Title: April 2018 – What Is It?

Submitted By:Lawrence G. Jankowski, CBDT
Illinois Bone and Joint Institute, LLC Morton Grove, Illinois. USA

Patient History:

A 71 yr old female, surgical menopause at age 43, with a diagnosis of osteoporosis and 13 year history of bisphosphonate exposure (9 years on oral alendronate or ibandronate, a three year drug “holiday” and one dose of zoledronic acid 5mg IV, one year ago). Past surgical medical history includes bilateral total knee replacements for osteoarthritis, and extensive multi-level lumbar spine fusion with hardware.   She was referred to our osteoporosis clinic by her PCP as she was concerned about recent publicity of serious side effects of bisphosphonates, and has had chronic vague right thigh pain for many years.

Bilateral hip BMD and bilateral single energy femur scans were performed. Results of the bilateral hip DXAs as well as right femur frontal radiograph and corresponding coronal MRI are shown in figures 1 and 2 below, respectively. Left femur image (not shown) was unremarkable.


Figure 1: Bilateral hip DXA images and results

Figure 2: Single energy image of the right femur and coronal fluid STIR MRI of the right femur 8 years prior.

Question:

  • Is there imaging evidence for atypical femur fracture based on these images?

To see the rest of this case study please login.