Table 3.
Radiographic observations from patients treated with bisphosphonates
| Fracture status | Patient | Black line on plain film | Black line on CT | MRI | Bone scan | Radiographic thick cortex | Transverse lateral cortical fracture |
|---|---|---|---|---|---|---|---|
| Stress fracture treated prophylactically | 1 | NA | No | NA | NA | Yes | NA |
| 2 | No | No | A, B, C | NA | Yes | NA | |
| 3 | Yes* | NA | A, B | E | Yes | NA | |
| 4 | Yes | NA | NA | E | Yes | NA | |
| 4 | Yes | NA | NA | E | Yes | NA | |
| 5 | No | No | NA | E | Yes | NA | |
| 6 | No | NA | NA | NA | Yes | NA | |
| 7 | No | NA | C | NA | No¶ | NA | |
| 8 | NA | NA | A, B | NA | Yes | NA | |
| 9 | No | NA | NA | NA | Yes | NA | |
| 9 | Yes† | NA | NA | NA | Yes | NA | |
| 10 | No | No | A, B | NA | Yes | NA | |
| 11 | No‡ | No | A, B | NA | Yes | NA | |
| 12 | No‡ | NA | A, B | NA | Yes | NA | |
| Completed fracture after radiographic studies | 3 | NA | NA | B, D | NA | Yes | Yes |
| 7 | Yes* | Yes | B§ | F§ | Yes | Yes | |
| 10 | No | No | A, B | NA | Yes | Yes | |
| 13 | Yes* | NA | NA | E | Yes | Yes | |
| 14 | NA | NA | A, B | NA | Yes | Yes | |
| 14 | NA | NA | A, B∥ | NA | Yes | Yes | |
| 16 | No | NA | NA | E | Yes | Yes | |
| Completed fracture before any radiographic studies | 5 | NA | NA | NA | NA | Yes | Yes |
| 15 | NA | NA | NA | NA | Yes | Yes | |
| 16 | NA | NA | NA | NA | NA# | Yes** |
* Subtle; †partial-thickness black line; ‡developed a thin black line in the zone of thickened cortical bone after intramedullary nail fixation; §4 months before CT scan and fracture; ∥6 months before fracture (3 months before symptom onset); ¶periosteal reactive bone present (she had minimal thickening on the opposite side before it fractured); #original fracture films not available; **original fracture films not available; transverse fracture exhibits rounding of edges on 16 months postoperative films; NA = not available; A = lateral cortical thickening; B = localized edema pattern; C = visible stress fracture line; D = lateral cortical irregularity, questionable thickening; E = focal lateral cortical increased activity; F = focal increased activity, medial greater than lateral.