定骨折并降低发展为完全骨折的风险。
该病例提出了多个此前未被探讨过的关键点，比如在使用双膦酸盐仅1个月后就发生了骨折，而非数月或数年。这些要点表明，对于潜在的病理性骨折，进行检查（包括MRI扫描）的阈值应较低，并且无论双膦酸盐的使用时长如何，其使用都应作为启动这些检查的警示信号。
