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Bisphosphonates and Atypical Femoral Shaft Fractures REPLY
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2011 (English)In: New England Journal of Medicine, ISSN 0028-4793, Vol. 365, no 4, 377-377 p.Article in journal, Letter (Refereed) Published
Abstract [en]

Any judgment about the magnitude of a risk must be seen in relation to other risks and benefits. Women with osteoporosis run a high risk of fracture, which is substantially reduced by bisphosphonate therapy.1 The numbers needed to treat with bisphosphonates for 3 years are 91 for hip fractures and 14 for radiologic vertebral fractures.1 Without consideration of duration of use, we found that the number needed to harm given 3 years of treatment was 667 — that is, the benefits with the therapy outweigh the risks. The absolute risk of stress (atypical) fracture in our study tended to be higher with a longer duration of bisphosphonate use. With more than 2 years of treatment, the difference in absolute risk as compared with no treatment was 8 per 10,000 women per year of treatment. This estimate corresponds to a number needed to harm of 417 for a 3-year treatment period. Thus, theoretically, for each stress fracture caused, at least 30 vertebral and about 5 hip fractures will be prevented. This is reassuring. However, without a proper indication, the benefit–risk ratio with bisphosphonate use may not be advantageous.

Place, publisher, year, edition, pages
2011. Vol. 365, no 4, 377-377 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-157226ISI: 000293172200027OAI: oai:DiVA.org:uu-157226DiVA: diva2:435893
Available from: 2011-08-20 Created: 2011-08-20 Last updated: 2012-07-12Bibliographically approved

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