Bisphosphonate use and the risk of atypical fractures

Abstract

Bisphosphonates (BPs) have been in the market for the past 40 years and proven beneficial especially for patients with osteoporosis and prevention of hypercalcemic in malignancy. However, their long-term use raises safety concerns like Atypical femoral fracture and Osteonecrosis of the Jaw whose pathophysiology still remains unclear. Atypical femoral fracture is more commonly seen among BP users with at least six years of therapy and concomitant use of drugs such as glucocorticoids. The most common treatment for atypical femoral fracture is to withdraw the therapy with monitoring of bone resorption markers but the definitive treatment is intramedullary nail fixation where necessary. Hence, physicians must be vigilant to rarer and long-term BP-reported adverse effects and understand the evidence around the use of these drugs including drug free holidays. A structured benefit-risk assessment should be made for every individual patient including communicating the risk of these rare side effects.