Unusual mid‐shaft fractures during long‐term bisphosphonate therapy
- 19 January 2010
- journal article
- Published by Wiley in Clinical Endocrinology
- Vol. 72 (2), 161-168
- https://doi.org/10.1111/j.1365-2265.2009.03581.x
Abstract
Bisphosphonates are the most commonly prescribed medications for the treatment of osteoporosis. Although existing evidence supports a good safety profile, there is concern that chronic administration of these agents could result in severe suppression of bone turnover with increased risk of nonvertebral fractures. The objective of this study was to report the clinical presentation, selected bone histomorphometry and X-ray images of patients who developed mid-shaft long bone fractures during bisphosphonate therapy, six of whom had bone biopsy for histomorphometery. Of the 13 patients who sustained atraumatic mid-shaft fractures, 10 were on alendronate and three were on risedronate therapy before the fractures. In addition to bisphosphonates, three patients were on oestrogen and two on tamoxifen concomitantly. Four patients with glucocorticoid-induced osteoporosis were on alendronate for 3-11 years along with glucocorticoid therapy. Bone histomorphometry showed severe suppression of bone turnover in five patients and low bone turnover in one patient. Long-term bisphosphonate therapy may increase the risk of unusual long bone mid-shaft fractures. This is probably due to prolonged suppression of bone turnover, which could lead to accumulation of microdamage and development of hypermineralized bone. At present, the scope of this complication in the larger context of patients receiving bisphosphonate therapy remains unknown, but appears to be small.Keywords
This publication has 35 references indexed in Scilit:
- Subtrochanteric displaced insufficiency fracture after long‐term alendronate therapy—a case reportActa Orthopaedica, 2008
- Pelvic insufficiency fracture associated with severe suppression of bone turnover by alendronate therapyJournal of Bone and Mineral Metabolism, 2007
- Subtrochanteric insufficiency fractures in patients on alendronate therapyThe Journal of Bone and Joint Surgery. British volume, 2007
- Suppressed Bone Turnover during Alendronate Therapy for High-Turnover OsteoporosisNew England Journal of Medicine, 2006
- Pretreatment Levels of Bone Turnover and the Antifracture Efficacy of Alendronate: The Fracture Intervention TrialJournal of Bone and Mineral Research, 2006
- Ten Years' Experience with Alendronate for Osteoporosis in Postmenopausal WomenNew England Journal of Medicine, 2004
- BMD at Multiple Sites and Risk of Fracture of Multiple Types: Long-Term Results From the Study of Osteoporotic FracturesJournal of Bone and Mineral Research, 2003
- The effects of ageing and changes in mineral content in degrading the toughness of human femoraJournal of Biomechanics, 1996
- Mechanical behavior of damaged trabecular boneJournal of Biomechanics, 1994