title: Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution.
abstract: 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.
authors.affiliation: Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, Republic of Singapore. seokiat.goh@cantab.net
authors.forename: S-K
authors.initials: SK
authors.lastname: Goh
authors.forename: K Y
authors.initials: KY
authors.lastname: Yang
authors.forename: J S B
authors.initials: JS
authors.lastname: Koh
authors.forename: M K
authors.initials: MK
authors.lastname: Wong
authors.forename: S Y
authors.initials: SY
authors.lastname: Chua
authors.forename: D T C
authors.initials: DT
authors.lastname: Chua
authors.forename: T S
authors.initials: TS
authors.lastname: Howe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000139:chemically induced* / Q000209:etiology / Q000473:pathology; D005269:Femur / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D010146:Pain / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate