Beyond a reasonable doubt?: Bisphosphonates and atypical femur fractures

Bo Abrahamsen; Thomas A Einhorn

doi:10.1016/j.bone.2012.02.009

Beyond a reasonable doubt? Bisphosphonates and atypical femur fractures

Bo Abrahamsen, Thomas A Einhorn

19 Citations (Scopus)

Abstract

In May 2011, we were privileged to debate on behalf of the ECTS and the ASBMR in a Clinical Debate hosted by the IBMS and the ECTS with the motion "Atypical femoral shaft fractures are a consequence of bisphosphonate therapy". The evidence presented for and against the motion is summarized and discussed in this joint commentary. The hypothetical chain of evidence between bisphosphonates, decreased toughness of bone, microcrack accumulation in man and atypical fractures is plausible but unproven. However, the combination of consistent clinical features (which may include a stress reaction at the site of maximum tensile load), a significant statistical association and a feasible biological mechanism gives grounds for caution especially as regards long term treatment in patients at low or moderate risk of osteoporotic fractures.

Original language	English
Journal	Bone
Volume	50
Issue number	5
Pages (from-to)	1196-200
Number of pages	5
ISSN	8756-3282
DOIs	https://doi.org/10.1016/j.bone.2012.02.009
Publication status	Published - 2012

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10.1016/j.bone.2012.02.009

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abstract = "In May 2011, we were privileged to debate on behalf of the ECTS and the ASBMR in a Clinical Debate hosted by the IBMS and the ECTS with the motion {"}Atypical femoral shaft fractures are a consequence of bisphosphonate therapy{"}. The evidence presented for and against the motion is summarized and discussed in this joint commentary. The hypothetical chain of evidence between bisphosphonates, decreased toughness of bone, microcrack accumulation in man and atypical fractures is plausible but unproven. However, the combination of consistent clinical features (which may include a stress reaction at the site of maximum tensile load), a significant statistical association and a feasible biological mechanism gives grounds for caution especially as regards long term treatment in patients at low or moderate risk of osteoporotic fractures.",

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AU - Einhorn, Thomas A

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AB - In May 2011, we were privileged to debate on behalf of the ECTS and the ASBMR in a Clinical Debate hosted by the IBMS and the ECTS with the motion "Atypical femoral shaft fractures are a consequence of bisphosphonate therapy". The evidence presented for and against the motion is summarized and discussed in this joint commentary. The hypothetical chain of evidence between bisphosphonates, decreased toughness of bone, microcrack accumulation in man and atypical fractures is plausible but unproven. However, the combination of consistent clinical features (which may include a stress reaction at the site of maximum tensile load), a significant statistical association and a feasible biological mechanism gives grounds for caution especially as regards long term treatment in patients at low or moderate risk of osteoporotic fractures.

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JO - Bone

JF - Bone

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Beyond a reasonable doubt? Bisphosphonates and atypical femur fractures

Abstract

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