Bisphosphonate-related atypical insufficiency fracture of the tibial plateau : A case report

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  • Suthar Ashish
    Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan Shrey Orthopedic Hospital, Vadodara, Gujarat, India
  • Yukata Kiminori
    Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
  • Suetomi Yutaka
    Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
  • Yamazaki Kazuhiro
    Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan
  • Sakai Takashi
    Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
  • Fujii Hiroshi
    Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Yamaguchi, Japan

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<p>Objective : Only a few cases of insufficiency fractures of the tibial plateau following bisphosphonate use have been reported. The authors report a case with bisphosphonate (BP) -related atypical insufficiency fracture of tibial plateau, which developed delayed union. Patient : A 65-year-old Japanese woman presented with left knee pain without any trauma. She had a 5-year history of risedronate use for primary osteoporosis. Initial X-rays were unremarkable, but magnetic resonance imaging (MRI) confirmed an insufficiency fracture at the left tibial plateau at 3 weeks after the initial visit. Risedronate treatment was stopped because we diagnosed her with a BP-related atypical insufficiency fracture of the tibial plateau. She was treated with rest, a lateral wedge insole and protective weight-bearing with a T-cane for 3 months. Result : At 3-month follow-up, the patient still had a pain and a delayed healing on radiographs. Six months later, X-rays showed that the fracture site had a sclerotic change, but MRI revealed delayed union. At 8-month follow-up, the fracture was healed without any symptoms. Conclusion : All clinicians need to be aware of the delayed healing of atypical insufficiency fracture related with prolonged BP use. J. Med. Invest. 68 : 186-188, February, 2021</p>

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