title: Low-energy femoral shaft fractures after long-term alendronate therapy: report of seven cases.
abstract: BACKGROUND
  There is increasing evidence suggesting a high incidence of low-energy fractures of the diaphysis or the proximal femur in patients receiving bisphosphonates for a long time. Bisphosphonate-related femoral fractures occur after low-energy trauma and have a typical simple transverse or oblique radiographic pattern, with focal or generalized increased cortical thickness, cortical beaking, and medial spiking.
  
  
  METHODS
  This article presents six female patients who experienced seven transverse femoral diaphysis and subtrochanteric fractures with cortical thickening and beaking; all patients had alendronate treatment for 4-10 years (average, 9 years) before their fracture.
  
  
  RESULTS
  The typical radiographic findings, long-term administration of alendronate, low-energy mechanism of fracture, and related literature support the fact that the fractures in the patients presented in this series should be related to alendronate treatment.
  
  
  CONCLUSIONS
  Until definite evidence is available, alendronate treatment in patients with osteoporosis is not now prohibited by the healthcare authorities, probably because its beneficial influence outweighs the adverse effects. However, this adverse effect deserves attention of medical practitioners; physicians should be alert on alendronate's possible suppressive effect on bone turnover, which in turn may be responsible for the occurrence of femoral fractures.
authors.affiliation: First Department of Orthopaedics, ATTIKON University Hospital, Athens University Medical School, 41 Ventouri Street, Holargos, 15562, Athens, Greece.
authors.forename: Efstathios G
authors.initials: EG
authors.lastname: Ballas
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Mavrogenis
authors.forename: Eirineos
authors.initials: E
authors.lastname: Karamanis
authors.forename: Zinon T
authors.initials: ZT
authors.lastname: Kokkalis
authors.forename: Evanthia
authors.initials: E
authors.lastname: Mitsiokapa
authors.forename: Demetrios
authors.initials: D
authors.lastname: Koulalis
authors.forename: Demetrios
authors.initials: D
authors.lastname: Mastrokalos
authors.forename: Panayiotis J
authors.initials: PJ
authors.lastname: Papagelopoulos
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000009:adverse effects*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D018483:Diaphyses / Q000293:injuries; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000601:surgery; D006801:Humans; D017770:Lifting / Q000009:adverse effects; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy; D011859:Radiography; D013997:Time Factors; D016138:Walking
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate