Risk of Atypical Femoral Fracture during and after Bisphosphonate Use

Overdiagnosis of bone fragility in the quest to prevent hip fracture

“…57 Similar skeletal complications are associated with other antiresorptive therapies. 58 Strontium ranelate is currently under renewed scrutiny for increased cardiovascular risks.…”

Bone protective agents in children

“…It is also thought that those taking concomitant GCs in addition to BPs or with a genetic disposition to fracture may have a further increased risk. A large Swedish observational study of femoral fractures in postmenopausal women39 showed that fracture rate decreased rapidly after drug withdrawal, therefore intermittent use may be favourable and a BP ‘holiday’ in children on long-term BPs could be considered.Iatrogenic osteopetrosis: in 2003, the first case of BP-induced osteopetrosis (or marble bone disease) was described in a boy aged 12 years who had received pamidronate infusions for the previous 3 years for idiopathic bone pain and osteopaenia 40. Abnormal oversuppression of bone remodelling (with a histological absence of osteoclasts on bone surfaces) was still present when he was followed up 7 years after cessation of BP.…”

“…It is also thought that those taking concomitant GCs in addition to BPs or with a genetic disposition to fracture may have a further increased risk. A large Swedish observational study of femoral fractures in postmenopausal women39 showed that fracture rate decreased rapidly after drug withdrawal, therefore intermittent use may be favourable and a BP ‘holiday’ in children on long-term BPs could be considered.…”

Bisphosphonates beyond five years

“…The annual absolute risk of atypical femur fractures is reported as 11 per 10 000 person years of bisphosphonate use. 4 There is no consensus about the incidence of osteonecrosis of the jaw, however, risk is increased with more than three years of treatment, more potent intravenous bisphosphonates, and higher doses (such as those used in managing cancer).…”