ArticleActa orthopaedica2015
Risk of atypical femoral fracture during and after bisphosphonate use.
Article in Acta orthopaedica, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 96 papers, 4 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
96 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Medical Management of Patients After Atypical Femur Fractures: a Systematic Review and Recommendations From the European Calcified Tissue Society.The Journal of clinical endocrinology and metabolism · 2020Guideline
- Fracture risk following intermission of osteoporosis therapy.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2019Pooled it
- Long-Term Drug Therapy and Drug Discontinuations and Holidays for Osteoporosis Fracture Prevention: A Systematic Review.Annals of internal medicine · 2019Pooled it
- Pooled it
- Alendronate Improves Bone Mineral Density in Children and Adolescents Perinatally Infected With Human Immunodeficiency Virus With Low Bone Mineral Density for Age.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Trial
- Artificial Intelligence-Driven Precision Bisphosphonate Therapy in Osteoporosis: Mechanisms, Clinical Applications, Risks, and Future Directions.Orthopaedic surgery · 2026Review
- Biomechanical Study of the Preventive Effect of Different Cephalomedullary Fixation Methods on the Occurrence of Femoral Neck Fractures in Osteoporotic Femurs.Medicina (Kaunas, Lithuania) · 2026Article
- Manual chart review reveals bisphosphonate exposure misclassification in atypical femur fracture patients: auditing medical records in two international cohorts.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Risk factors for atypical femur fractures with and without bisphosphonate treatment: a national nested case-control study.JBMR plus · 2026Article
- Association between femoral localized cortical thickening ("beaking" or "flaring") and bisphosphonate duration in glucocorticoid-induced osteoporosis.Journal of bone and mineral metabolism · 2026Article
- Osteoporosis After Menopause and After Drug Therapy: The Molecular Mechanism of Bone Loss and Its Treatment.International journal of molecular sciences · 2026Review
- Incidental Unilateral Lateral Cortical Hypertrophy of the Proximal Femur Following Low-Energy Trauma Without Prior Bisphosphonate Exposure: A Case Report.Case reports in orthopedics · 2026Article
- Radiological Assessment of Atypical Femoral Fractures: A 10-Year Experience Across Two Centres.Journal of osteoporosis · 2026Article
- Therapeutic Management of Glucocorticoid-Induced Osteoporosis with a Focus on Older Adults: A Narrative Review.Drugs & aging · 2026Review
- Asian Federation of Osteoporosis Societies 2025 consensus on atypical femoral fractures in patients with osteoporosis.Osteoporosis and sarcopenia · 2025Review
- Review
- Epidemiology, Pathophysiology and Management of Atypical Femur Fractures: an Update.Current osteoporosis reports · 2025Review
- Comparing incomplete atypical femur fractures in patients with or without bisphosphonate treatment: radiography and bone morphology in a retrospective study of 19 cases.Acta orthopaedica · 2025Article
- Atypical Femoral Fracture Following Long-Term Bisphosphonate Therapy: An Uncommon Complication of a Common Treatment.Cureus · 2025Article
- Article
36 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
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeUse of bisphosphonates in women is associated with higher risk of atypical femoral fractures. The risk in terms of timing of use and type of bisphosphonate, and in men, remains unclear. PATIENTS AND
methodsWe reviewed radiographs of 5,342 Swedish women and men aged 55 years or more who had had a fracture of the femoral shaft in the 3-year period 2008-2010 (97% of those eligible), and found 172 patients with atypical fractures (93% of them women). We obtained data on medication and comorbidity. The risk of atypical fracture associated with bisphosphonate use was estimated in a nationwide cohort analysis. In addition, we performed a case-control analysis with comparison to 952 patients with ordinary shaft fractures. A short report of the findings has recently been presented (Schilcher et al. 2014a). Here we provide full details.
resultsThe age-adjusted relative risk (RR) of atypical fracture associated with bisphosphonate use was 55 (95% CI: 39-79) in women and 54 (CI: 15-192) in men. In bisphosphonate users, women had a 3-fold higher risk than men (RR = 3.1, CI: 1.1-8.4). Alendronate users had higher risk than risedronate users (RR = 1.9, CI: 1.1-3.3). The RR after 4 years or more of use reached 126 (CI: 55-288), with a corresponding absolute risk of 11 (CI: 7-14) fractures per 10,000 person-years of use. The risk decreased by 70% per year since last use.
interpretationWomen have a higher risk of atypical femoral fracture than men. The type of bisphosphonate used may affect risk estimates and the risk decreases rapidly after cessation.
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.