title: Long-term bisphosphonate usage and subtrochanteric insufficiency fractures: a cause for concern?
abstract: For over a decade, bisphosphonate administration has evolved and become the cornerstone of the prevention and treatment of fragility fractures. Millions of post-menopausal women have relied on, and continue to depend on, the long-acting, bone density-maintaining pharmaceutical drug to prevent low-energy fractures. In return, we have seen the number of fragility fractures decrease, along with associated costs and emotional benefits. However, with any drug, there are often concerns with side effects and complications, and this unique drug class is seeing one such complication in atypical subtrochanteric femoral fracture, counterproductive to that which it was designed to prevent. This has created concern over long-term bisphosphonate administration and its potential link to these atypical fractures. There is controversial evidence surrounding such a definitive link, and no protocol for managing these fractures.  This review offers the latest information regarding this rare but increasingly controversial adverse effect and its potential connection to one of the most successful forms of treatment that is available for the management of fragility fractures.
authors.affiliation: NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, New York 10003, USA.
authors.forename: R S
authors.initials: RS
authors.lastname: Yoon
authors.forename: J S
authors.initials: JS
authors.lastname: Hwang
authors.forename: K S
authors.initials: KS
authors.lastname: Beebe
mesh_terms: D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D015775:Fractures, Stress / Q000139:chemically induced*; D006620:Hip Fractures / Q000139:chemically induced*; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000517:prevention & control
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates