title: Atypical fractures, a biased perspective.
abstract: When stress fractures started to show up in the femurs of elderly ladies, it was soon evident that bisphosphonate use lay behind, and the absolute risk increase due to bisphosphonate use was reasonably well estimated already in 2008. Thereafter followed a period of confusion: the term atypical fracture was introduced, with a definition so vague that the true stress fractures tended to disappear in a cloud of ambiguity. This cast doubt on the association with bisphosphonates. The association was then re-established by large epidemiological studies based on radiographic adjudication. Atypical fractures are largely caused by bisphosphonates. With a correct indication, bisphosphonates prevent many more fractures than they cause, at least during the first years of use. With an incorrect indication they are likely to cause more harm than good.
authors.affiliation: Linköping University, Department of Clinical and Experimental Medicine Orthopaedics, Linköping, Sweden. Electronic address: per.aspenberg@liu.se.
authors.forename: Per
authors.initials: P
authors.lastname: Aspenberg
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; D005265:Femoral Neck Fractures / Q000139:chemically induced* / Q000453:epidemiology; D015775:Fractures, Stress / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy* / Q000453:epidemiology; D018570:Risk Assessment
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: atypical fractures; bisphosphonates; osteoporosis; proximal femoral fractures