Bisphosphonates: balancing atypical fracture risk and fracture prevention


  • Dawn O'Shea
  • Univadis Medical News
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A new study published in the New England Journal of Medicine has concluded that duration of bisphosphonates treatment and race influence the risk of atypical femur fracture versus fragility fracture prevention with bisphosphonates.

The researchers studied women 50 years of age or older who were receiving bisphosphonates and who were enrolled in the Kaiser Permanente Southern California healthcare system. Women were followed from January 1, 2007 to November 30, 2017.

Among 196,129 women, 277 atypical femur fractures occurred. After multivariable adjustment, the risk of atypical femoral fracture increased with longer duration of bisphosphonate treatment. Compared to treatment duration

Risk factors also included race; the HR for Asians women vs Whites women was 4.84 (95% CI 3.57-6.56).

Bisphosphonate discontinuation was associated with a rapid decrease in the risk of atypical fracture. After three years, 149 hip fractures were prevented and two bisphosphonate-associated atypical fractures occurred in Whites, compared with 91 and eight, respectively, in Asians.