Atypical femur fractures

Area of Science:

• Bone biology and pharmacology
• Orthopedic surgery
• Endocrinology

Background:

• Osteoporosis (OP) is a global health issue characterized by reduced bone mass and quality, increasing fracture risk.
• Bisphosphonates (BPs) are primary treatments for OP, significantly reducing common fracture incidence.
• Long-term BP use has been linked to atypical femur fractures (AFFs), raising concerns about treatment safety.

Purpose of the Study:

• To review and analyze studies investigating the association between bisphosphonate (BP) use and atypical femur fractures (AFFs).
• To evaluate the incidence, risk, and clinical implications of AFFs in the context of BP therapy for osteoporosis.
• To provide evidence-based recommendations regarding the continued use of BPs for osteoporosis management.

Main Methods:

• Systematic review and meta-analysis of clinical trials and population-based studies on BP and AFF association.
• Assessment of study methodologies, including sample selection and measurement bias.
• Evaluation of fracture incidence data and risk-benefit analysis of BP therapy.

Main Results:

• The association between bisphosphonates (BPs) and atypical femur fractures (AFFs) shows variable findings, potentially due to study biases.
• AFFs are rare, and the increased risk associated with BP use is minimal.
• The benefits of BPs in preventing hip, vertebral, and nonvertebral fractures significantly outweigh the small risk of AFFs.

Conclusions:

• Bisphosphonates (BPs) remain a highly effective first-line therapy for osteoporosis, particularly in postmenopausal women.
• The current clinical practice of using BPs for fracture prevention in osteoporosis should be maintained.
• Further research is needed to determine optimal BP treatment duration and discontinuation strategies.