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Several case series have described atypical femur fractures after long-term use of bisphosphonate drugs for osteoporosis (JW Gen Med Dec 15 2009); the presumed mechanism is oversuppression of bone remodeling. Recently, data from three randomized placebo-controlled trials of bisphosphonate therapy did not confirm this observation, but the analysis lacked power to demonstrate differences in rare outcomes (JW Gen Med Apr 27 2010).
Now, researchers in Ontario, Canada, have conducted a population-based, nested case-control study. Case patients were 716 women (age, ≥68) who received bisphosphonates and suffered atypical (femoral shaft or subtrochanteric) fractures during 7 years. Controls were 3580 age-matched bisphosphonate recipients without fra…