Scientific article
Case report

Low-energy femoral fractures associated with the long-term use of bisphosphonates: a case series from a Swiss university hospital

Published inDrug safety, vol. 32, no. 9, p. 775-785
Publication date2009

BACKGROUND: Bisphosphonates are effective and well tolerated anti-resorptive drugs used for the treatment of osteoporosis. However, some concerns about their potential long-term negative effects are emerging. OBJECTIVE: We report a series of patients with a history of bisphosphonate treatment admitted to our institution with a low-energy subtrochanteric fracture. PATIENTS AND METHODS: Eight patients fulfilling these two criteria within the last 2 years were included in our retrospective analysis. All cases were reported to the Swiss National Pharmacovigilance Centre. RESULTS: All patients presented with a typical radiological pattern consisting of a cortical thickening at the lateral femoral subtrochanteric cortex with a horizontal fracture line originating precisely at this level. Four patients eventually developed a stress fracture or complete fracture of the contralateral femur. Two patients demonstrated delayed healing of their fracture. Five patients had been on alendronate therapy for a period ranging from 16 months to 8 years, two had been on ibandronate for 4 months and 1 year, respectively, after changing from alendronate, and one patient had been on pamidronate until 1 year before the fracture occurred. Seven patients were also receiving long-term proton pump inhibitor (PPI) treatment which could have contributed to the increased risk of fracture. Four patients were receiving both PPI and long-term corticosteroid treatment. The hypothesis of a negative pharmacodynamic interaction between bisphosphonates, PPIs and corticosteroids which could lead to a decrease in bone strength after long-term use needs further investigation. CONCLUSION: Prescribers should be aware of the possibility of these rare adverse reactions and the prolonged use of bisphosphonates should be reconsidered until long-term robust safety data are available.

  • Aged
  • Aged, 80 and over
  • Alendronate/adverse effects/therapeutic use
  • Bone Density Conservation Agents/adverse effects/therapeutic use
  • Bone Nails
  • Diphosphonates/adverse effects/therapeutic use
  • Female
  • Femoral Fractures/epidemiology/radiography/surgery
  • Follow-Up Studies
  • Fractures, Spontaneous/epidemiology/radiography/surgery
  • Humans
  • Male
  • Middle Aged
  • Osteoporosis/complications/drug therapy
  • Product Surveillance, Postmarketing
  • Retrospective Studies
  • Switzerland
  • Treatment Outcome
Citation (ISO format)
ING LORENZINI, Kuntheavy et al. Low-energy femoral fractures associated with the long-term use of bisphosphonates: a case series from a Swiss university hospital. In: Drug safety, 2009, vol. 32, n° 9, p. 775–785. doi: 10.2165/00002018-200932090-00002
Main files (1)
Article (Published version)
ISSN of the journal0114-5916

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