LETTER TO THE EDITOR - Atypical fractures of the femoral diaphysis in postmenopausal women taking Fosamax

[Guest guest]

New England Journal of Medicine

Correspondence

Volume 358:1304-1306 March 20, 2008 Number 12

Atypical Fractures of the Femoral Diaphysis in Postmenopausal Women

Taking Alendronate

To the Editor:

The long-term safety of bisphosphonates for the treatment of

osteoporosis has been questioned. Two case series have suggested a

link between prolonged bisphosphonate therapy and atypical fractures.

In one series, a small number of patients sustained low-energy

nonvertebral fractures while receiving long-term alendronate therapy;

three were fractures of the femoral shaft.1 Bone biopsies in these

patients showed evidence of severely suppressed bone turnover and

fracture healing that was delayed or absent. In the other series,

low-energy subtrochanteric fractures were found in nine women who had

been receiving long-term alendronate therapy.2 Theoretically,

bisphosphonates suppress bone turnover and thus might be associated

with accumulated microdamage in bone. To our knowledge, no study has

demonstrated microdamage accumulation in patients treated with

bisphosphonates, and data from studies in animals remain difficult to

interpret because supranormal doses of bisphosphonates are used.

Nevertheless, the possibility that bisphosphonates alter bone strength

with prolonged use appears to exist.

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Read the rest of the letter here:

http://content.nejm.org/cgi/content/full/358/12/1304

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Not an MD