{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T23:30:26Z","timestamp":1782603026123,"version":"3.54.5"},"reference-count":4,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2011,10,17]],"date-time":"2011-10-17T00:00:00Z","timestamp":1318809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>We present a case of a 61-year-old female with history of long-term bisphosphonate therapy for osteoporosis initially diagnosed by screening dual-energy X-ray absorptiometry (DXA). After 4 years of treatment with bisphosphonates, the patient presented to primary care with left hip pain. Diagnostic hip radiographs were interpreted as normal, and she continued to take bisphosphonates. Two months later, she experienced a complete transverse subtrochanteric left femur fracture after minimal trauma. The patient underwent open reduction and internal fixation. Review of the patient's postoperative films revealed lateral subtrochanteric cortical beaking at the fracture. This type of \u201catypical\u201d fracture has been reported to be a result of chronic bisphosphonate-associated fractures with high specificity. In addition, the right femur also showed cortical beaking with a horizontal linear lucency in an identical location, suggesting an impending fracture. Longitudinal review of the both diagnostic radiographs as well as DXA images shows a stepwise development of these subtrochanteric abnormalities in both femurs. A current hypothesis regarding the pathophysiology of bisphosphonate-associated fracture is that the medication inhibits bone turnover and repair of microscopic trauma. A cycle of defective repair and continual microtrauma compounded over time gradually weakens the bone and creates an architectural conduit for transverse or \u201catypical\u201d fracture. Standard practice is not to use DXA as a diagnostic \u201cimage.\u201d We present this case to show that a common location and classic appearance of subtrochanteric bisphosphonate-associated fractures may be clearly visualized on absorptiometry images long before fracture. This observation is important because the majority of patients taking bisphosphonate therapy also receive regular DXA imaging. Because of the chronicity of standard bone-density monitoring for these patients throughout their treatment regimen, DXA may find a role for early detection of cortical abnormalities. \u00a9 2012 American Society for Bone and Mineral Research<\/jats:p>","DOI":"10.1002\/jbmr.543","type":"journal-article","created":{"date-parts":[[2011,10,17]],"date-time":"2011-10-17T11:30:12Z","timestamp":1318851012000},"page":"496-498","source":"Crossref","is-referenced-by-count":23,"title":["Evolution of bisphosphonate-related atypical fracture retrospectively observed with DXA scanning"],"prefix":"10.1093","volume":"27","author":[{"given":"Mark A","family":"Ahlman","sequence":"first","affiliation":[{"name":"Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S","family":"Rissing","sequence":"additional","affiliation":[{"name":"Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonie","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2011,10,17]]},"reference":[{"issue":"3","key":"2024020318211134600_bib1","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1302\/0301-620X.89B3.18146","article-title":"Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution","volume":"89","author":"Goh","year":"2007","journal-title":"J Bone Joint Surg."},{"key":"2024020318211134600_bib2","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.2214\/AJR.09.3383","article-title":"Diagnosis of proximal femoral insufficiency fractures in patients receiving bisphosphonate therapy","volume":"194","author":"Porrino","year":"2010","journal-title":"Am J Roentgenol."},{"issue":"11","key":"2024020318211134600_bib3","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1002\/jbmr.253","article-title":"Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research","volume":"25","author":"Shane","year":"2010","journal-title":"J Bone Miner Res."},{"issue":"1","key":"2024020318211134600_bib4","first-page":"311","article-title":"Bisphosphonates and atypical fractures","volume":"3","author":"Masoodi","year":"2010","journal-title":"Br J Med Pract."}],"container-title":["Journal of Bone and Mineral Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjbmr.543","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/27\/2\/496\/56561110\/543_ftp.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/27\/2\/496\/56561110\/543_ftp.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T10:48:21Z","timestamp":1710326901000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmr\/article\/27\/2\/496-498\/7598374"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,10,17]]},"references-count":4,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2011,10,17]]},"published-print":{"date-parts":[[2012,2,1]]}},"URL":"https:\/\/doi.org\/10.1002\/jbmr.543","relation":{},"ISSN":["0884-0431","1523-4681"],"issn-type":[{"value":"0884-0431","type":"print"},{"value":"1523-4681","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2012,2,1]]},"published":{"date-parts":[[2011,10,17]]}}}