Bisphosphonate Use and Atypical Fractures of the Femoral Shaft

Abstract

These population-based nationwide analyses may be reassuring for patients who receive bisphosphonates. Although there was a high prevalence of current bisphosphonate use among patients with atypical fractures, the absolute risk was small. (Funded by the Swedish Research Council.).

Subtrochanteric/femoral shaft Versus hip fractures: Incidences and identification of risk factors

“…Here, we could not use, as others, the ICD-10 codes that allowed to know the circumstance of the occurrence of the trauma (codes beginning by ''W''). (20) This information was underencoded as reported in less than 1% of the selection for 2009, for example. Table 1 described the selected hospitalizations at each step.…”

Atypical femur fractures: Refining the clinical picture

“…The odds ratio of ever having used a BP in patients who had an atypical rather than a typical femoral shaft fracture was a modest 2.11 (95% CI 0.99-4.49). Where 78% of Swedish patients with atypical femur fractures had a history of BP use, (4) the US study found this to be the case for 62% of patients with COMMENTARY…”

“…Although not a case-control study in a strict sense, this study provides interesting insights that add to those from the Swedish national register data published last year in the New England Journal of Medicine by Schilcher and colleagues. (4) Briefly, the Swedish Schilcher study suggested a rapid, reversible, and above all very pronounced increase in atypical femur fractures among bisphosphonate (BP) users. Thus, the OR for these fractures was 1.3 (95% confidence interval [CI] 1.1-1.6) per 100 prescribed daily doses, corresponding to an almost 10-fold increase in risk within the first 2 years of treatment and a 120-fold increase in the first 5 years.…”

“…The US study (3) reviewed 864 X-rays from patients with fractures of the femoral shaft or subtrochanteric femur and found 75 atypical fractures, whereas the Swedish study reviewed 1234 X-rays and found 59 atypical fractures. (4) The study populations differed slightly in demographics; the Swedish data set was for women aged 55þ years, whereas the US data set included men aged 65þ years and women aged 50þ years. The Swedish study used a national data set that covered a background population almost 20 times the size of the Kaiser Permanente Northwest HMO but was constrained by having access to less than 3 years of medication history.…”

Bisphosphonate therapy for osteoporosis: The long and short of it

“…In particular, although recent evidence supports an association between the duration of bisphosphonate therapy and the development, albeit rarely, both of ONJ and atypical fractures, (13)(14)(15) ONJ was reported in only one woman in the zoledronic acid extension trial and atypical fractures were not seen in any of the studies. Nevertheless, these remain potential concerns with long-term treatment and emphasize the need for regular review of the need to continue treatment.…”