Long-term consequences of osteoporosis therapy with bisphosphonates

Abstract

Bisphosphonates (BPs) are medications widely used in clinical practice to treat osteoporosis and reduce fragility fractures. Its beneficial effects on bone tissue have been consolidated in the literature for the last decades. They have a high affinity for bone hydroxyapatite crystals, and most bisphosphonates remain on the bone surface for a long period of time. Benefits of long-term use of BPs: Large and important trials (Fracture Intervention Trial Long-term Extension and Health Outcomes and Reduced Incidence with Zoledronic acid Once Yearly-Pivotal Fracture Trial) with extended use of alendronate (up to 10 years) and zoledronate (up to 6 years) evidenced significant gain of bone mineral density (BMD) and vertebral fracture risk reduction. Risks of long-term use of BPs: The extended use of antiresorptive therapy has drawn attention to two extremely rare, although severe, adverse events. That is, atypical femoral fracture and medication-related osteonecrosis of the jaw are more common in patients with high cumulative doses and longer duration of therapy. BPs have demonstrated safety and effectiveness throughout the years and evidenced increased BMD and reduced fracture risks, resulting in reduced morbimortality, and improved quality of life. These benefits overweight the risks of rare adverse events.

Atypical Fracture of the Scapular Spine: A Case Report

“…Along with suppressed bone turnover, AFFs are known to be prone to nonunion. Because the femur is a weight-bearing bone and its nonunion may highly reduce a patient's ADLs, an early discontinuance of BMA treatment and the introduction of another drug such as teriparatide after surgical treatment are mandatory for the faster healing of AFFs [3,17]. Moreover, Tsuchie et al reported that the administration of teriparatide after the occurrence of the first AFF and the use of active vitamin D3 after the completion of teriparatide therapy may prevent the recurrence of AFF [18].…”

“…With the background of the globally aging population and the high awareness of osteoporosis and osteoporosis-related fragility fractures [1], the number of individuals diagnosed with osteoporosis and requiring medical treatment is increasing. Bone-modifying agents (BMAs), including bisphosphonate and denosumab, are widely used to treat osteoporosis, but some severe potential side effects of long-term BMA treatment have emerged: osteonecrosis of the jaw and atypical fractures [1][2][3][4]. Most of the reported atypical fractures occurred in weight-bearing bones, and the femur is the most frequently affected weight-bearing bone (atypical femoral fracture; AFF) [2].…”