ReviewOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2011
Subtrochanteric fractures after long-term treatment with bisphosphonates: a European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, and International Osteoporosis Foundation Working Group Report.
Review in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 87 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
The trial behind it
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
87 citing papers in PubMed, 6 syntheses or guidelines pooled it, 247 citations in OpenAlex.
- European guidance for the diagnosis and management of osteoporosis in postmenopausal women.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2019Guideline
- Epidemiology and Postoperative Outcomes of Atypical Femoral Fractures in Older Adults: A Systematic Review.The journal of nutrition, health & aging · 2017Pooled it
- Recommendations for preventing fracture in long-term care.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2015Guideline
- Bisphosphonates and nonhealing femoral fractures: analysis of the FDA Adverse Event Reporting System (FAERS) and international safety efforts: a systematic review from the Research on Adverse Drug Events And Reports (RADAR) project.The Journal of bone and joint surgery. American volume · 2013Pooled it
- European guidance for the diagnosis and management of osteoporosis in postmenopausal women.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2013Guideline
- A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2012Pooled 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
- Atypical Femoral Fractures Induced by Anti-Resorptive Medications.Current osteoporosis reports · 2026Review
- First-line treatment of osteoporosis with osteoanabolic therapy: a new opportunity.Internal medicine journal · 2025Review
- Bisphosphonates in the Management of Patients with Postmenopausal Osteoporosis; Back to the Future.Pharmaceuticals (Basel, Switzerland) · 2025Review
- Long-term administration of alendronate sodium caused an atypical femoral shaft fracture in a 36-year-old woman: a case report and literature review.The Journal of international medical research · 2024Review
- Surgical management and outcomes following atypical subtrochanteric femoral fractures - results from a matched-pair analysis of the registry for geriatric trauma of the German Trauma Society.Archives of orthopaedic and trauma surgery · 2024Article
- Long-term and sequential treatment for osteoporosis.Nature reviews. Endocrinology · 2023Review
- Acetabular and sacral insufficiency fractures in a patient with a long-term history of Alendronate consumption; a case report.BMC musculoskeletal disorders · 2023Article
- Nitrogen-Containing Bisphosphonates Downregulate Cathepsin K and Upregulate Annexin V in Osteoclasts CulturedInternational journal of dentistry · 2023Article
- Atypical femoral fracture mimicking lumbar radiculopathy in two patients taking bisphosphonate long-term: A case report.BMC musculoskeletal disorders · 2022Article
- Health-related quality of life outcomes after surgical treatment of atypical femur fractures: a multicenter retrospective cohort study.JBMR plus · 2021Article
- Atypical bilateral femoral fractures: a rare adverse effect of long-term bisphosphonate use.BMJ case reports · 2021Article
- 'Bone within bone appearance' in a pathological fracture.BMJ case reports · 2020Article
- Histologic evaluation of femoral nerve demyelinating and axonal neuropathy in Wistar rats due to alendronate intake: a randomised study.Journal of biological research (Thessalonike, Greece) · 2020Article
27 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 8 institutions in 7 countries.
Funding
Abstract
unlabelledThis paper reviews the evidence for an association between atypical subtrochanteric fractures and long-term bisphosphonate use. Clinical case reports/reviews and case-control studies report this association, but retrospective phase III trial analyses show no increased risk. Bisphosphonate use may be associated with atypical subtrochanteric fractures, but the case is yet unproven.
introductionA Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the International Osteoporosis Foundation has reviewed the evidence for a causal association between subtrochanteric fractures and long-term treatment with bisphosphonates, with the aim of identifying areas for further research and providing recommendations for physicians.
methodsA PubMed search of literature from 1994 to May 2010 was performed using key search terms, and articles pertinent to subtrochanteric fractures following bisphosphonate use were analysed.
resultsSeveral clinical case reports and case reviews report a possible association between atypical fractures at the subtrochanteric region of the femur in bisphosphonate-treated patients. Common features of these 'atypical' fractures include prodromal pain, occurrence with minimal/no trauma, a thickened diaphyseal cortex and transverse fracture pattern. Some small case-control studies report the same association, but a large register-based study and retrospective analyses of phase III trials of bisphosphonates do not show an increased risk of subtrochanteric fractures with bisphosphonate use. The number of atypical subtrochanteric fractures in association with bisphosphonates is an estimated one per 1,000 per year. It is recommended that physicians remain vigilant in assessing their patients treated with bisphosphonates for the treatment or prevention of osteoporosis and advise patients of the potential risks.
conclusionsBisphosphonate use may be associated with atypical subtrochanteric fractures, but the case is unproven and requires further research. Were the case to be proven, the risk-benefit ratio still remains favourable for use of bisphosphonates to prevent fractures.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.