Abstract

Recently, atypical femoral fracture has emerged as potential complication of long-term bisphosphonate therapy. Before considering the potential harmful effects of oversupression of bone turnover, it has been supposed that suppressed bone turnover in postmenopausal skeleton has well documented beneficial effects on bone strength and fracture risk. However, the benefit of long-term use of bisphosphonate for the prevention of femoral fractures seems to be lower than previously speculated. There are several factors by which severely suppressed bone turnover may reduce bone mechanical properties. These include increased mineralization of bone and increased homogeneity of mineralization, changes in collagen cross linking and accumulation of bone microdamage.

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