• Satoshi Soen.
• Department of Orthopaedic Surgery and Rheumatology, Nara Hospital, Kinki University School of Medicine, Japan.
• Clin Calcium. 2012 Jun 1;22(6):919-22.

AbstractRecent studies indicating a relationship between duration of bisphosphonate therapy and risk of atypical femoral fractures, together with epidemiological data demonstrating divergent trends in hip versus subtrochanteric fracture incidence, support the contention that there is an association between bisphosphonate therapy and atypical femoral fractures. However, although there are biologically plausible mechanisms by which bisphosphonates may impair bone strength, a direct causal association has yet to be established. The vast majority of patients treated with bisphosphonates do not develop atypical femoral fractures despite suppressed bone turnover, and, moreover, there is no evidence that suppression is greater in those with than without atypical fractures. Current evidence suggests that bisphosphonates, whilst not a prerequisite for the development of atypical femoral fractures, may contribute to their development in some cases. Identification of the factors that predispose individuals to develop these rare fractures may hold the key to uncovering their pathophysiology. The benefits of bisphosphonates use outweigh the risks.

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