Atypical Femoral Fractures Shortly After Osteonecrosis of the Jaw in a Postmenopausal Woman Taking Alendronate for Osteoporosis

Context: Bisphosphonates effectively increase bone mineral density and reduce fracture risk in patients with osteoporosis, but there are concerns about osteonecrosis of the jaw (ONJ) and atypical femoral fractures (AFFs) in the long-term users. So far both complications have not been reported as occurring simultaneously in an osteoporotic individual on oral alendronate. Objective: The aim of this study was to report a postmenopausal woman presenting with concomitant ONJ and AFF on oral alendronate treatment. Subject, Measures, and Result: The patient was a 63-year-old woman with a history of rheumatoid arthritis for 30 years and diabetes for 3 years. Spinal compression fractures at levels L3 and L4 were documented, and she took alendronate 70 mg weekly for 7 years. She is the first case whose dental periapical imaging and pelvic radiography documented her ONJ and AFF, which developed subsequently within 6 months. Conclusions: This case report supports the association of both ONJ and AFF with long-term oral bisphosphonate therapy. (J Clin Endocrinol Metab 98: E723-E726, 2013)