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Case control study
Older women who use bisphosphonate for longer than 5 years may have increased odds of a subtrochanteric or femoral shaft fracture, but absolute risk is low
  1. Bo Abrahamsen
  1. Department of Medicine, Gentofte Hospital, Copenhagen, Denmark
  1. Correspondence to Bo Abrahamsen
    Department of Medicine, Gentofte Hospital, Niels Andersensvej 65 Hellerup DK-2900, Denmark; b.abrahamsen{at}

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It is now recognised that fractures of the subtrochanteric femur or femoral shaft (ST/FS fractures) can be divided radiologically into (1) typical fractures and (2) atypical fractures. The latter appear to be rare in patients untreated by bisphosphonates. In this new study, Park-Wyllie et al used Ontario claims data to investigate the association between the amount of bisphosphonates taken and the risk of ST/FS fractures.


The study was a nested 5:1 case-control study, linking prescriptions with hospitalisations, physician service claims and death certificates. Women aged 68 years or older who filled prescriptions for bisphosphonates at least once over a 6-year period were included. Those with malignant disease in the past 10 years, specific bone diseases or secondary causes of osteoporosis (past 5 years) and osteoporosis treatment in the past year were excluded, providing 205 466 women for study.

Cases were defined as first ST/FS fracture, excluding fractures treated …

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