A 70 years old female is on treatment with Alendronate for 7 years for osteoporosis. Now she complains of pain in right thigh. What is the next investigation to be performed? (AIIMS Nov 20/3, May 2013)
Ans. b. X-ray (Ref: American Journal of Geriatric Pharmacotherapy, Volume 9, Issue 3, June 2011, 194-198; T 2012/1118)The pain in right thigh in a 70 years old female, who is on treatment with alendronate for 7 years for osteoporosis might be due to fragility fracture due to prolonged use of bisphosphonates. X-ray would be the best investigation to see the fractures.'Despite the great success achieved by using bisphosphonates in osteoporotic patients during last two decades, there remains a group of patients who may develop femoral fragility fractures secondary to Severely Suppressed Bone Turnover (SSBT) caused by prolonged bisphosphonate use, mainly with alendronate.Plain X-rays showed a characteristic picture consisting of a transverse or short oblique fracture line, lateral cortical thickening, and medial spiking.Spontaneous femoral shaft fracture after long-term alendronate:Alendronate is used as first-line treatment for osteoporosis in postmenopausal women worldwide.The evidence supporting its benefit in reducing the risk of fragility fracture among this high-risk group is well established.Due to its mechanism of action, there were concerns about potential reduction in bone turnover, repair of microdamage and hence reduced bone toughness and increased risk of fractures with long-term use.Plain X-rays:Plain X-rays showed a characteristic picture consisting of a transverse or short oblique fracture line, lateral cortical thickening, and medial spiking.
DEXA scan
X-ray
Serum vitamin D levels
Serum alkaline phosphate levels
Imaging of Metabolic Bone Disease