Low-Energy Femoral Shaft Fractures Associated With Alendronate Use

Abstract

Low-energy fractures of the femoral shaft with a simple, transverse pattern and hypertrophy of the diaphyseal cortex are associated with alendronate use. This may result from propagation of a stress fracture whose repair is retarded by diminished osteoclast activity and impaired microdamage repair resulting from its prolonged use.

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

“…It is also important to note that atypical fractures have been reported in patients who have not been exposed to BPs. This occurred in 3 of the 8 patients with atypical fragility fractures of the femur reported by Schilcher and colleagues, (101) in 1 of 20 patients in the Neviaser case series, (100) in 5 of 102 patients reported by Dell and colleagues, (99) in 1 of 4 patients reported by Bunning and colleagues, (102) and in 3 of 26 patients in the Lenart study, (93) as well as in patients with hypophosphatasia. (2,103) Epidemiologic studies show that fractures of the subtrochanteric region of the femur and the femoral shaft follow an age and sex distribution similar to osteoporotic fractures.…”

“…The proportion of subtrochanteric and diaphyseal fractures that have features of atypia depends on whether fractures owing to high-impact trauma or periprosthetic fractures are excluded and varies in the different patient series from 17% (99) to 29%. (100) It is this subset of fractures that has been associated with the use of BPs, an association that may or may not be causal. It is also important to note that atypical fractures have been reported in patients who have not been exposed to BPs.…”

“…Only nine fractures were in men, but gender was not identified in three large case series. (100,107,108) The majority (160 of 189) occurred after oral alendronate monotherapy: 12 patients were treated with oral risedronate (of these, 1 was followed by oral alendronate, whereas 2 were treated previously with alendronate and another was treated previously with pamidronate), 4 with a combination of intravenous pamidronate followed by intravenous zoledronic acid (myeloma), 4 with either oral or intravenous pamidronate (osteoporosis), 2 with intravenous zoledronic acid (renal cell carcinoma and osteoporosis), 2 with oral alendronate followed by oral ibandronate, and 102 with an unspecified oral BP.…”

“…Conventional radiography is the first line of approach, with more sophisticated imaging such as bone scintigraphy, magnetic resonance imaging (MRI), or computed tomography (CT) useful principally for detecting early or subtle prefracture features. (12,93,100,119,145) Conventional radiographs of the femur, acquired in anteroposterior and lateral projections, usually suffice to demonstrate a range of characteristic findings in complete or incomplete fractures (149)(150)(151)(152) (Fig. 2A).…”

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

“…Interest in these fractures has increased recently, as many reports have been published suggesting that the distinction between typical and atypical fractures may be related to long-term bisphosphonate use. (1)(2)(3)(4)(5)(6)(7)(8) However, the increased risk of ST/FS fractures in patients taking bisphosphonates long term has not been clearly established and might be related to fragility fractures. (9)(10)(11)(12) Although the incidence of hip fractures has been well characterized, the incidence of ST/FS fractures has only recently been reported.…”