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Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
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I heard if I take bone building drugs like Fosamax, I could actually develop some kind of rare bone fracture of the thigh anyway. What are they talking about? Does this happen to everyone or just certain people?

You may be referring to the development of atypical femoral fractures in older adults who are taking bisphosphonates for their osteoporosis. A few definitions might help you understand what you heard. First, atypical femoral fractures affect the long, shaft portion of the thigh bone (femur). The do not present or look like the more common osteoporotic bone fractures that older adults experience. But just exactly how to describe or define atypical femoral fractures has not been determined yet. At the present time, the major features of atypical femoral fractures include: 1) the location (the long shaft of the bone), 2) type of fracture (across the bone on a diagonal), and 3) the way the fracture occurred (no trauma or very low trauma, like falling down from a standing position). A visible spike at one end of the fracture seen on X-rays is a tell-tale sign of these types of fractures. The use of bisphosphonate medications for osteoporosis (brittle bones) has turned up as a possible risk factor for the atypical femoral fractures. These bone building drugs for osteoporosis stop the normal cycle of bone turnover. Over time, they can actually increase the risk of fracture. But studies with different results have been reported, so the debate and controversy over these drugs continues. Whether or not long-term use (defined as five years or more) is a cause of atypical femoral fractures is unknown. Collection of data on femoral fractures show that the fractures currently described as "atypical" are unusual, if not rare. Physicians who are aware of the risk factors may not be able to keep them from occurring. But early recognition and management following the recommendations of these authors may help minimize poor results. Physicians weigh the pros and cons of bisphosphonate therapy for osteoporosis, including the potential for unusual fractures like those described here. Most of the time, the value of the medication outweighs the possible adverse effects like atypical femoral fractures, which are rare. If an atypical femoral fracture develops, the patient can take a "drug holiday" (stop taking the medication for a while). It does not appear that doing so increases the risk of an osteoporotic fracture. However, the risk of another atypical femoral fracture on the other side is high. These are the kinds of things the physician must take into consideration. Each patient is evaluated individually before putting him or her on any medication.


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