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Although the efficacy of bisphosphonates in preventing osteoporotic fractures is well established, concerns about atypical femur fractures (AFFs) in long-term users have triggered recent declines in bisphosphonate use. To examine AFF risk and estimate the number of osteoporotic fractures prevented by bisphosphonate use, investigators used data from a California integrated health system and identified a cohort of women aged ≥50 who had used oral or intravenous bisphosphonates between 2007 and 2017.
Among 196,129 women (53% white, 24% Hispanic, 14% Asian, 6% Black, 3% other), 277 AFFs occurred for an incidence of 1.7 fractures per 10,000 patient-years. AFF incidence increased with patients' age; other risk factors included Asian ethnicity and …