A controversy: linking atypical femoral fractures to bisphosphonate therapy

Several cases have been reported of unusual spontaneous fractures with minimal trauma in the subtrochanteric and diaphyseal areas of the femur linked to long-term bisphosphonate use. After encountering three such patients, we conducted a review of published cases. The average age of these individual...

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Bibliographic Details
Published inWest Virginia medical journal Vol. 107; no. 2; p. 8
Main Authors Trotter, Christopher C, Pfister, Alfred K, Whited, Brant A, Goldberg, Todd H, Artz, Steven A
Format Journal Article
LanguageEnglish
Published United States 01.03.2011
Subjects
Adult
Aged
Aged, 80 and over
Biopsy
Bone and Bones - drug effects
Bone and Bones - metabolism
Bone and Bones - pathology
Bone Density Conservation Agents - administration & dosage
Bone Density Conservation Agents - adverse effects
Diphosphonates - administration & dosage
Diphosphonates - adverse effects
Female
Femoral Fractures - diagnostic imaging
Femoral Fractures - etiology
Femoral Fractures - prevention & control
Fractures, Spontaneous - diagnostic imaging
Fractures, Spontaneous - etiology
Fractures, Spontaneous - prevention & control
Glucocorticoids - administration & dosage
Glucocorticoids - adverse effects
Humans
Male
Middle Aged
Osteoporosis - complications
Osteoporosis - diagnostic imaging
Osteoporosis - metabolism
Osteoporosis - physiopathology
Osteoporosis - therapy
Primary Prevention
Radiography
Risk Factors
Time
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Summary:Several cases have been reported of unusual spontaneous fractures with minimal trauma in the subtrochanteric and diaphyseal areas of the femur linked to long-term bisphosphonate use. After encountering three such patients, we conducted a review of published cases. The average age of these individuals were 68 years and approximately 25% had received concomitant glucocorticoids. Histomorphometric bone biopsy studies performed in some individuals have suggested that severe suppression of bone turnover may be the underlying cause; however, cause and effect has not been firmly established. Moreover, population studies have found this type of fracture rare and not increased in patients who have received bisphosphonate treatment. Physicians should continue to use bisphosphonate agents as a primary treatment for osteoporosis.
ISSN:0043-3284