Article

Recent case reports have identified an association between long-term
bisphosphonate treatment and stress fractures of the femoral shaft. The risk of
such fractures in bisphosphonate users has not been determined. METHODS: We
identified women over 55 years of age with the specific fracture pattern by
searching the operation registry of the hospitals in 2 healthcare districts.
Prevalence of bisphosphonate treatment was provided by a Swedish national
registry covering all drugs delivered to all individuals since 2005. RESULTS: The
number of women on bisphosphonate treatment was 3,087. Of these, 5 had femoral
stress fractures. They had been taking bisphosphonates for 3.5 to 8.5 years. The
incidence density for a patient on bisphosphonate was 1/1,000 per year (95% CI:
0.3-2). In the remaining 88,869 women who were not taking bisphosphonates, there
were 3 stress fractures. Thus, their risk (without correction for inhomogeneity
in age distribution) was 46 times less (95% CI: 11-200). INTERPRETATION: These
results are rough estimations based on a comparatively small material. Still, a
treatment-associated incidence density of 1/1,000 is acceptable, considering that
bisphosphonate treatment is likely to reduce the incidence density of any
fracture by 15/1,000 according to a large randomized trial (Black et al. 1996).

Langue : ANGLAIS