title: Low-energy femoral shaft fractures associated with alendronate use.
abstract: OBJECTIVE
  Increasing evidence suggests long-term alendronate use may overly suppress bone metabolism, limiting repair of microdamage and creating risk for insufficiency fractures. The purpose of this study is to demonstrate an association between alendronate use and a specific pattern of low-energy femoral shaft fracture.
  
  
  METHODS
  A retrospective review was performed of patients with femoral shaft fractures admitted to a Level 1 trauma center between January 2002 and March 2007. Seventy low-energy fractures were identified.
  
  
  METHODS
  The medical records were reviewed, and the incidence and duration of alendronate use were recorded. The incidence of a specific femoral shaft fracture in those patients taking alendronate compared with those not being treated was determined.
  
  
  RESULTS
  There were 59 females and 11 males. The average age was 74.7 years. Twenty-five (36%) were being treated with alendronate. None of the patients had used or were using other bisphosphonates. Nineteen (76%) of these 25 patients demonstrated a simple, transverse fracture with a unicortical beak in an area of cortical hypertrophy. This fracture pattern was seen in only 1 patient (2%) not being treated with alendronate. Alendronate use was a significant risk factor for the fracture pattern (odds ratio [OR]) 139.33, 95% CI [19.0-939.4], P < 0.0001). This pattern was 98% specific to alendronate users. The average duration of alendronate use in those with the pattern was significantly longer than those who did not exhibit the pattern but were taking alendronate, 6.9 years versus 2.5 years of use, respectively (P = 0.002). Only 1 patient with the fracture pattern had been taking alendronate for less than 4 years.
  
  
  CONCLUSIONS
  Low-energy fractures of the femoral shaft with a simple, transverse pattern and hypertrophy of the diaphyseal cortex are associated with alendronate use. This may result from propagation of a stress fracture whose repair is retarded by diminished osteoclast activity and impaired microdamage repair resulting from its prolonged use.
authors.affiliation: Hospital for Special Surgery, New York, NY, USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Neviaser
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Lane
authors.forename: Brett A
authors.initials: BA
authors.lastname: Lenart
authors.forename: Folorunsho
authors.initials: F
authors.lastname: Edobor-Osula
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
mesh_terms: D000367:Age Factors; D000368:Aged; D019386:Alendronate / Q000008:administration & dosage / Q000009:adverse effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate