Goh S-K, Yang K Y, Koh J S B, Wong M K, Chua S Y, Chua D T C, Howe T S
Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, Republic of Singapore.
J Bone Joint Surg Br. 2007 Mar;89(3):349-53. doi: 10.1302/0301-620X.89B3.18146.
We carried out a retrospective review over ten months of patients who had presented with a low-energy subtrochanteric fracture. We identified 13 women of whom nine were on long-term alendronate therapy and four were not. The patients treated with alendronate were younger, with a mean age of 66.9 years (55 to 82) vs 80.3 years (64 to 92) and were more socially active. The fractures sustained by the patients in the alendronate group were mainly at the femoral metaphyseal-diaphyseal junction and many had occurred after minimal trauma. Five of these patients had prodromal pain in the affected hip in the months preceding the fall, and three demonstrated a stress reaction in the cortex in the contralateral femur. Our study suggests that prolonged suppression of bone remodelling with alendronate may be associated with a new form of insufficiency fracture of the femur. We believe that this finding is important and indicates the need for caution in the long-term use of alendronate in the treatment of osteoporosis.
我们对10个月内出现低能量型转子下骨折的患者进行了回顾性研究。我们确定了13名女性患者，其中9名正在接受阿仑膦酸钠长期治疗，4名未接受该治疗。接受阿仑膦酸钠治疗的患者更年轻，平均年龄为66.9岁（55至82岁），而未接受治疗的患者平均年龄为80.3岁（64至92岁），且前者社交活动更为频繁。阿仑膦酸钠组患者的骨折主要发生在股骨干骺端交界处，许多骨折是在受到极小创伤后发生的。其中5名患者在跌倒前数月患侧髋部有前驱疼痛，3名患者对侧股骨皮质出现应力反应。我们的研究表明，阿仑膦酸钠对骨重塑的长期抑制可能与一种新的股骨不全性骨折形式有关。我们认为这一发现很重要，表明在长期使用阿仑膦酸钠治疗骨质疏松症时需要谨慎。
