Division of Bone Diseases, Department of Rehabilitation and Geriatrics, University Hospitals and Faculty of Medicine of Geneva, 1211, Geneva 14, Switzerland.
Osteoporos Int. 2011 Feb;22(2):373-90. doi: 10.1007/s00198-010-1453-5. Epub 2010 Nov 18.
This paper reviews the evidence for an association between atypical subtrochanteric fractures and long-term bisphosphonate use. Clinical case reports/reviews and case-control studies report this association, but retrospective phase III trial analyses show no increased risk. Bisphosphonate use may be associated with atypical subtrochanteric fractures, but the case is yet unproven.
A Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the International Osteoporosis Foundation has reviewed the evidence for a causal association between subtrochanteric fractures and long-term treatment with bisphosphonates, with the aim of identifying areas for further research and providing recommendations for physicians.
A PubMed search of literature from 1994 to May 2010 was performed using key search terms, and articles pertinent to subtrochanteric fractures following bisphosphonate use were analysed.
Several clinical case reports and case reviews report a possible association between atypical fractures at the subtrochanteric region of the femur in bisphosphonate-treated patients. Common features of these 'atypical' fractures include prodromal pain, occurrence with minimal/no trauma, a thickened diaphyseal cortex and transverse fracture pattern. Some small case-control studies report the same association, but a large register-based study and retrospective analyses of phase III trials of bisphosphonates do not show an increased risk of subtrochanteric fractures with bisphosphonate use. The number of atypical subtrochanteric fractures in association with bisphosphonates is an estimated one per 1,000 per year. It is recommended that physicians remain vigilant in assessing their patients treated with bisphosphonates for the treatment or prevention of osteoporosis and advise patients of the potential risks.
Bisphosphonate use may be associated with atypical subtrochanteric fractures, but the case is unproven and requires further research. Were the case to be proven, the risk-benefit ratio still remains favourable for use of bisphosphonates to prevent fractures.
本研究综述了股骨转子下非典型骨折与长期使用双膦酸盐之间关联的证据。临床病例报告/综述和病例对照研究报告了这种关联，但回顾性 III 期试验分析并未显示风险增加。双膦酸盐的使用可能与股骨转子下非典型骨折有关，但尚未得到证实。
欧洲临床和经济骨质疏松症和骨关节炎学会和国际骨质疏松基金会的一个工作组审查了股骨转子下骨折与长期使用双膦酸盐治疗之间因果关系的证据，目的是确定进一步研究的领域，并为医生提供建议。
使用关键搜索词在 PubMed 上搜索 1994 年至 2010 年 5 月的文献，并分析与双膦酸盐使用后转子下骨折相关的文章。
一些临床病例报告和病例综述报告了在接受双膦酸盐治疗的患者中，股骨转子下区域出现非典型骨折的可能关联。这些“非典型”骨折的共同特征包括前驱疼痛、轻微/无创伤发生、骨干皮质增厚和横向骨折模式。一些小型病例对照研究报告了同样的关联，但一项大型登记研究和双膦酸盐 III 期试验的回顾性分析并未显示双膦酸盐使用与转子下骨折风险增加相关。与双膦酸盐相关的非典型转子下骨折的数量估计为每年每 1000 例 1 例。建议医生在评估接受双膦酸盐治疗骨质疏松症的治疗或预防的患者时保持警惕，并告知患者潜在风险。
双膦酸盐的使用可能与非典型转子下骨折有关，但尚未得到证实，需要进一步研究。如果这一情况得到证实，使用双膦酸盐预防骨折的风险效益比仍然有利。
