Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution.

We carried out a retrospective review over ten months of patients who had presented with a low-energy subtrochanteric fracture. We identified 13 women of whom nine were on long-term alendronate therapy and four were not. The patients treated with alendronate were younger, with a mean age of 66.9 years (55 to 82) vs 80.3 years (64 to 92) and were more socially active. The fractures sustained by the patients in the alendronate group were mainly at the femoral metaphyseal-diaphyseal junction and many had occurred after minimal trauma. Five of these patients had prodromal pain in the affected hip in the months preceding the fall, and three demonstrated a stress reaction in the cortex in the contralateral femur. Our study suggests that prolonged suppression of bone remodelling with alendronate may be associated with a new form of insufficiency fracture of the femur. We believe that this finding is important and indicates the need for caution in the long-term use of alendronate in the treatment of osteoporosis.

[1]  W. K. Massie.  FRACTURES OF THE HIP. , 1964, The Journal of bone and joint surgery. American volume.

[2]  F. Pauwels.  Die Bedeutung der Bauprinzipien des Sttz-und Bewegungsapparates fr die Beanspruchung der Rhrenknochen: Erster Beitrag zur funktionellen Anatomie und kausalen Morphologie des Sttzapparates , 1948 .

[3]  P. Meunier,et al.  Alendronate increases bone strength by increasing the mean degree of mineralization of bone tissue in osteoporotic women. , 2000, Bone.

[4]  D. Wenkert,et al.  Bisphosphonate-induced osteopetrosis. , 2003, The New England journal of medicine.

[5]  John P. Bilezikian,et al.  Principles of Bone Biology , 1996 .

[6]  Ten years' experience with alendronate for osteoporosis in postmenopausal women. , 2004 .

[7]  H. Fleisch.  Bisphosphonates: Mechanisms of Action , 1998 .

[8]  D. Burr,et al.  Suppressed Bone Turnover by Bisphosphonates Increases Microdamage Accumulation and Reduces Some Biomechanical Properties in Dog Rib , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[9]  Lynn Wei,et al.  Histomorphometric assessment of the long-term effects of alendronate on bone quality and remodeling in patients with osteoporosis. , 1997, The Journal of clinical investigation.

[10]  J. Zerwekh,et al.  Severely suppressed bone turnover: a potential complication of alendronate therapy. , 2005, The Journal of clinical endocrinology and metabolism.

[11]  Joseph Schatzker,et al.  The Rationale Of Operative Fracture Care , 1987 .

[12]  G. O. Eaton,et al.  Fractures of the hip. , 1959, The American surgeon.

[13]  Claus Christiansen,et al.  Diagnosis of Osteoporosis , 1992, Southern medical journal.

[14]  Friedrich Tischendorf.  Beitrag zur Frage abnormer Caninusbildung bei Hippopotamus amphibius , 2004, Zeitschrift für Anatomie und Entwicklungsgeschichte.

[15]  F. Pauwels,et al.  Die Bedeutung der Bauprinzipien des Stütz-und Bewegungsapparates für die Beanspruchung der Röhrenknochen , 2004, Zeitschrift für Anatomie und Entwicklungsgeschichte.

[16]  S. Cummings,et al.  Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. , 2000, The Journal of clinical endocrinology and metabolism.

[17]  S. Cummings,et al.  Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures , 1996, The Lancet.

[18]  J. Rodriguez-Portales,et al.  Ten years' experience with alendronate for osteoporosis in postmenopausal women. , 2004, The New England journal of medicine.