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Bilateral Fractures of the Femur Diaphysis in a Patient With Rheumatoid Arthritis on Long-Term Treatment With Alendronate: Clues to the Mechanism of Increased Bone Fragility†‡

  1. Matthijs P Somford1,
  2. Frits W Draijer1,
  3. Bregje JW Thomassen1,
  4. Pascale M Chavassieux2,
  5. Georges Boivin2,
  6. Socrates E Papapoulos MD, PhD3,*

Article first published online: 27 APR 2009

DOI: 10.1359/jbmr.090408

Issue

Journal of Bone and Mineral Research

Journal of Bone and Mineral Research

Volume 24, Issue 10, pages 1736–1740, October 2009

Additional Information

How to Cite

Somford, M. P., Draijer, F. W., Thomassen, B. J., Chavassieux, P. M., Boivin, G. and Papapoulos, S. E. (2009), Bilateral Fractures of the Femur Diaphysis in a Patient With Rheumatoid Arthritis on Long-Term Treatment With Alendronate: Clues to the Mechanism of Increased Bone Fragility. J Bone Miner Res, 24: 1736–1740. doi: 10.1359/jbmr.090408

Author Information

  1. 1

    Department of Orthopaedics, Maasland Hospital, Sittard, The Netherlands

  2. 2

    INSERM Unit 831, University of Lyon, Faculty of Medicine R. Laennec, Lyon, France

  3. 3

    Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Leiden, The Netherlands

*Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands

  1. †

    The authors state that they have no conflicts of interest

  2. ‡

    Published online on April 27, 2009

Publication History

  1. Issue published online: 4 DEC 2009
  2. Article first published online: 27 APR 2009
  3. Manuscript Accepted: 21 APR 2009
  4. Manuscript Revised: 2 MAR 2009
  5. Manuscript Received: 8 JAN 2009

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REFERENCES

  • 1
    Papapoulos SE 2008 Bisphosphonates for postmenopausal osteoporosis. In: RosenCJ, (ed.) Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 7th ed. American Society for Bone and Mineral Research, Washington, DC, USA, 237–241.
  • 2
    Ott SM 2005 Long-term safety of bisphosphonates. J Clin Endocrinol Metab 90: 1897–1899.
  • 3
    Bone HG, Hosking D, Devogelaer JP, Tucci JR, Emkey RD, Tonino RP, Rodriguez-Portales JA, Downs RW, Gupta J, Santora AC, Liberman UA 2004 Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 350: 1189–1199.
  • 4
    Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA, Satterfield S, Wallace RB, Bauer DC, Palermo L, Wehren LE, Lombardi A, Santora AC, Cummings SR 2006 Effects of continuing or stopping alendronate after 5 years of treatment: The Fracture Intervention Trial Long-term Extension (FLEX): A randomized trial. JAMA 296: 2927–2938.
  • 5
    Visekruna M, Wilson D, McKiernan FE 2008 Severely suppressed bone turnover and atypical skeletal fragility. J Clin Endocrinol Metab 93: 2948–2952.
  • 6
    Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CYC 2005 Severely suppressed bone turnover: A potential complication of alendronate therapy. J Clin Endocrinol Metab 90: 1294–1301.
  • 7
    Lenart BA, Lorich DG, Lane JM 2008 Atypical fractures of the femoral diaphysis in postmenopausal women taking alendronate. N Engl J Med 358: 1304–1305.
  • 8
    Neviaser AS, Lane JM, Lenart BA, Edobor-Osula F, Lorich DG 2008 Low energy femoral shaft fractures associated with alendronate use. J Orthop Trauma 22: 346–350.
  • 9
    Kwek EBK, Goh SK, Koh JSB, Png MA, Howe TS 2007 An emerging pattern of subtrochanteric stress fractures: A long-term complication of alendronate therapy ? Injury 39: 224–231.
  • 10
    Goh SK, Yang KY, Koh JSB, Wong MK, Chua SY, Chua DTC, Howe TS 2007 Subtrochanteric insufficiency fractures in patients on alendronate therapy; a caution. J Bone Joint Surg Br 89: 349–353.
  • 11
    Chavassieux P, Arlot M, Meunier PJ 2001 Clinical use of bone biopsy In: MarcusR, FeldmanD, KelseyJ (eds.) Osteoporosis, 2nd ed. Academic Press, San Diego, CA, USA, 501–512.
  • 12
    Chavassieux PM, Arlot ME, Reda C, Wel L, Yates AJ, Meunier PJ 1997 Histomorphometric assessment of the long-term effects of alendronate on bone quality and remodeling in patients with osteoporosis. J Clin Invest 100: 1475–1480.
  • 13
    Chavassieux PM, Arlot ME, Roux JP, Portero N, Daifotis A, Jates AJ, Hamdy NAT, Malice M-P, Freedholm D, Meunier PJ 2000 Effects of alendronate on bone quality and remodeling in glucocorticoid-induced osteoporosis. A histomorphometric analysis of transiliac biopsies. J Bone Miner Res 15: 754–762.
  • 14
    Ross FP, Teitelbaum SL 2001 Osteoclast biology In: MarcusR, FeldmanD, KelseyJ (eds.) Osteoporosis, 2nd ed. Academic Press, San Diego, CA, USA, 73–105.
  • 15
    Weinstein RS, Robertson PK, Manolagas SC 2009 Giant osteoclast formation and long-term bisphosphonate therapy. N Engl J Med 360: 53–62.
  • 16
    Boivin G, Bala Y, Doublier A, Farlay D, Ste-Marie LG, Meunier PJ, Delmas PD 2008 The role of mineralization and organic matrix in the microhardness of bone tissue from controls and osteoporotic patients. Bone 43: 532–538.
  • 17
    Boivin G, Meunier PJ 2002 The degree of mineralization of bone tissue measured by computerized quantitative contact microradiography. Calcif Tissue Int 70: 503–511.
  • 18
    Kanis JA, Johansson H, Oden AA 2004 A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19: 893–899.
    Direct Link:
  • 19
    Targownik LE, Lix LM, Metge CJ, Prior HJ, Leung S, Leslie WD 2008 Use of proton pump inhibitors and osteoporosis-related fractures. Can Med Assoc J 179: 319–326.
  • 20
    van der Bijl AE, Zijlstra TR, Engelage AH, Posthuma BJM, van Veen GJM 2008 Drie patiënten met een botfractuur tijdens het gebruik van methotrexaat, mogelijk door methotrexaatosteopathie. Ned Tijdschr Geneeskd 152: 2357–2360.
  • 21
    Stenes H, Jacobs JWG, van Tijk PP, de Klerk JMH 2001 Methotrexate osteopathy demonstrated by technetium-99m bone scintigraphy. Clin Nucl Med 5: 389–391.
  • 22
    Wells GA, Cranney A, Peterson J, Boucher M, Shea B, Robinson V, Coyle D, Tugwell P 2008 Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 23: CD001155.
  • 23
    Bauer DC, Black DM, Garnero P, Hochberg M, Ott S, Orloff J, Thompson DE, Ewing SK, Delmas PD 2004 Change in bone turnover and hip, non-spine, and vertebral fracture in alendronate-treated women: The fracture intervention trial. J Bone Miner Res 19: 1250–1258.
    Direct Link:
  • 24
    Abrahamsen B, Eiken P, Eastell R 2009 Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: A register-based national cohort study. J Bone Miner Res 24: 1095 1102.
    Direct Link:
  • 25
    Rehman MT, Hoyland JA, Denton J, Freemont AJ 1994 Age related histomorphometric changes in bone in normal British men and women. J Clin Pathol 47: 529–534.
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