Alendronate induced femur fracture complicated with secondary hyperparathyroidism.

Alendronate is considered to be the gold standard drug for the treatment of postmenopausal osteoporosis. A 75 years old female presented with diaphyseal fracture following trivial fall. Though this fracture pattern was reported in the western world its presence among the population of this subcontinent is very rare. Radiographs showed a transverse fracture in diaphyseal area with lateral cortical thickening and medial spiking. History confirmed that patient was on long term bisphosphonate therapy. Opposite femur also showed lateral cortical thickening at the same level as was seen on fractured side. Biochemical picture was complicated with secondary (Vitamin-D deficiency) hyperparathyroidism. Fracture was fixed with Locking Compression plate and allogenic bone grafting was done. Prophylactic nailing was done on the contralateral side. Vitamin-D and calcium deficiency was corrected and subcutaneous Teriparatide was started. Radiographic evidence of callus formation is present but confirmation of union is uncertain.