The BMJ's video: Risk of hip subtrochanteric and femoral shaft fractures amongst mid and longterm users of alendron

Read the open access researcj: http://www.bmj.com/content/353/bmj.i3365 The clinical management of osteoporosis has progressed greatly in the past four decades with the introduction of potent antiresorptive drugs that substantially reduce the risk of fractures in men and women with osteoporosis. Despite the relatively low cost of such intervention, the treatment gap is widening in many areas of the world because of concerns that antiresorptive treatment could lead to atypical femur fractures and that this could offset the benefits of long term use. Prescription rates for bisphoshonates have declined by 50% in the United States and similar trends have been observed in the European Union. A recent commentary in The BMJ concluded that bisphosphonates could achieve at best a marginal reduction in the risk of hip fracture and that the risk of serious medical adverse events, including atypical femur fractures, makes pharmacotherapy non-viable as a health strategy against hip fractures. In this study, the authors set out to determine the skeletal safety and efficacy of long term alendronate use in patients with osteoporosis. They conclude that their findings support an acceptable balance between benefit and risk with treatment with alendronate in terms of fracture outcomes, even for over 10 years of continuous use.