Bisphosphonates and Fractures of the Subtrochanteric or Diaphyseal Femur
Recent case reports and series have identified a subgroup of atypical femoral-shaft fractures associated with bisphosphonate use. This study analyzed data from three large, randomized bisphosphonate trials. Subtrochanteric or diaphyseal femur fractures were very rare, even among women who had been t...
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| Veröffentlicht in: | The New England journal of medicine 2010-05, Vol.362 (19), p.1761-1771 |
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| container_title | The New England journal of medicine |
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| creator | Black, Dennis M Kelly, Michael P Genant, Harry K Palermo, Lisa Eastell, Richard Bucci-Rechtweg, Christina Cauley, Jane Leung, Ping Chung Boonen, Steven Santora, Arthur de Papp, Anne Bauer, Douglas C |
| description | Recent case reports and series have identified a subgroup of atypical femoral-shaft fractures associated with bisphosphonate use. This study analyzed data from three large, randomized bisphosphonate trials. Subtrochanteric or diaphyseal femur fractures were very rare, even among women who had been treated with bisphosphonates for as long as 10 years. In patients with osteoporosis, proven benefits for fracture reduction appear to outweigh the possible risk of femoral-shaft fractures.
This study analyzed data from three large, randomized bisphosphonate trials. Subtrochanteric or diaphyseal femur fractures were very rare, even among women who had been treated with bisphosphonates for as long as 10 years.
Several case series have described cases of “atypical” subtrochanteric and diaphyseal fractures of the femoral shaft and have suggested that the risk may be increased in long-term users of bisphosphonates.
1
–
13
Descriptions of associated atypical characteristics vary but have been described as a simple transverse or oblique ( |
| doi_str_mv | 10.1056/NEJMoa1001086 |
| format | Article |
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This study analyzed data from three large, randomized bisphosphonate trials. Subtrochanteric or diaphyseal femur fractures were very rare, even among women who had been treated with bisphosphonates for as long as 10 years.
Several case series have described cases of “atypical” subtrochanteric and diaphyseal fractures of the femoral shaft and have suggested that the risk may be increased in long-term users of bisphosphonates.
1
–
13
Descriptions of associated atypical characteristics vary but have been described as a simple transverse or oblique (<30 degrees) fracture with cortical beaking and diffuse cortical thickening.
2
Clinical associations that have been mentioned in some reports include low-level trauma, prodromal pain or evidence of a previous stress fracture, contralateral changes, and the use of specific concomitant drugs (including corticosteroids),
9
,
10
antiresorptive drugs (including hormone-replacement therapy),
10
and proton-pump inhibitors.
13
However, these . . .</description><identifier>ISSN: 0028-4793</identifier><identifier>EISSN: 1533-4406</identifier><identifier>DOI: 10.1056/NEJMoa1001086</identifier><identifier>PMID: 20335571</identifier><identifier>CODEN: NEJMAG</identifier><language>eng</language><publisher>Waltham, MA: Massachusetts Medical Society</publisher><subject>Alendronate - adverse effects ; Biological and medical sciences ; Bone density ; Bone Density Conservation Agents - adverse effects ; Bone Density Conservation Agents - therapeutic use ; Confidence Intervals ; Diphosphonates - adverse effects ; Diphosphonates - therapeutic use ; Female ; Femoral Fractures - chemically induced ; Femoral Fractures - epidemiology ; Femoral Fractures - prevention & control ; Fractures ; General aspects ; Hip Fractures - chemically induced ; Hip Fractures - epidemiology ; Humans ; Imidazoles - adverse effects ; Medical sciences ; Older people ; Osteoporosis ; Osteoporosis - drug therapy ; Randomized Controlled Trials as Topic ; Women</subject><ispartof>The New England journal of medicine, 2010-05, Vol.362 (19), p.1761-1771</ispartof><rights>Copyright © 2010 Massachusetts Medical Society. All rights reserved.</rights><rights>2015 INIST-CNRS</rights><rights>2010 Massachusetts Medical Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c484t-be42e4bc6198a17d3c708275afeaaabf0fbe74d3164dd511e4128cf4896a73293</citedby><cites>FETCH-LOGICAL-c484t-be42e4bc6198a17d3c708275afeaaabf0fbe74d3164dd511e4128cf4896a73293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.nejm.org/doi/pdf/10.1056/NEJMoa1001086$$EPDF$$P50$$Gmms$$H</linktopdf><linktohtml>$$Uhttps://www.nejm.org/doi/full/10.1056/NEJMoa1001086$$EHTML$$P50$$Gmms$$H</linktohtml><link.rule.ids>314,776,780,2746,2747,26080,27901,27902,52357,54039</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22752418$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20335571$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Black, Dennis M</creatorcontrib><creatorcontrib>Kelly, Michael P</creatorcontrib><creatorcontrib>Genant, Harry K</creatorcontrib><creatorcontrib>Palermo, Lisa</creatorcontrib><creatorcontrib>Eastell, Richard</creatorcontrib><creatorcontrib>Bucci-Rechtweg, Christina</creatorcontrib><creatorcontrib>Cauley, Jane</creatorcontrib><creatorcontrib>Leung, Ping Chung</creatorcontrib><creatorcontrib>Boonen, Steven</creatorcontrib><creatorcontrib>Santora, Arthur</creatorcontrib><creatorcontrib>de Papp, Anne</creatorcontrib><creatorcontrib>Bauer, Douglas C</creatorcontrib><creatorcontrib>HORIZON Pivotal Fracture Trial Steering Committee</creatorcontrib><creatorcontrib>Fracture Intervention Trial Steering Committee</creatorcontrib><title>Bisphosphonates and Fractures of the Subtrochanteric or Diaphyseal Femur</title><title>The New England journal of medicine</title><addtitle>N Engl J Med</addtitle><description>Recent case reports and series have identified a subgroup of atypical femoral-shaft fractures associated with bisphosphonate use. This study analyzed data from three large, randomized bisphosphonate trials. Subtrochanteric or diaphyseal femur fractures were very rare, even among women who had been treated with bisphosphonates for as long as 10 years. In patients with osteoporosis, proven benefits for fracture reduction appear to outweigh the possible risk of femoral-shaft fractures.
This study analyzed data from three large, randomized bisphosphonate trials. Subtrochanteric or diaphyseal femur fractures were very rare, even among women who had been treated with bisphosphonates for as long as 10 years.
Several case series have described cases of “atypical” subtrochanteric and diaphyseal fractures of the femoral shaft and have suggested that the risk may be increased in long-term users of bisphosphonates.
1
–
13
Descriptions of associated atypical characteristics vary but have been described as a simple transverse or oblique (<30 degrees) fracture with cortical beaking and diffuse cortical thickening.
2
Clinical associations that have been mentioned in some reports include low-level trauma, prodromal pain or evidence of a previous stress fracture, contralateral changes, and the use of specific concomitant drugs (including corticosteroids),
9
,
10
antiresorptive drugs (including hormone-replacement therapy),
10
and proton-pump inhibitors.
13
However, these . . .</description><subject>Alendronate - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Bone density</subject><subject>Bone Density Conservation Agents - adverse effects</subject><subject>Bone Density Conservation Agents - therapeutic use</subject><subject>Confidence Intervals</subject><subject>Diphosphonates - adverse effects</subject><subject>Diphosphonates - therapeutic use</subject><subject>Female</subject><subject>Femoral Fractures - chemically induced</subject><subject>Femoral Fractures - epidemiology</subject><subject>Femoral Fractures - prevention & control</subject><subject>Fractures</subject><subject>General aspects</subject><subject>Hip Fractures - chemically induced</subject><subject>Hip Fractures - epidemiology</subject><subject>Humans</subject><subject>Imidazoles - adverse effects</subject><subject>Medical sciences</subject><subject>Older people</subject><subject>Osteoporosis</subject><subject>Osteoporosis - drug therapy</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Women</subject><issn>0028-4793</issn><issn>1533-4406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp10ElLxDAUB_Agio7L0asUQTxV85K0aY86Oi64HNRzeU1fmQ5tMybtwW9vxFFRMBBC4Mdb_oztAz8BnqSnD5e39xaBc-BZusYmkEgZK8XTdTbhXGSx0rncYtveL3g4oPJNtiW4lEmiYcKuzxu_nNuP2-NAPsK-imYOzTC68LN1NMwpehrLwVkzx34g15jIuuiiweX8zRO20Yy60e2yjRpbT3urd4e9zC6fp9fx3ePVzfTsLjYqU0NckhKkSpNCniHoShrNM6ETrAkRy5rXJWlVSUhVVSUApEBkplZZnqKWIpc77Piz7tLZ15H8UHSNN9S22JMdfaHDZqBByCAP_8iFHV0fhiuEkDmExklA8ScyznrvqC6WrunQvRXAi4-Ai18BB3-wKjqWHVXf-ivRAI5WAL3BtnbYm8b_uLCrUJD9uK7zRU-L7p-G72SajZg</recordid><startdate>20100513</startdate><enddate>20100513</enddate><creator>Black, Dennis M</creator><creator>Kelly, Michael P</creator><creator>Genant, Harry K</creator><creator>Palermo, Lisa</creator><creator>Eastell, Richard</creator><creator>Bucci-Rechtweg, Christina</creator><creator>Cauley, Jane</creator><creator>Leung, Ping Chung</creator><creator>Boonen, Steven</creator><creator>Santora, Arthur</creator><creator>de Papp, Anne</creator><creator>Bauer, Douglas C</creator><general>Massachusetts Medical Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TZ</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K0Y</scope><scope>LK8</scope><scope>M0R</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20100513</creationdate><title>Bisphosphonates and Fractures of the Subtrochanteric or Diaphyseal Femur</title><author>Black, Dennis M ; Kelly, Michael P ; Genant, Harry K ; Palermo, Lisa ; Eastell, Richard ; Bucci-Rechtweg, Christina ; Cauley, Jane ; Leung, Ping Chung ; Boonen, Steven ; Santora, Arthur ; de Papp, Anne ; Bauer, Douglas C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c484t-be42e4bc6198a17d3c708275afeaaabf0fbe74d3164dd511e4128cf4896a73293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Alendronate - adverse effects</topic><topic>Biological and medical sciences</topic><topic>Bone density</topic><topic>Bone Density Conservation Agents - adverse effects</topic><topic>Bone Density Conservation Agents - therapeutic use</topic><topic>Confidence Intervals</topic><topic>Diphosphonates - adverse effects</topic><topic>Diphosphonates - therapeutic use</topic><topic>Female</topic><topic>Femoral Fractures - chemically induced</topic><topic>Femoral Fractures - epidemiology</topic><topic>Femoral Fractures - prevention & control</topic><topic>Fractures</topic><topic>General aspects</topic><topic>Hip Fractures - chemically induced</topic><topic>Hip Fractures - epidemiology</topic><topic>Humans</topic><topic>Imidazoles - adverse effects</topic><topic>Medical sciences</topic><topic>Older people</topic><topic>Osteoporosis</topic><topic>Osteoporosis - drug therapy</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Black, Dennis M</creatorcontrib><creatorcontrib>Kelly, Michael P</creatorcontrib><creatorcontrib>Genant, Harry K</creatorcontrib><creatorcontrib>Palermo, Lisa</creatorcontrib><creatorcontrib>Eastell, Richard</creatorcontrib><creatorcontrib>Bucci-Rechtweg, Christina</creatorcontrib><creatorcontrib>Cauley, Jane</creatorcontrib><creatorcontrib>Leung, Ping Chung</creatorcontrib><creatorcontrib>Boonen, Steven</creatorcontrib><creatorcontrib>Santora, Arthur</creatorcontrib><creatorcontrib>de Papp, Anne</creatorcontrib><creatorcontrib>Bauer, Douglas C</creatorcontrib><creatorcontrib>HORIZON Pivotal Fracture Trial Steering Committee</creatorcontrib><creatorcontrib>Fracture Intervention Trial Steering Committee</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Pharma and Biotech Premium PRO</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>New England Journal of Medicine</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The New England journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Black, Dennis M</au><au>Kelly, Michael P</au><au>Genant, Harry K</au><au>Palermo, Lisa</au><au>Eastell, Richard</au><au>Bucci-Rechtweg, Christina</au><au>Cauley, Jane</au><au>Leung, Ping Chung</au><au>Boonen, Steven</au><au>Santora, Arthur</au><au>de Papp, Anne</au><au>Bauer, Douglas C</au><aucorp>HORIZON Pivotal Fracture Trial Steering Committee</aucorp><aucorp>Fracture Intervention Trial Steering Committee</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bisphosphonates and Fractures of the Subtrochanteric or Diaphyseal Femur</atitle><jtitle>The New England journal of medicine</jtitle><addtitle>N Engl J Med</addtitle><date>2010-05-13</date><risdate>2010</risdate><volume>362</volume><issue>19</issue><spage>1761</spage><epage>1771</epage><pages>1761-1771</pages><issn>0028-4793</issn><eissn>1533-4406</eissn><coden>NEJMAG</coden><abstract>Recent case reports and series have identified a subgroup of atypical femoral-shaft fractures associated with bisphosphonate use. This study analyzed data from three large, randomized bisphosphonate trials. Subtrochanteric or diaphyseal femur fractures were very rare, even among women who had been treated with bisphosphonates for as long as 10 years. In patients with osteoporosis, proven benefits for fracture reduction appear to outweigh the possible risk of femoral-shaft fractures.
This study analyzed data from three large, randomized bisphosphonate trials. Subtrochanteric or diaphyseal femur fractures were very rare, even among women who had been treated with bisphosphonates for as long as 10 years.
Several case series have described cases of “atypical” subtrochanteric and diaphyseal fractures of the femoral shaft and have suggested that the risk may be increased in long-term users of bisphosphonates.
1
–
13
Descriptions of associated atypical characteristics vary but have been described as a simple transverse or oblique (<30 degrees) fracture with cortical beaking and diffuse cortical thickening.
2
Clinical associations that have been mentioned in some reports include low-level trauma, prodromal pain or evidence of a previous stress fracture, contralateral changes, and the use of specific concomitant drugs (including corticosteroids),
9
,
10
antiresorptive drugs (including hormone-replacement therapy),
10
and proton-pump inhibitors.
13
However, these . . .</abstract><cop>Waltham, MA</cop><pub>Massachusetts Medical Society</pub><pmid>20335571</pmid><doi>10.1056/NEJMoa1001086</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0028-4793 |
| ispartof | The New England journal of medicine, 2010-05, Vol.362 (19), p.1761-1771 |
| issn | 0028-4793 1533-4406 |
| language | eng |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; New England Journal of Medicine |
| subjects | Alendronate - adverse effects Biological and medical sciences Bone density Bone Density Conservation Agents - adverse effects Bone Density Conservation Agents - therapeutic use Confidence Intervals Diphosphonates - adverse effects Diphosphonates - therapeutic use Female Femoral Fractures - chemically induced Femoral Fractures - epidemiology Femoral Fractures - prevention & control Fractures General aspects Hip Fractures - chemically induced Hip Fractures - epidemiology Humans Imidazoles - adverse effects Medical sciences Older people Osteoporosis Osteoporosis - drug therapy Randomized Controlled Trials as Topic Women |
| title | Bisphosphonates and Fractures of the Subtrochanteric or Diaphyseal Femur |
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