Bilateral Femoral Neck Stress Fractures Due to Opioid Abuse-Induced Osteoporosis: Two Case Reports and Review of Literature

Abstract

Stress fractures are relatively rare injuries. Femoral neck stress fractures are uncommon, while bilateral femoral neck stress fractures are much rarer. Herein, we aimed to report two cases of simultaneous bilateral femoral neck stress fractures in patients with a long-time history of opium addiction. To our knowledge, there are limited reports that describe bilateral femoral neck stress fractures due to opioid abuse-induced osteoporosis. We report simultaneous bilateral femoral neck stress fractures in two patients with long-standing opium addiction who suffered from a complete fracture following a simple fall. Both of them had a history of pain in the hip region that was neglected. Both patients used opium without any medical justification. Initial evaluation revealed bilateral femoral neck stress fractures in both patients. Patients underwent bilateral total hip arthroplasty. They were symptom-free in their last follow-up. Based on previous studies, opioid addiction can reduce bone density (approximately 20–25% of the bone mass) and induce osteoporosis. When the content of bone minerals and its elastic resistance is reduced, any normal or physiological stress applied to the bone can cause insufficiency fractures. Considering that these substances can block the patient’s pain, it is necessary to fully evaluate any bone discomfort in these patients to prevent any irreversible complications.