Bisphosphonates Are Not Always Helpful: Commentary on an article by Hae-Seong Lim, MD, et al.: "Factors Associated with Increased Healing Time in Complete Femoral Fractures After Long-Term Bisphosphonate Therapy".

Abstract

Somewhere between 20% and 33% of people will sustain an osteoporotic fracture during their lifetime1. Preventative treatment has mainly been antiresorptive therapy, such as bisphosphonates. These medications have reduced the risk of fractures in large clinical trials2,3. Unfortunately, prolonged use of bisphosphonates is associated with relatively rare but potentially troublesome atypical femur fractures (AFFs)4,5. We are just beginning to understand the clinical scenario of AFFs and develop patient treatment plans. The occurrence of AFFs is still relatively rare for bisphosphonate users6,7. Lim et al. have now evaluated 109 AFFs in 99 consecutive patients who had been operatively treated for complete AFFs. AFFs were defined by characteristic radiographic features, including a transverse or short oblique fracture line, medial spike, focal lateral cortical thickening, and no or minimal comminution, according …