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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 3, 349-353.
doi: 10.1302/0301-620X.89B3.18146  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Subtrochanteric insufficiency fractures in patients on alendronate therapy

A CAUTION

S.-K. Goh, MA, MRCS, Registrar1; K. Y. Yang, FRCS(Orth), Consultant Orthopaedic Surgeon1; J. S. B. Koh, FRCS(Orth), Consultant Orthopaedic Surgeon1; M. K. Wong, FRCS(Orth), Senior Consultant Orthopaedic Surgeon1; S. Y. Chua, MRCS, Registrar2; D. T. C. Chua, FRCS(Orth), Senior Consultant Orthopaedic Surgeon2; and T. S. Howe, FRCS(Orth), Senior Consultant Orthopaedic Surgeon and Director of Trauma1

1 Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Republic of Singapore.
2 Department of Orthopaedic Surgery, Changi General Hospital, 2, Simei Street 3, Singapore, 529889, Republic of Singapore.

Correspondence should be sent to Dr S. K. Goh; e-mail: seokiat.goh{at}cantab.net

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.




eLetters:

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Alendronate therapy and insufficiency fractures
adel tavakkolizadeh
J Bone Joint Surg Br Online, 20 Apr 2007 [Full text]
Subtrochanteric insufficiency fractures in patients on alendronate therapy
Laurence E Dodd
J Bone Joint Surg Br Online, 25 Apr 2007 [Full text]
Authors' reply:
Seo-Kiat Goh, et al.
J Bone Joint Surg Br Online, 17 May 2007 [Full text]

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Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General