ArticleBMJ (Clinical research ed.)2016
Risk of hip, subtrochanteric, and femoral shaft fractures among mid and long term users of alendronate: nationwide cohort and nested case-control study.
Article in BMJ (Clinical research ed.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 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
51 citing papers in PubMed, 6 syntheses or guidelines pooled it, 88 citations in OpenAlex.
- The 2024 UK clinical guideline for the prevention and treatment of osteoporosis.Archives of osteoporosis · 2025Guideline
- UK clinical guideline for the prevention and treatment of osteoporosis.Archives of osteoporosis · 2022Guideline
- The Effect of Bisphosphonates on Fracture Healing Time and Changes in Bone Mass Density: A Meta-Analysis.Frontiers in endocrinology · 2021Pooled it
- Meta-analysis for the efficacy of bisphosphonates on hip fracture prevention.Journal of bone and mineral metabolism · 2020Pooled it
- The association between medication non-adherence and adverse health outcomes in ageing populations: A systematic review and meta-analysis.British journal of clinical pharmacology · 2019Pooled it
- 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 cost-effectiveness of screening for fracture risk in a UK primary care setting: the SCOOP study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2020Trial
- Antiresorptive Use and Risk of Hip Fracture in Older Women with Osteoporosis: Findings from a Real-World National Database of 21,332 Women.Journal of clinical medicine · 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
- Bisphosphonates use is associated with increased coronary artery calcification in the general population: The Rotterdam study.Atherosclerosis plus · 2026Article
- Article
- Management Concepts of Bisphosphonate-Related Atypical Femoral Fractures.Journal of clinical medicine · 2025Article
- Enhancing Osteogenesis in Osteoporosis via Electromagnetized Gold Nanoparticles.Biomaterials research · 2025Article
- Insights and implications of sexual dimorphism in osteoporosis.Bone research · 2024Review
- Atypical femur fracture associated with common anti-osteoporosis drugs in FDA adverse event reporting system.Scientific reports · 2023Article
- Effect of Bifidobacterium on osteoclasts: TNF-α/NF-κB inflammatory signal pathway-mediated mechanism.Frontiers in endocrinology · 2023Review
- Osteoporosis in 2022: Care gaps to screening and personalised medicine.Best practice & research. Clinical rheumatology · 2022Review
- Oral Bisphosphonates Are Associated With Increased Risk of Severe Acute Kidney Injury in Elderly Patients With Complex Health Needs: A Self-Controlled Case Series in the United Kingdom.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022Article
- Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group.Archives of osteoporosis · 2022Article
- Real-life short-term effectiveness of anti-osteoporotic treatments: a longitudinal cohort study.Therapeutic advances in musculoskeletal disease · 2022Article
Corrections and comments
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Authors and funding
4 authors at 4 institutions in 3 countries.
Funding
Abstract
objectivesTo determine the skeletal safety and efficacy of long term (≥10 years) alendronate use in patients with osteoporosis.
designOpen register based cohort study containing two nested case control studies.
settingNationwide study of population of Denmark.
participants61 990 men and women aged 50-94 at the start of treatment, who had not previously taken alendronate, 1996-2007.
interventionsTreatment with alendronate.
main outcome measuresIncident fracture of the subtrochanteric femur or femoral shaft (ST/FS) or the hip. Non-fracture controls from the cohort were matched to fracture cases by sex, year of birth, and year of initiation of alendronate treatment. Conditional logistic regression models were fitted to calculate odds ratios with and without adjustment for comorbidity and comedications. Sensitivity analyses investigated subsequent treatment with other drugs for osteoporosis.
results1428 participants sustained a ST/FS (incidence rate 3.4/1000 person years, 95% confidence interval 3.2 to 3.6), and 6784 sustained a hip fracture (16.2/1000 person years, 15.8 to 16.6). The risk of ST/FS was lower with high adherence to treatment with alendronate (medication possession ratio (MPR, a proxy for compliance) >80%) compared with poor adherence (MPR <50%; odds ratio 0.88, 0.77 to 0.99; P=0.05). Multivariable adjustment attenuated this association (adjusted odds ratio 0.88, 0.77 to 1.01; P=0.08). The risk was no higher in long term users (≥10 dose years; 0.70, 0.44 to 1.11; P=0.13) or in current compared with past users (0.91, 0.79 to 1.06; P=0.22). Similarly, MPR >80% was associated with a decreased risk of hip fracture (0.73, 0.68 to 0.78; P<0.001) as was longer term cumulative use for 5-10 dose years (0.74, 0.67 to 0.83; P<0.001) or ≥10 dose years (0.74, 0.56 to 0.97; P=0.03).
conclusionsThese findings support an acceptable balance between benefit and risk with treatment with alendronate in terms of fracture outcomes, even for over 10 years of continuous use.
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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.