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Women Taking Fosamax for Several Years May Be Prone to Femur Fractures

Femur FractureBisphosphonates, along with calcium and vitamin D supplementation, are a common conventional treatment for osteoporosis. These drugs are even used for prevention of osteoporosis in those with osteopenia.

Bone tissue continually goes through a cycle of formation of new bone and breakdown of old bone. Bisphosphonates (Fosamax, Boniva, Actonel, Reclast) increase bone mineral density in the short term by reducing bone breakdown, essentially reducing bone loss. However, since bisphosphonates accumulate in bone tissue and suppress bone turnover, there has been concern about the strength and integrity of the affected bone. This suppression of bone turnover by bisphosphonates is hypothesized to make bones become brittle despite the increase seen in bone mineral density. It is not the same thing as building natural healthy bone with exercise.

Data has arisen showing that these concerns are indeed warranted. Evidence supporting the hypothesis above has been provided showing reduced bone formation and increased bone resorption upon long-term use of alendronate (Fosamax)—these bones would be far more prone to fracture.1

Several studies have reported the occurrence of specific and rare types of femur fractures—low-impact subtrochanteric or diaphyseal fractures—in individuals (mostly women) who had been taking bisphosphonates, specifically alendronate, for approximately 4-8 years.2-4 1,5 A frightening detail of these reports is that the fractures are occurring under minimal trauma—these fractures are not from big falls. In fact, in most cases, these women were performing low-energy activity, sometimes just walking down a flight of stairs.6,7

Prevention of osteoporosis and bone fractures need not involve potentially dangerous drugs. Exercise is a crucial component of Dr. Fuhrman’s recommendations—most hip fractures result from falls, and increasing muscle strength and balance improve stability and prevent these falls.8-10 Increased thigh muscle strength is also associated with lower mortality risk.11

Learn more about preventing osteoporosis.


1. Somford MP, Draijer FW, Thomassen BJ, et al: Bilateral fractures of the femur diaphysis in a patient with rheumatoid arthritis on long-term treatment with alendronate: clues to the mechanism of increased bone fragility. J Bone Miner Res 2009;24:1736-1740.
2. Kwek EB, Goh SK, Koh JS, et al: An emerging pattern of subtrochanteric stress fractures: a long-term complication of alendronate therapy? Injury 2008;39:224-231.
3. Lenart BA, Lorich DG, Lane JM: Atypical fractures of the femoral diaphysis in postmenopausal women taking alendronate. N Engl J Med 2008;358:1304-1306.
4. Somford MP, Geurts GF, den Teuling JW, et al: Long-Term Alendronate Use Not without Consequences? Int J Rheumatol 2009;2009:253432.
5. Cermak K, Shumelinsky F, Alexiou J, et al: Case reports: subtrochanteric femoral stress fractures after prolonged alendronate therapy. Clin Orthop Relat Res 2010;468:1991-1996.
6. Park-Wyllie LY, Mamdani MM, Juurlink DN, et al: Bisphosphonate use and the risk of subtrochanteric or femoral shaft fractures in older women. JAMA 2011;305:783-789.
7. Sellmeyer DE: Atypical fractures as a potential complication of long-term bisphosphonate therapy. JAMA 2010;304:1480-1484.
8. Suzuki T, Kim H, Yoshida H, et al: Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women. J Bone Miner Metab 2004;22:602-611.
9. Iwamoto J, Suzuki H, Tanaka K, et al: Preventative effect of exercise against falls in the elderly: a randomized controlled trial. Osteoporos Int 2009;20:1233-1240.
10. Barnett A, Smith B, Lord SR, et al: Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Age Ageing 2003;32:407-414.
11. Newman AB, Kupelian V, Visser M, et al: Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci 2006;61:72-77.



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