Bisphosphonates and the Risk of Femoral Shaft Fractures

by Margaret Martin on February 24, 2011

A study was just recently released in the Journal of the American Medical Association (JAMA) on prolonged bisphosphonate therapy and the increased risk of femoral shaft fractures in older women. Treatment for five years or longer was associated with an increased risk of femoral shaft fracture.

In the following video, I discuss this study and its implications for you.

The study can be found at the JAMA website.

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Janis

Awesome. I share with all of my female friends. Looks like all roads lead to exercise.
sherri shilcrat

I saw the video-Now I am really confused. Why would anyone take the drugs to reduce fractures if these drugs can cause femur fractures. It makes no sense. Are you saying we should take them? If your response is to talk to the drs-well in my experience doctors throw drugs at you even if they are safe or not. Even in high risk with osteoporosis if I am going to have blood clots, restless leg syndroms, chances for different types of cancers, femur fractures why should I consider them at all?
http://www.melioguide.com Margaret Martin

Hello Sherri. Sorry for the confusion. I will try to clarify: Bisphosphonates have been shown to significantly reduce the type of fracture one typically sees in osteoporosis, neck or intertrochanteric fractures. This has not changed. What the study shows us is that women who had been on a bisphosphonate for over five years run an increase risk of a fracture in the shaft of the femur, which is not typical.

Bisphosphonates accumulate in the skeleton (accumulation differs among bisphosphonate drugs). Among high risk individuals, bisphosphonates protective benefit appears to reach it’s limit by the 5th year. The study shows that beyond five years the risk for atypical fractures increase the longer someone is on the drug.

Like many things in medicine you must weigh the risks and the benefits against one another. Hence, if your bone health places you at a low or moderate risk for a fracture, you likely would not benefit from a bisphosphonate. If your risk is greater, then you have to weigh the benefit of avoiding a typical fracture to the risk of having an atypical fracture. I like to think that your doctor could help you in making that decision. I hope this clarifies this for you. Please feel free to ask me any further questions or add your comment.
http://www.melioguide.com Margaret Martin

Hi Janis. Well put. Looks like the weather is calling us to come out and play. Enjoy your weekend.
Deepa Joseph

Hello Margaret
This means that having the biphosphonates for 5 years is beneficial to prevent osteoporotic fractures,,but should be better off stopped after 5 years,,to prevent the femur shaft fractures
So after 5 years the effects of the biphosphates taken,wear off and ultimately the patients would have to come to exercising…
http://www.melioguide.com Margaret Martin

Hello Deepa, As with everything in medicine it is not always black and white – lots of grey areas. So if your risk for a fracture is high, studies indicate that the benefit of taking a bisphosphonate may outways the risk until the 5th year. After 5 years, the risk for an femural fracture increases the longer you are on them. The effect of the bisphosphonates do not “wear off” . Bisphosphonates accumulate in your skeleton. At some conferences I have attended many physicians talk about their clients taking a “drug holiday” for up to five years at a time. Not all bisphosphonates are created equally. At the last ASBMR conference in Toronto there was a paper presented comparing bisphosphonates. Some seem to stay in your body longer than others. More research is being done in this area.
I would encourage individuals to start exercising as soon a possible, with or without the drugs.
The following is a copy of a portion of an email I received from a client of mine who sustained a fracture of his femur after being on bisphosphonates for 10 years: ” I very much appreciated the last observation you made on your video about exercise being the natural and logical approach to brittle bones. The “natural” and “logical” are my words and I wish the medical community would put more emphasis on exercise over the medication route. You have provided the structured supportive approach to exercise through your book and videos that most physicians do not have the time, training or background to provide…I do feel much stronger this winter compared to last.” This gentleman is having his third Aclasta injection this week. He has suffered numerous fractures in his life. Regardless of the decision to take medication or not, a safe exercise program is the only prescription that will make someone feel stronger, improve their quality of life and reduce their risk for a fall. Be well and I hope you get a workout in today!
Shari

I had one of our physicians word the dilemma in these terms…. Her concern was regarding a 95 year old patient who had had multiple fractures (and “bones you could spit through”) and who was previously quite active. (Her two most recent fractures at that time were femoral shaft fractures.) Her fractures were very slow healing; her understanding was that although the long term use of bisphosphonates lead to a lower quality of bone that was regrowing at fracture sites that was better than no bone at all. Your thoughts about that dilemma? and are there any other recommendations to assist with bone healing once the fracture is already present? Thanks.