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\frac{\left(x^{4}+4x^{2}+9\right)x^{2}}{x^{2}}-\frac{45}{x^{2}}
To add or subtract expressions, expand them to make their denominators the same. Multiply x^{4}+4x^{2}+9 times \frac{x^{2}}{x^{2}}.
\frac{\left(x^{4}+4x^{2}+9\right)x^{2}-45}{x^{2}}
Since \frac{\left(x^{4}+4x^{2}+9\right)x^{2}}{x^{2}} and \frac{45}{x^{2}} have the same denominator, subtract them by subtracting their numerators.
\frac{x^{6}+4x^{4}+9x^{2}-45}{x^{2}}
Do the multiplications in \left(x^{4}+4x^{2}+9\right)x^{2}-45.