SynthesisJournal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2013
Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systematic review and meta-analysis.
Synthesis in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 99 papers, 8 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
99 citing papers in PubMed, 8 syntheses or guidelines pooled it, 257 citations in OpenAlex.
- Health and adverse events associated with extended oral bisphosphonates among postmenopausal women: a systematic review.The Journal of clinical endocrinology and metabolism · 2026Pooled it
- The 2024 UK clinical guideline for the prevention and treatment of osteoporosis.Archives of osteoporosis · 2025Guideline
- Atypical fractures at non-classical sites associated with anti-resorptive therapy: a systematic review.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2024Pooled it
- UK clinical guideline for the prevention and treatment of osteoporosis.Archives of osteoporosis · 2022Guideline
- Epidemiology and Postoperative Outcomes of Atypical Femoral Fractures in Older Adults: A Systematic Review.The journal of nutrition, health & aging · 2017Pooled it
- Effect of Stem Cell Therapy on Bone Mineral Density: A Meta-Analysis of Preclinical Studies in Animal Models of Osteoporosis.PloS one · 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
- 2015 Guidelines for Osteoporosis in Saudi Arabia: Recommendations from the Saudi Osteoporosis Society.Annals of Saudi medicineGuideline
- Effect of calcifediol and cholecalciferol on muscle function in postmenopausal women: a randomized controlled trial.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Trial
- Safety of long-term denosumab therapy: results from the open label extension phase of two phase 3 studies in patients with metastatic breast and prostate cancer.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2016Trial
- Non-union after bisphosphonate-associated atypical femoral fractures: a review of the current literature.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2026Review
- A predictive nomogram for treatment response in osteonecrosis patients receiving denosumab with UKA: integrating bone turnover markers and functional parameters.Endocrine connections · 2025Article
- Femur geometry influences atypical femoral fracture location.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Progress of research on the gut microbiome and its metabolite short-chain fatty acids in postmenopausal osteoporosis: a literature review.Frontiers of medicine · 2025Review
- Femoral diaphyseal fatigue stress fracture in an older adult male with normal bone mineral density.BMJ case reports · 2025Article
- Severe atypical iliac wing fracture associated with long-term bisphosphonate use.Skeletal radiology · 2025Article
- Osteoporosis and Rheumatoid Arthritis: Mechanisms Underlying Osteoclast Differentiation and Activation or Factors Associated with Hip Fractures.Journal of clinical medicine · 2025Review
- Integrating network pharmacology, IPA, and molecular docking to reveal the anti-osteoporosis effects of EA and EB via the FAK pathway.Frontiers in pharmacology · 2025Article
- Risk factors for fragility fractures in patients with immunobullous diseases on long-term systemic glucocorticoids.Dermatology reports · 2024Article
- Comparison of bone turnover suppression in atypical femoral fractures and osteoporotic hip fractures.Scientific reports · 2024Article
39 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
3 authors at 1 institution in 1 country.
Funding
Abstract
Although there is strong evidence that bisphosphonates prevent certain types of osteoporotic fractures, there are concerns that these medications may be associated with rare atypical femoral fractures (AFF). Recent published studies examining this potential association are conflicting regarding the existence and strength of this association. We conducted a systematic review and meta-analysis of published studies examining the association of bisphosphonates with subtrochanteric, femoral shaft, and AFF. The random-effects model was used to calculate the pooled estimates of adjusted risk ratios (RR). Subgroup analysis was performed by study design, for studies that used validated outcome definitions for AFF, and for studies reporting on duration of bisphosphonate use. Eleven studies were included in the meta-analysis: five case-control and six cohort studies. Bisphosphonate exposure was associated with an increased risk of subtrochanteric, femoral shaft, and AFF, with adjusted RR of 1.70 (95% confidence interval [CI], 1.22-2.37). Subgroup analysis of studies using the American Society for Bone and Mineral Research criteria to define AFF suggests a higher risk of AFF, with bisphosphonate use with RR of 11.78 (95% CI, 0.39-359.69) as compared to studies using mainly diagnosis codes (RR, 1.62; 95% CI, 1.18-2.22), although there is a wide confidence interval and severe heterogeneity (I(2) = 96.15%) in this subgroup analysis. Subgroup analysis of studies examining at least 5 years of bisphosphonate use showed adjusted RR of 1.62 (95% CI, 1.29-2.04). This meta-analysis suggests there is an increased risk of subtrochanteric, femoral shaft, and AFF among bisphosphonate users. Further research examining the risk of AFF with long-term use of bisphosphonates is indicated as there was limited data in this subgroup. The public health implication of this observed increase in AFF risk is not clear.
Indexed as
Identifiers
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.