Bisphosphonates and Atypical Hip Fractures: Current Status of Issue and Answers to Discussion Questions

I.Yu. Golovach


The paper presents the recent data with the literature review on the controversial issue of the link between chronic administration of bisphosphonates, and atypical femoral shaft fractures. Bisphosphonates are now the most potent modulators of bone tissue with high efficiency, which is confirmed in high-quality randomized controlled trials to estimate the incidence of fractures as an endpoint. At the same time, since 2005, at medical congresses at various levels was heard several reports, as well as published observations of unusual, low-energy, with an atypical localization (subtrochanteric and diaphyseal) fractures of the femur, which occur in patients taking alendronate for 5–10 years. A concern was made that these atypical fractures may be associated with prolonged intake of bisphosphonates due to adverse effects of the latter on bone metabolism. However, numerous studies and thorough analysis of the FDA have has not established a link between chronic administration of bisphosphonates and the occurrence of atypical fractures. Overview of the data showed no increase in fracture risk for women taking bisphosphonates, and the lack of a clear link between long-term intake of bisphosphonates and the development of atypical fractures of the hip. For the vast majority of patients with osteoporosis bisphosphonates are an important and powerful weapon against fractures and their benefits far outweigh the risks of their use. Thus, there is currently no convincing evidence to support an increased risk of this type of fracture with long-term bisphosphonates, and not clearly defined mechanisms to explain this relationship.


bisphosphonates; osteoporosis; treatment; atypical hip fractures; analysis of study results


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