ArticleThe Journal of clinical endocrinology and metabolism2010
Cumulative alendronate dose and the long-term absolute risk of subtrochanteric and diaphyseal femur fractures: a register-based national cohort analysis.
Article in The Journal of clinical endocrinology and metabolism, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
51 citing papers in PubMed, 3 syntheses or guidelines pooled it, 159 citations in OpenAlex.
- Bisphosphonates for steroid-induced osteoporosis.The Cochrane database of systematic reviews · 2016Pooled it
- Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: sensitivity and trim and fill studies.Genetic testing and molecular biomarkers · 2014Pooled it
- Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systematic review and meta-analysis.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2013Pooled it
- The effect of 3 versus 6 years of zoledronic acid treatment of osteoporosis: a randomized extension to the HORIZON-Pivotal Fracture Trial (PFT).Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2012Trial
- Asian Federation of Osteoporosis Societies 2025 consensus on atypical femoral fractures in patients with osteoporosis.Osteoporosis and sarcopenia · 2025Review
- Atypical Femur Fractures-An Analysis of 69 Patients from 15 Years.Journal of clinical medicine · 2025Article
- Position Statement: Atypical Femoral Fracture from the Korean Society for Bone and Mineral Research in 2023.Journal of bone metabolism · 2023Article
- Atypical femur fractures associated with bisphosphonate therapy: post-operative outcomes.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023Article
- The Korean hip fracture registry study.BMC musculoskeletal disorders · 2023Observational
- Surgical strategy of the treatment of atypical femoral fractures.World journal of orthopedics · 2023Review
- Risk Factors Associated with Intraoperative Iatrogenic Fracture in Patients Undergoing Intramedullary Nailing for Atypical Femoral Fractures with Marked Anterior and Lateral Bowing.Medicina (Kaunas, Lithuania) · 2023Article
- Preventive bilateral femoral nailing in atypical femoral fracture non responder to anabolic therapy: case report and mini-review.Acta bio-medica : Atenei Parmensis · 2022Article
- Surgical and Pharmacological Management of Periprosthetic Atypical Femoral Fractures: A Narrative Literature Review.Geriatric orthopaedic surgery & rehabilitation · 2022Article
- Hip and Subtrochanteric or Femoral Shaft Fractures after Bisphosphonate Use in Korean Women, Using Korean National Sample Cohort.Journal of Korean medical science · 2020Article
- [Treatment of osteoporosis in the outpatient field : Possibilities and challenges].Der Unfallchirurg · 2019Review
- Review
- Incidence Rate of Atypical Femoral Fracture after Bisphosphonates Treatment in Korea.Journal of Korean medical science · 2018Article
- Bisphosphonates and atypical subtrochanteric fractures of the femur.Bone & joint research · 2017Article
- Bilateral atypical femur fractures without bisphosphonate exposure.Skeletal radiology · 2017Article
- Rethinking the Appraisal and Approval of Drugs for Fracture Prevention.Frontiers in pharmacology · 2017Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
contextBisphosphonates are the mainstay of anti-osteoporotic treatment and are commonly used for a longer duration than in the placebo-controlled trials. A link to development of atypical subtrochanteric or diaphyseal fragility fractures of the femur has been proposed, and these fractures are currently the subject of a U.S. Food and Drug Administration review.
objectiveOur objective was to examine the risk of subtrochanteric/diaphyseal femur fractures in long term users of alendronate.
designWe conducted an age- and gender-matched cohort study using national healthcare data. PATIENTS: Patients were alendronate users, without previous hip fracture, who began treatment between January 1, 1996, and December 31, 2005 (n=39,567) and untreated controls, (n=158,268).
main outcome measuresSubtrochanteric or diaphyseal femur fractures were evaluated.
resultsSubtrochanteric and diaphyseal fractures occurred at a rate of 13 per 10,000 patient-years in untreated women and 31 per 10,000 patient-years in women receiving alendronate [adjusted hazard ratio (HR)=1.88; 95% confidence interval (CI)=1.62-2.17]. Rates for men were six and 31 per 10,000 patient-years, respectively (HR=3.98; 95% CI=2.62-6.05). The HR for hip fracture was 1.37 (95% CI=1.30-1.46)) in women and 2.47 (95% CI=2.07-2.95) in men. Risks of subtrochanteric/diaphyseal fracture were similar in patients who had received 9 yr of treatment (highest quartile) and patients who had stopped therapy after the equivalent of 3 months of treatment (lowest quartile).
conclusionsAlendronate-treated patients are at higher risk of hip and subtrochanteric/diaphyseal fracture than matched control subjects. However, large cumulative doses of alendronate were not associated with a greater absolute risk of subtrochanteric/diaphyseal fractures than small cumulative doses, suggesting that these fractures could be due to osteoporosis rather than to alendronate.
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