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We are aware of recent press reports concerning the possibility that
long-term use of alendronate for osteoporosis and the occurrence of unusual
fractures reported mostly in the thigh bone (1).
We recognize that you might find these reports concerning. Osteoporosis
Canada takes your concerns seriously and we will continue to be vigilant in
order to inform you about the latest research. The study cited in the newspaper
articles has been reviewed by experts from the Scientific Advisory Committee at
Osteoporosis Canada and their response is below.
It is a fact - all medications have risks associated with them. Osteoporosis
medications are no exception. Every time a physician recommends and prescribes a
medication, it includes carefully weighing the risks and benefits of taking a
medication.
The study referenced above reported that the authors identified 15 women with
atypical fractures of the thigh, called subtrochanteric fractures, who had been
treated with alendronate. They noted that bisphosphonate use was observed in 37%
of all patients presenting with this type of fracture and that in their group of
patients these fractures represent only 6% of all hip fractures The authors
state that their report provides further evidence of a potential link between
alendronate use and low energy fractures of the thigh bone. They do go on to
state that further studies are required to establish whether a clear association
exists.
This letter to the editor has some limitations, which were discussed
by the authors, and which should lead us to interpret the findings with
caution. Three major limitations are the small number of women identified with
these atypical fractures on prior alendronate therapy, the unknown number of
patients who sustained these types of fracture who never received alendronate
therapy, and the fact that this was not a prospective randomized controlled
trial - as such it is not possible to state that alendronate cause atypical
fractures.
To date, thigh fracture has not been reported with other commonly used
osteoporosis medications including related bisphosphonates such as risedronate
and etidronate. Other studies, evidence and data support that the notion that
thigh fracture associated with bisphosphonate use is extremely
rare.
Fractures (broken bones) due to osteoporosis, on the other hand, are
extremely common. Osteoporotic fractures are linked to additional
fractures, altered quality of life, worsening of other health conditions and in
some cases – death. Bisphosphonate medications provide protection from
osteoporotic fractures. It is important to remember that your physician
carefully weighs the risks and benefits of taking a medication for your unique
situation every time he or she recommends and prescribes a medication.
Your healthcare team is available to review any concerns or questions you may
have about this issue.
1. Lenart BA, Lorich DG, Lane J. Atypical fractures of the
femoral diaphysis in postmenopausal women taking alendronate. N Engl J Med. 2008
358;1304-1306
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