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Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study

Open access
Lenart, B. A., Neviaser, A. S., Lyman, S., Chang, C. C., Edobor-Osula, F., Steele, B., van der Meulen, M. C. H., Lorich, D. G., Lane, J. M.·2009·Osteoporosis International

Abstract

SummaryRecent evidence has linked long-term bisphosphonate use with insufficiency fractures of the femur in postmenopausal women. In this case–control study, we have identified a significant association between a unique fracture of the femoral shaft, a transverse fracture in an area of thickened cortices, and long-term bisphosphonate use. Further studies are warranted.IntroductionAlthough clinical trials confirm the anti-fracture efficacy of bisphosphonates over 3–5 years, the long-term effects of bisphosphonate use on bone metabolism are unknown. Femoral insufficiency factures in patients on prolonged treatment have been reported.MethodsWe performed a retrospective case–control study of postmenopausal women who presented with low-energy femoral fractures from 2000 to 2007. Forty-one subtrochanteric and femoral shaft fracture cases were identified and matched by age, race, and body mass index to one intertrochanteric and femoral neck fracture each.ResultsBisphosphonate use was observed in 15 of the 41 subtrochanteric/shaft cases, compared to nine of the 82 intertrochanteric/femoral neck controls (Mantel–Haenszel odds ratio (OR), 4.44 [95% confidence interval (CI) 1.77–11.35]; P = 0.002). A common X-ray pattern was identified in ten of the 15 subtrochanteric/shaft cases on a bisphosphonate. This X-ray pattern was highly associated with bisphosphonate use (OR, 15.33 [95% CI 3.06–76.90]; P < 0.001). Duration of bisphosphonate use was longer in subtrochanteric/shaft cases compared to both hip fracture controls groups (P = 0.001).ConclusionsWe found a significantly greater proportion of patients with subtrochanteric/shaft fractures to be on long-term bisphosphonates than intertrochanteric/femoral neck fractures. Bisphosphonate use was highly associated with a unique X-ray pattern. Further studies are warranted.

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Metadata

Authors
Lenart, B. A., Neviaser, A. S., Lyman, S., Chang, C. C., Edobor-Osula, F., Steele, B., van der Meulen, M. C. H., Lorich, D. G., & Lane, J. M.
Venue
Osteoporosis International
Published
2008-12-09
Volume
20
Issue
8
Pages
1353-1362
ISSN
  • 0937-941X (ISSN-L)
  • 1433-2965
OpenAlex
W2094638050
Cited by
384
References
41
FWCI
36.66
Type
journal article
Language
en
Open access
green

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CoChat. (2026). Citation check: Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study. https://app.cochat.ai/papers/10.1007/s00198-008-0805-x
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Lenart, B. A., Neviaser, A. S., Lyman, S., Chang, C. C., Edobor-Osula, F., Steele, B., van der Meulen, M. C. H., Lorich, D. G., & Lane, J. M. (2009). Association of low-energy femoral fractures with prolonged bisphosphonate use: a case control study. Osteoporosis International. https://doi.org/10.1007/s00198-008-0805-x

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