2014
DOI: 10.1111/nyas.12551
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Questioning the association between bisphosphonates and atypical femoral fractures

Abstract: Bisphosphonates are the first line treatment for osteoporosis. Structurally, they are stable analogues of pyrophosphate and therefore exhibit a high affinity for bone mineral. They reduce bone loss by attenuating the ability of the osteoclast to resorb bone, decreasing activation frequency and the rate of remodelling. Large prospective randomized placebo-control trials provide unequivocal evidence for a reduction in the incidence of fractures.1 Impressively, 40 years since their first use in patients, the safe… Show more

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Cited by 17 publications
(8 citation statements)
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“…This is not the place for a detailed analysis of the data on causation of AFFs and, as indicated, our data are insufficiently robust to allow much comment beyond the observation that bisphosphonate treated patients accounted for a larger proportion of patients with AFFs compared with BP naive patients as is commonly found [316]. These latter studies also support our finding of at least a 4-fold increased risk of AFFs for BP treated patients but the argument has been made that this is a specific and emerging radiological entity [41], a perspective supported by our data suggesting a newly emerging syndrome over the duration we studied.…”
Section: Discussionmentioning
confidence: 86%
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“…This is not the place for a detailed analysis of the data on causation of AFFs and, as indicated, our data are insufficiently robust to allow much comment beyond the observation that bisphosphonate treated patients accounted for a larger proportion of patients with AFFs compared with BP naive patients as is commonly found [316]. These latter studies also support our finding of at least a 4-fold increased risk of AFFs for BP treated patients but the argument has been made that this is a specific and emerging radiological entity [41], a perspective supported by our data suggesting a newly emerging syndrome over the duration we studied.…”
Section: Discussionmentioning
confidence: 86%
“…These fragility fractures of the subtrochanteric region of the femur were called atypical femoral fractures (AFF) [4]. Numerous reports have subsequently confirmed the characteristics of this type of fracture [515] and suggested that they are related in some, but perhaps not all cases, to bisphosphonate therapy—a matter that remains controversial [16].…”
mentioning
confidence: 99%
“…We suggest that BP therapy contributed to recurrent femur fractures with the appearance of atypical femoral fractures in this case. In adults with osteoporosis, atypical femoral fractures are a rare, recognized but not undisputed, side‐effect of prolonged BP therapy . The current clinical and radiological criteria for atypical femoral fractures, however, do not currently apply to individuals with OI, or children in general …”
Section: Discussionmentioning
confidence: 99%
“…They reduce bone loss by attenuating the ability of the osteoclast to resorb bone, decreasing activation frequency and the rate of remodeling [1].…”
Section: Introductionmentioning
confidence: 99%