Bisphosphonate use and fracture risk

January 01, 0001

Bisphosphonate use and fracture risk

Bisphosphonates are the centerpiece of pharmacotherapy in osteoporosis. However, concerns have been raised that their use in the long term may increase some of the relatively rarer fracture types due to the suppression of bone remodeling. These Canadian and Saudi researchers examined whether bisphosphonate therapy for more than five years is associated with an increased risk of different fracture types. They performed a population-based, nested case-control study in a cohort of women 68 years of age and older who were started on oral bisphosphonates. Cases with a subtrochanteric or femoral shaft fracture were matched with up to 5 controls.

The researchers report: "We identified 716 women who sustained a subtrochanteric or femoral shaft fracture following initiation of bisphosphonate therapy and 9723 women who sustained a typical osteoporotic fracture of the intertrochanteric region or femoral neck. Compared with transient bisphosphonate use, treatment for 5 years or longer was associated with an increased risk of subtrochanteric or femoral shaft fracture (adjusted odds ratio, 2.74). A reduced risk of typical osteoporotic fractures occurred among women with more than 5 years of bisphosphonate therapy (adjusted odds ratio, 0.76). Among 52 595 women with at least 5 years of bisphosphonate therapy, a subtrochanteric or femoral shaft fracture occurred in 71 (0.13%) during the subsequent year and 117 (0.22%) within 2 years."

The researchers concluded: "Among older women, treatment with a bisphosphonate for more than 5 years was associated with an increased risk of subtrochanteric or femoral shaft fractures. However, the absolute risk of these fractures is low."

More than 5 years of bisphosphonate use is associated with decreased risk of typical fractures, but increased risk the relatively rare subtrochanteric or femoral shaft fracture.

For the full abstract, click here.

JAMA 305(8):783-789, 23 February 2011 © 2011 American Medical Association
Bisphosphonate Use and the Risk of Subtrochanteric or Femoral Shaft Fractures in Older Women. Laura Y. Park-Wyllie, Muhammad M. Mamdani, David N. Juurlink, et al.

Category: M. Musculoskeletal. Keywords: bisphosphonates, osteoporosis, subtrochanteric fracture, femoral shaft fracture, geriatric, case-control study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 8 March 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.