0
Editor's Correspondence |

Are Bisphosphonates Associated With an Increased Risk of Atypical Femoral Fractures as a Class?—Reply

Raphael P. H. Meier, MD; Rene Rizzoli, MD; Robin E. Peter, MD
JAMA Intern Med. 2013;173(1):79-80. doi:10.1001/jamainternmed.2013.1238.
Text Size: A A A
Published online

Extract

In reply

We thank Dr Pazianas for his thoughtful comments on our recent article.1 We agree that bisphosphonates differ in their pharmacological proprieties and should therefore be individually analyzed, particularly when looking at their potential adverse effects. In our study, alendronate and pamidronate use was associated with significantly higher odds ratios (ORs) for atypical fractures compared with the classic fracture group, with ORs of 44.7 (95% CI, 19.9-100.3) and 18.2 (95% CI, 2.9-112.3), respectively.1 Both risedronate and ibandronate were associated with a nonsignificant OR of 5.7 (95% CI, 0.5-64.7). Nevertheless, the 95% confidence intervals are wide, and it is therefore not possible to classify these agents according to this adverse effect. Regarding etidronate and zoledronic acid, ORs could not be calculated because there were no patients treated with these agents in the atypical fracture group. Therefore, on the basis of our results, we cannot conclude that there is a potential risk of atypical fractures with risedronate, ibandronate, etidronate, and zoledronic acid use, likely owing to a lack of statistical power. Indeed, these drugs were prescribed far less often than alendronate. However, some evidence is available in the literature. In a study by Schilcher et al,2 risedronate was associated with atypical fractures with an adjusted OR of 32.4 (95% CI, 5.5-192.0). A report by Vestergaard et al3 demonstrated an increased risk of atypical fractures for etidronate. Recently, zoledronic acid was associated with atypical fractures among patients with cancer (the type of patients who were excluded in our study).4 In only case reports, ibandronate was found to be associated with atypical fractures.5 Since this drug has been marketed since 2004 for cancer and 2005 for osteoporosis, adverse effects may take a further few years to appear. Moreover, in its recommendations for safety, the US Food and Drug Administration includes all type of bisphosphonates used in the treatment of osteoporosis. Indeed, if the assumption that atypical fractures appear as a consequence of prolonged osteoclast dysfunction is correct, then all bisphosphonates would be involved.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

January 14, 2013
Michael Pazianas, MD
JAMA Intern Med. 2013;173(1):79-80. doi:10.1001/2013.jamainternmed.753.
CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();