Leading experts from the European Society on Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the International Osteoporosis Foundation (IOF) have published a timely position paper on the association between subtrochanteric femoral (upper thigh bone) fractures and long-term treatment with bisphosphonates.
Bisphosphonates are the most common drug therapy for osteoporotic fracture prevention, prescribed to millions of people around the world. Concern among doctors and patients has arisen following recent media reports that cite a possible association between unusual and unexpected (atypical) fractures of the upper thigh bone and bisphosphonate use.
The Position Paper examines the evidence and concludes that:
"The risk versus benefit ratio is clear," stated Professor René Rizzoli of the Division of Bone Diseases at the University of Geneva and lead author of the Position Paper. "We estimate that for every 10,000 high-risk patients undergoing bisphosphonate treatment, approximately 100 hip fractures and 750 fractures at other sites are prevented, whereas only 3 to 6 atypical fractures could be expected."
"While we urge patients to discuss their concerns with their doctors, it is important that they do not stop taking their prescribed bisphosphonate therapy and so leave themselves open to the higher risk of osteoporotic fracture." He went on to state that doctors should, as with all drug treatments, advise patients of any potential side effects or risks. Patients with pain in the hips, thighs or femur should be radiologically assessed, and examined for possible atypical subtrochanteric fracture. The radiographic changes should be examined for orthopaedic intervention or close monitoring. The decision regarding therapy should be based on an individual benefit-risk assessment.
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