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Letters

Atypical femoral fractures

Paul Lee
CMAJ March 09, 2010 182 (4) 384-385; DOI: https://doi.org/10.1503/cmaj.110-2027
Paul Lee
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Osteoporotic fracture is associated with significant morbidity and mortality. Rahmani and Morin have reviewed the evidence supporting the use of oral bisphosphonates as first line therapy for postmenopausal women and older men with osteoporosis and/or fragility fractures. 1 Bisphosphonates reduce the risk of future fractures and their 10-year safety profile had appeared to be satisfactory. 2 However, long-term bisphosphonate use has been reported to contribute to the presentation of atypical femoral fractures, raising concern about long-term safety.

We recently sought to examine this potential risk in Australia through a national survey (April–August 2009). Questionnaires were sent to 750 orthopedic surgeons and 237 returned completed information. Of 15 463 patients treated with any acute fractures in the previous 12 months, 10 patients were considered to have had atypical femoral fractures. The estimated incidence of atypical femoral fractures was 0.6 per 1000 fractures. Patient details revealed a predominance of female sex, atraumatic fractures, corticosteroid use, tobacco smoking and underlying malignancy. Four patients were reported to have had osteoporosis. Only two had been treated with a bisphosphonate, alendronate.

The limited relationship to bisphosphonate is consistent with a Danish study suggesting similar incidence of atypical fractures in individuals treated or not with bisphosphonates. 3 As bisphosphonate therapy has been shown to approximately halve the risk of fractures, it is important to balance this benefit against the rare event of atypical femoral fracture, which also appears to have limited relationship to bisphosphonate use.

Footnotes

  • For the full letter, go to: www.cmaj.ca/cgi/eletters/181/11/815#266929

REFERENCES

  1. 1.↵
    Rahmani P, Morin S. Prevention of osteoporosis-related fractures among postmenopausal women and older men. CMAJ 2009;181:815–20.
    OpenUrlFREE Full Text
  2. 2.↵
    Bone, HG, Hosking, D, Devogelaer, JP, et al. Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 2004; 350:1189.
    OpenUrlCrossRefPubMed
  3. 3.↵
    Abrahamsen B, Eiken P, Eastell R. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study. J Bone Miner Res 2009;24:1095–102.
    OpenUrlCrossRefPubMed
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Canadian Medical Association Journal: 182 (4)
CMAJ
Vol. 182, Issue 4
9 Mar 2010
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Atypical femoral fractures
Paul Lee
CMAJ Mar 2010, 182 (4) 384-385; DOI: 10.1503/cmaj.110-2027

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Paul Lee
CMAJ Mar 2010, 182 (4) 384-385; DOI: 10.1503/cmaj.110-2027
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