ArticleThe Journal of clinical endocrinology and metabolism2024
Bisphosphonate Use and Risk of Atypical Femoral Fractures: A Danish Case-Cohort Study With Blinded Radiographic Review.
Article in The Journal of clinical endocrinology and metabolism, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 18 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed.
- Preventing Hip (Proximal Femoral) Fractures: An Evidence-Based Review for Clinicians.Journal of clinical medicine · 2026Review
- Manual chart review reveals bisphosphonate exposure misclassification in atypical femur fracture patients: auditing medical records in two international cohorts.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- The role of income and educational level as risk factors for atypical femur fractures: A Nationwide Danish Case-Cohort Study with Blinded Radiographic Review.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Management of postmenopausal osteoporosis.Endocrine reviews · 2026Review
- Risk factors for atypical femur fractures with and without bisphosphonate treatment: a national nested case-control study.JBMR plus · 2026Article
- Molecular-level understanding of the aging bone and regeneration mechanisms using computational methods.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Review
- Exercise Timing and its Effects on Eating Behavior, Weight, and Body Composition: A Systematic Scoping Review to Identify Gaps and Inform Future Research.Current nutrition reports · 2026Review
- Alternative Osteoporosis Therapies After Bisphosphonate Associated Atypical Femur Fractures: A Retrospective Analysis.Geriatric orthopaedic surgery & rehabilitation · 2026Article
- Therapeutic Management of Glucocorticoid-Induced Osteoporosis with a Focus on Older Adults: A Narrative Review.Drugs & aging · 2026Review
- Atypical Femur Fractures Without Bisphosphonate Exposure (AFFwB): A Retrospective Report of 21 Cases.Journal of clinical medicine · 2025Article
- GDF15: An emerging disease target and biomarker of metabolic diseases.Journal of endocrinological investigation · 2025Review
- Epidemiology, Pathophysiology and Management of Atypical Femur Fractures: an Update.Current osteoporosis reports · 2025Review
- Bisphosphonates in the Management of Patients with Postmenopausal Osteoporosis; Back to the Future.Pharmaceuticals (Basel, Switzerland) · 2025Review
- Staging classification of atypical ulnar fractures.Archives of osteoporosis · 2025Article
- Treatment Considerations for Severe Osteoporosis in Older Adults.Drugs & aging · 2025Review
- PDGF-BB improves cortical bone quality through restoring the osteogenic microenvironment in the steroid-associated osteonecrosis of rabbits.Journal of orthopaedic translation · 2025Article
- Bisphosphonate Use and Risk of Atypical Femoral Fractures: A Danish Case-Cohort Study With Blinded Radiographic Review.The Journal of clinical endocrinology and metabolism · 2024Article
- Prevalence and risk factors for atypical femoral fracture among Lebanese patients with hip and shaft fractures.JBMR plus · 2024Article
Corrections and comments
- Erratum issued
Authors and funding
11 authors.
Funding
Abstract
contextProlonged bisphosphonate (BP) treatment for osteoporosis prevents hip and other fractures but causes atypical femoral fractures (AFF).
objectiveTo establish the relationship between patterns of BP use and the risk of AFF and hip fractures. Other potential risk factors for AFF were also examined.
methodsThis population-based case-cohort study utilized data from the Danish National Healthcare system, including longitudinal records of medication use, healthcare utilization, and x-ray images. Among all 1.9 million Danish adults ≥50, those with subtrochanteric or femoral shaft fractures between 2010 and 2015 (n = 4973) were identified and compared to a random sample (n = 37 021). Bisphosphonate use was collected from 1995-2015. Fracture radiographs (n = 4769) were reviewed by blinded study radiologists to identify AFFs (n = 189) using established criteria. Traditional hip fractures in the random sample (n = 691) were identified by ICD-10.
resultsCompared to <1 year of BP use, 5 to 7 years of use was associated with a 7-fold increase in AFF (adjusted HR = 7.29 [CI: 3.07, 17.30]); the risk of AFF fell quickly after discontinuation. The 5-year number needed to harm for one AFF was 1424, while the 5-year number needed to treat to prevent one hip fracture was 56. Glucocorticoid and proton pump inhibitor use were independently associated with increased AFF risk. Thirty-one percent of those with AFF had no BP exposure.
conclusionThe risk of AFF increases with duration of BP use but the beneficial effects of BP therapy in adults ≥50 dramatically exceed this increased risk. Nearly one-third of those with AFF have no BP exposure.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.