Clodronate in a case of femoral head stress fracture in a male with idiopathic osteoporosis: complete recovery with a 6-year follow-up

A male patient 54-year-old, sport practice (tennis and keep-fit exercise) suddenly suffered from disabling pain in the right hip with a severe functional limitation, in absence of any trauma. MRI showed an evident bone marrow edema of the whole femoral right head and neck, that leaded to the diagnosis of CRPS-1. He was therefore treated with a 30-day course of hyperbaric room without results. After rheumatological visit a further radiological opinion changed the diagnosis to incomplete fracture of femoral head with diffuse bone marrow edema. Therefore, he was treated with intravenous clodronate (CLO) at the dose of 300 mg in 250 cc of saline solution for 10 days, added to cholecalciferol, with complete recovery within 4 weeks. Maintenance treatment was performed with weekly intramuscular CLO for 6 months. At this time male idiopathic osteoporosis (spine T-score -3.1) was diagnosed and treated with alendronate. After 6-year follow-up, no pain nor functional limitation was present, and spine T-score decreased to -1.9.