Are Bisphosphonates Associated With an Increased Risk of Atypical Femoral Fractures as a Class?

In a recently published article, Meier et al¹ investigated the reported association between subtrochanteric or femoral shaft fractures and bisphosphonate use. This topic has been reviewed recently by the US Food and Drug Administration as part of the broader evaluation of the use of bisphosphonates with regard to long-term efficacy and safety in osteoporosis. It is reassuring that there is universal agreement in all epidemiological studies published to date that the incidence rate of atypical fractures is very low. Moreover, as the authors point out, the mechanisms underlying any possible causal relationship with bisphosphonate use remains unexplained.