title: Menopause practitioner perspective on the American Society of Bone and Mineral Research Task Force report on atypical femoral fracture.
abstract: One of your patients, a 59-year-old postmenopausal Asian woman (menopause, age 52), took hormone therapy for about one year for her menopause symptoms. When she was 54, her mother (age 80) suffered a hip fracture, and she requested a bone density test at her next gynecology visit. The t-score results were spine, -1.1; total hip, -1.8; and femoral neck, -2.1, all in the osteopenic range. After some discussion, she was started on alendronate 70 mg once a week, together with calcium and vitamin D. Follow-up dual-energy x-ray absorptiometry testing after 2 and 5 years of therapy showed increases in bone mineral density, resulting in t-score improvements of about 0.3 to 0.5 units (spine was now normal; femoral neck was -1.8). The Fracture Risk Assessment Tool estimated her 10-year risk of hip fracture to be 0.4% and her 10-year risk of any of 4 major osteoporotic fractures to be 7.5%. During her most recent gynecology visit, she expressed concern about unusual femoral fractures being linked to long-term use of alendronate. She asks if there is reason for her to stop using this drug.
authors.affiliation: From the 1Department of Medicine, University of California, San Francisco, San Francisco, CA; 2Department of Medicine, University of California, San Diego, La Jolla, CA; and 3Departments of ObGyn and Medicine, The Reading Hospital and Medical Center, Reading, PA; Departments of ObGyn and Internal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ettinger
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Stuenkel
authors.forename: Peter F
authors.initials: PF
authors.lastname: Schnatz
mesh_terms: D026683:Advisory Committees; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000139:chemically induced*; D006620:Hip Fractures; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000517:prevention & control; D012955:Societies, Medical; D014807:Vitamin D
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D014807:Vitamin D; D019386:Alendronate