More Findings About Atypical Femoral Fractures And The Use Of Fosamax Or Other Bisphosphonate Therapy For Osteoporosis (But Often Osteopenia)
In the fall of 2012 we have two more medical journal articles about Fosamax-related femur fractures, with each taking a different perspective on this still-emerging drug safety / side-effects issue.
The first article, "Atypical femoral fracture after long-term alendronate treatment: Report of a case evidenced with magnetic resonance imaging.", found in the October 2012 edition of The Kaohsiung Journal of Medical Sciences, describes the diagnosis of yet one more Fosamax femur fracture incident:
We report here the case of a 69-year-old woman with postmenopausal osteoporosis who presented with an atypical femoral subtrochanteric fracture on magnetic resonance imaging (MRI) confirmation after having received [Fosamax (alendronate)] therapy for about 3 years.
It goes on to discuss some clinical characteristics of this atraumatic thighbone fracture:
- the clinical symptoms of thigh pain;
- stress reaction or stress fracture; and,
- transverse fracture with unicortical beak in an area of cortical hypertrophy.
Our second article is more unique in its perspective insofar that it provides information about long-term outcomes of 81 patients who suffered an atypical femur fracture associated with Fosamax and other bisphosphonates. This "postfracture" coverage of the femur fracture problem is relatively rare in the medical literature, to date.
This article, "Atypical Femur Fractures: 81 Individual Personal Histories" was published online (ahead of print) in October 2012 by The Journal of Clinical Endocrinology & Metabolism. It discusses 81 cases of patients with atypical femur fractures (AFF) which occurred over an 11-year period, 2001 to 2011.
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In the Discussion part of this study article, the authors point out its "distinction" from other medical journal articles about the femur fractures associated with bisphosphonates like Fosamax:
We recognize that our described method of data collection is not typical of chart-based retrospective reviews. However, we believe that in many cases the patient may be able
to provide a continuous personal story that exists only in part in any individual medical chart.
From the Abstract we get these findings from their review of the surveys obtained from the 81 individuals and other patient-specific materials:
Results: The mean duration of bisphosphonate treatment was 9.5 yr. Prevention was the initial indication in 68% of the subjects; 94% started on [Fosamax (alendronate)], 77% reported prodromal pain, only 16% of these were diagnosed with incident stress fractures, and 39.5% experienced a contralateral AFF from less than 1 month to 49 months after the first. Of 71 subjects with a completed first AFF, 38% reported delayed healing, 11% had a complete contralateral AFF, and 22% underwent prophylactic rodding for a contralateral stress AFF. Forty-four percent of subjects with complete AFFs were continued on a bisphosphonate after the fracture. Thirty-five percent incurred a metatarsal fracture.
Going back to the article full-text, the two prescription-practices facts below are rather disturbing:
The majority of patients in our study were put on a [bisphosphonate (BP)] after a dual-energy x-ray absorptiometry [(DEXA)]-based diagnosis of osteopenia rather than osteoporosis, and most of those on [Fosamax (alendronate)] were on double the dose that is Food and Drug Administration (FDA)-approved for prevention of osteoporosis. (emphasis added)
These two new late 2012 contributions to the body of medical literature about Fosamax femur fractures, although different in perspective, both serve to raise the level of awareness and understanding about this growing drug injury problem here in the U.S.
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