title: Increased risk for atypical fractures associated with bisphosphonate use.
abstract: BACKGROUND
  Studies suggest an increasing occurrence of atypical femoral fractures with the use of bisphosphonates.
  
  
  OBJECTIVE
  To examine whether the use of bisphosphonates increases the risk for atypical fractures.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Literature search of MEDLINE, Embase and Cochrane CENTRAL (1948-June 2013).
  
  
  METHODS
  
  
  
  METHODS
  (i) randomized controlled trial or an observational study, (ii) evaluated bisphosphonate therapy versus no treatment and (iii) reported an incidence of subtrochanteric or diaphyseal fracture individually, or a composite of both. Two independent investigators completed study selection, data extraction and validity assessment. The Cochrane Risk of Bias Tool was used to assess the quality of included studies.
  
  
  RESULTS
  Ten (n = 658497) studies were included in the meta-analysis which demonstrated a statistically significant increased risk of subtrochanteric or diaphyseal fracture with bisphosphonate use [adjusted odds ratios (AOR) = 1.99, 95% confidence intervals (CI)= 1.28-3.10] with I (2) = 84.3% (95% CI = 73.5%-89.5%) and Egger P = 0.01. Subtrochanteric fractures showed an AOR = 2.71 (95% CI = 1.86-3.95) with I (2) = 83.6% (95% CI = 64.3%-90.3%) and Egger's P = 2.29. Diaphyseal fractures had an AOR = 2.06 (95% CI = 1.70-2.50), I (2) = 29.7% (95% CI = 0%-73.7%) and Egger's P = 1.22.
  
  
  CONCLUSIONS
  Results suggest there is an increased risk for atypical fractures associated with bisphosphonates and raises awareness to the potential complications related with bisphosphonates. These findings warrant the comprehensive evaluation of patients before initiating bisphosphonate therapy and highlights the need for additional medical decision analyses in future studies to compare the benefit over potential harms of bisphosphonate therapy.
authors.affiliation: School of Pharmacy, University of Connecticut, Storrs, CT, Department of Pharmacy, Hartford Hospital, Hartford, CT.
authors.forename: Soyon
authors.initials: S
authors.lastname: Lee
authors.affiliation: College of Pharmacy, Western University of Health Sciences, Pomona, CA, and.
authors.forename: Raynold V
authors.initials: RV
authors.lastname: Yin
authors.affiliation: College of Pharmacy, Western University of Health Sciences, Pomona, CA, and.
authors.forename: Hemant
authors.initials: H
authors.lastname: Hirpara
authors.affiliation: College of Pharmacy, Western University of Health Sciences, Pomona, CA, and.
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Lee
authors.affiliation: College of Pharmacy, Western University of Health Sciences, Pomona, CA, and.
authors.forename: Adrian
authors.initials: A
authors.lastname: Lee
authors.affiliation: College of Pharmacy and Health Sciences, Massachusetts University, Worcester, MA, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Llanos
authors.affiliation: College of Pharmacy, Western University of Health Sciences, Pomona, CA, and ophung@westernu.edu.
authors.forename: Olivia J
authors.initials: OJ
authors.lastname: Phung
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D016206:Databases, Bibliographic; D018483:Diaphyses / Q000293:injuries; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology; D050723:Fractures, Bone / Q000145:classification / Q000453:epidemiology* / Q000209:etiology; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D018570:Risk Assessment
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Osteoporosis; prevention; primary care; risk assessment.