title: Radiographic Changes and Fracture in Patients Having Received Bisphosphonate Therapy for ≥ 5 Years at a Single Institution.
abstract: BACKGROUND
  Bisphosphonates have been shown to reduce the incidence of vertebral fractures, as well as intertrochanteric and femoral neck fractures; however, data also demonstrate the association of prolonged use and atypical femur fractures. We intend to report the incidence of atypical femur fractures and cortical irregularities in patients from a single institution having received prolonged bisphosphonate therapy.
  
  
  METHODS
  A retrospective review of the pharmaceutical database was performed for all patients who were prescribed bisphosphonates at a single institution from 2002 to 2012. People taking bisphosphonates for ≥ 5 years were included. Those identified as having adequate radiographs with visualization of at least 5-cm distal to the lesser trochanter were selected. Radiographs were reviewed for evidence of atypical femur fractures or lateral cortical beaking. Medical records were retrospectively reviewed to determine any prodromal symptoms or clinical risk factors.
  
  
  RESULTS
  A total of 7,671 patients were identified between the years of 2002 and 2012 as having been prescribed bisphosphonates at a single institution. Of these, 1,684 were using bisphosphonates for ≥ 5 years (2002-2007). 396 patients taking bisphosphonates for greater than 5 years had adequate radiographs. In total, 8 patients (2.02%) had positive findings; 7 were females. More specifically, 2 (0.51%) patients had incomplete subtrochanteric fractures while 6 (1.52%) demonstrated lateral cortical beaking.
  
  
  CONCLUSIONS
  Over 2% of patients at our institution having received bisphosphonate therapy for ≥ 5 years demonstrated cortical irregularities or have already experienced an atypical femur fracture. These findings could call into question the need for radiographic screening for patients on prolonged bisphosphonate therapy.
authors.affiliation: Department of Orthopedic Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859.
authors.forename: Justin
authors.initials: J
authors.lastname: Ernat
authors.affiliation: Department of Orthopedic Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859.
authors.forename: Daniel
authors.initials: D
authors.lastname: Song
authors.affiliation: Department of Orthopedic Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859.
authors.forename: Michael
authors.initials: M
authors.lastname: Fazio
authors.affiliation: Department of Orthopedic Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lindell
authors.affiliation: Department of Orthopedic Surgery, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859.
authors.forename: Joseph
authors.initials: J
authors.lastname: Orchowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005264:Femoral Fractures / Q000139:chemically induced / Q000000981:diagnostic imaging*; D005269:Femur / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates