Low-Energy Femoral Fractures Associated with the Long-Term Use of Bisphosphonates: A Case Series from a Swiss University Hospital

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 admitt...

Full description

Saved in:
Bibliographic Details
Published in:Drug safety 2009-01, Vol.32 (9), p.775-785
Main Authors: Ing-Lorenzini, Kuntheavy, Desmeules, Jules, Plachta, Olivier, Suva, Domizio, Dayer, Pierre, Peter, Robin
Format: Article
Language:English
Subjects:
Biological and medical sciences
Bones, joints and connective tissue. Antiinflammatory agents
Clinical trial. Drug monitoring
Complications and side effects
Diphosphonates
Dosage and administration
Drug Safety and Pharmacovigilance
Drug therapy
Drug toxicity and drugs side effects treatment
Fractures
General pharmacology
Injuries of the limb. Injuries of the spine
Medical sciences
Medicine
Medicine & Public Health
Osteoporosis
Pharmacology. Drug treatments
Pharmacology/Toxicology
Risk factors
Short Communication
Toxicity: osteoarticular system
Traumas. Diseases due to physical agents
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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.
ISSN:0114-5916
1179-1942
DOI:10.2165/00002018-200932090-00002