'Stress fracture' in osteoporosis treated with sodium fluoride

Sodium fluoride (NaF) stimulates bone formation in the axial and appendicular skeleton, and is therefore used for the treatment of post-menopausal osteoporosis. Women receiving this treatment often complain of extremity pain explained by mechanical stress on bone tissue. Radiographs are usually normal. Bone scintigraphy demonstrated increased uptake consistent with increased osteoblastic activity, similar in its mechanism to stress fracture. The use of bone scintigraphy is recommended in patients treated with NaF with extremity pain.