title: Atypical femur fracture during bisphosphonate drug holiday: a case series.
abstract: Recent studies have noted an increased risk of low energy subtrochanteric and femoral shaft fractures termed "atypical femur fractures" (AFFs) associated with long-term bisphosphonate use. As such, many clinicians have begun recommending a "drug holiday" to reduce the risks associated with long-term bisphosphonate use. We present two cases of AFFs occurring during a 4-year or greater drug holiday following long-term bisphosphonate use. These findings highlight the need to reevaluate optimal bisphosphonate therapy duration, dosage, as well as initiation and duration of a drug holiday with continued monitoring in the prevention of AFFs.
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th St., 9th Floor, New York, NY, 10029, USA. andrew.lovy@mountsinai.org.
authors.forename: A J
authors.initials: AJ
authors.lastname: Lovy
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th St., 9th Floor, New York, NY, 10029, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Koehler
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th St., 9th Floor, New York, NY, 10029, USA.
authors.forename: A
authors.initials: A
authors.lastname: Keswani
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th St., 9th Floor, New York, NY, 10029, USA.|Department of Orthopaedic Surgery, Elmhurst Hospital Center, 79-01 Broadway, Queens, NY, 11373, USA.
authors.forename: D
authors.initials: D
authors.lastname: Joseph
authors.affiliation: Department of Orthopaedic Surgery, Elmhurst Hospital Center, 79-01 Broadway, Queens, NY, 11373, USA.
authors.forename: R
authors.initials: R
authors.lastname: Hasija
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th St., 9th Floor, New York, NY, 10029, USA.|Department of Orthopaedic Surgery, Elmhurst Hospital Center, 79-01 Broadway, Queens, NY, 11373, USA.
authors.forename: R
authors.initials: R
authors.lastname: Ghillani
mesh_terms: D000368:Aged; 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; D004334:Drug Administration Schedule; D005260:Female; D005264:Femoral Fractures / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000209:etiology*; D028761:Withholding Treatment
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Atypical femur fractures; Bisphosphonates; Drug holiday; Osteoporosis
references.citation: Curr Rheumatol Rep. 2003 Feb;5(1):65-74
references.pmid: 12590887
references.citation: Bone Joint J. 2014 May;96-B(5):658-64
references.pmid: 24788502
references.citation: N Engl J Med. 2011 May 5;364(18):1728-37
references.pmid: 21542743
references.citation: J Bone Miner Res. 2007 Nov;22(11):1759-65
references.pmid: 17663638
references.citation: J Orthop Trauma. 2014 Jul;28(7):433-8
references.pmid: 24121986
references.citation: J Bone Miner Res. 2014 Jan;29(1):1-23
references.pmid: 23712442
references.citation: J Orthop Res. 2011 Mar;29(3):419-24
references.pmid: 20886644
references.citation: J Bone Miner Res. 2011 Jan;26(1):3-11
references.pmid: 20662073
references.citation: Bone. 2011 May 1;48(5):966-71
references.pmid: 21195812
references.citation: Bone. 2014 Jan;58:126-35
references.pmid: 24120384
references.citation: Osteoporos Int. 2009 May;20(5):793-800
references.pmid: 18769963
references.citation: J Bone Miner Res. 2013 Aug;28(8):1729-37
references.pmid: 23408697
references.citation: Curr Med Res Opin. 2004 Aug;20(8):1291-300
references.pmid: 15324532
references.citation: J Bone Miner Res. 2012 Feb;27(2):243-54
references.pmid: 22161728
references.citation: N Engl J Med. 2008 Mar 20;358(12 ):1304-6
references.pmid: 18354114
references.citation: Nature. 1968 Feb 24;217(5130):742-3
references.pmid: 5641125
references.citation: J Bone Miner Res. 2012 Mar;27(3):672-8
references.pmid: 22072397
references.citation: Osteoporos Int. 2008 Jun;19(6):733-59
references.pmid: 18214569
references.citation: J Theor Biol. 1964 May;6(3):386-412
references.pmid: 5875212
references.citation: Osteoporos Int. 2008 Mar;19(3):365-72
references.pmid: 17938986
references.citation: Profiles Drug Subst Excip Relat Methodol. 2013;38:1-33
references.pmid: 23668401
references.citation: Ther Adv Musculoskelet Dis. 2013 Jun;5(3):107-11
references.pmid: 23858334
references.citation: JAMA. 1998 Dec 23-30;280(24):2077-82
references.pmid: 9875874
references.citation: N Engl J Med. 2001 Feb 1;344(5):333-40
references.pmid: 11172164
references.citation: N Engl J Med. 2004 Mar 18;350(12 ):1189-99
references.pmid: 15028823
references.citation: Ann N Y Acad Sci. 2007 Nov;1117:209-57
references.pmid: 18056045
references.citation: Pharm Res. 2001 Feb;18(2):166-70
references.pmid: 11405286
references.citation: Can Fam Physician. 2014 Apr;60(4):324-33
references.pmid: 24733321
references.citation: J Clin Endocrinol Metab. 2010 Dec;95(12):5258-65
references.pmid: 20843943
references.citation: JAMA. 2006 Dec 27;296(24):2927-38
references.pmid: 17190893
references.citation: N Engl J Med. 2014 Sep 4;371(10):974-6
references.pmid: 25184886
references.citation: J Bone Miner Res. 2010 May;25(5):976-82
references.pmid: 20200926