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Bisphosphonate therapy and atypical fractures
Anas Saleh1, Vishal V Hegde, Anish G Potty
1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA.
The Orthopedic Clinics of North America
|April 3, 2013
Summary
Prolonged bisphosphonate therapy is linked to atypical femoral fractures. This review examines the evidence, potential causes, and management strategies for these fractures in osteoporosis patients.
Area of Science:
- Orthopedics
- Endocrinology
- Pharmacology
Background:
- Atypical femoral fractures (AFFs) are increasingly recognized in patients with osteoporosis.
- A potential association between AFFs and long-term bisphosphonate use has generated significant debate.
Purpose of the Study:
- To review the epidemiological evidence connecting bisphosphonate medications to the occurrence of atypical femoral fractures.
- To explore the underlying pathological mechanisms contributing to bisphosphonate-related AFFs.
- To propose a management plan for AFFs based on current scientific evidence.
Main Methods:
- Literature review of epidemiological studies.
- Analysis of proposed pathophysiological mechanisms.
- Synthesis of clinical evidence for management strategies.
Main Results:
- Epidemiological data suggest a correlation between prolonged bisphosphonate use and increased risk of AFFs.
- Potential mechanisms include altered bone microarchitecture and impaired bone remodeling.
- Evidence supports conservative management for some cases and surgical intervention for others.
Conclusions:
- Bisphosphonates, particularly with extended use, are associated with atypical femoral fractures.
- Understanding the mechanisms is crucial for risk assessment and prevention.
- A tailored management approach is necessary for affected patients.
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