Population and treatment-based incidence estimates of atypical fractures

Christian M Girgis and Markus J Seibel
Med J Aust 2011; 194 (12): . || doi: 10.5694/j.1326-5377.2011.tb03163.x
Published online: 20 June 2011

To the Editor: Atypical femur fractures appear to be an emerging adverse outcome of long-term use of bisphosphonates. Although analyses of epidemiological data suggest that subtrochanteric and diaphyseal fractures per se are rare,1,2 the true incidence of atypical fractures (a distinct subset of such fractures) is unknown.

  • University of Sydney, Sydney, NSW.


Competing interests:

Markus Seibel is a member of advisory boards for Merck Sharp and Dohme, Novartis, Amgen and Sanofi-Aventis. He has also received funding from these companies for institutional research.

  • 1. Abrahamsen B, Eiken P, Eastell R. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study. J Bone Miner Res 2009; 24: 1095-1102.
  • 2. Black DM, Kelly MP, Genant HK, et al. Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med 2010; 362: 1761-1771.
  • 3. Girgis CM, Sher D, Seibel MJ. Atypical femoral fractures and bisphosphonate use. N Engl J Med 2010; 362: 1848-1849.
  • 4. Cranney A, Wells G, Willan A, et al. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev 2002; 23: 508-516.
  • 5. Cranney A, Wells G, Willan A, et al. Meta-analysis of risedronate for the treatment of postmenopausal osteoporosis. Endocr Rev 2002; 23: 517-523.
  • 6. Dell R, Greene D, Ott S, et al. A retrospective analysis of all atypical femur fractures seen in a large California HMO from the years 2007 to 2009. American Society of Bone and Mineral Research Annual Meeting 2010 [abstract]. J Bone Miner Res 2010; 25 (suppl 1): S61. (accessed May 2011).
  • 7. Park-Wyllie LY, Mamdani MM, Juurlink DN, et al. Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA 2011; 305: 783-789.


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