BoneKEy Reports | BoneKEy Watch
Intravenous BPs and atypical fracture risk in cancer patients
DOI:10.1038/bonekey.2012.249
Most atypical femur fractures associated with alendronate have been observed in osteoporotic patients, which is surprising as cancer patients often receive bisphosphonates (BPs) at much higher doses.
To explore the occurrence of atypical femur fractures in cancer patients, Chang et al. focused on 62 cancer patients who had sustained a fractured femur. From this group, they identified six patients with atypical femur fractures who had been undergoing intravenous BP therapy during treatment for metastatic breast cancer (four patients) or multiple myeloma (two patients).
Five out of the six had bilateral femur fractures and two also had osteonecrosis of the jaw (ONJ). Compared to the other 56 cancer patients, who had non-atypical fractures, this group of six had received a greater number of BP doses (55 vs 15), had taken more zoledronic acid (32 doses vs 12 doses) and had been undergoing treatment for longer (5.9 years vs 1.6 years).
Editor’s comment: This observation, if confirmed, will provide further evidence for the potential direct role of BPs in increasing the risk of atypical fractures. Considering that the rate of ONJ in cancer patients is similar with denosumab and zoledronate, these observations also question whether oncological doses of denosumab might be associated with atypical femur fractures.
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