{"doi":"10.1210/clinem/dgae023","title":"Bisphosphonate Use and Risk of Atypical Femoral Fractures: A Danish Case-Cohort Study With Blinded Radiographic Review","abstract":"CONTEXT: Prolonged bisphosphonate (BP) treatment for osteoporosis prevents hip and other fractures but causes atypical femoral fractures (AFF). OBJECTIVE: To 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. METHODS: This 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. RESULTS: Compared 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. CONCLUSION: The 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.","journal":"The Journal of Clinical Endocrinology & Metabolism","year":2024,"id":423171,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":24,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7554,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":19284,"name":"Dennis M. Black","orcid":"0000-0001-5318-7575","position":1,"is_corresponding":false},{"id":1218932,"name":"Rick Dell","orcid":null,"position":2,"is_corresponding":false},{"id":735178,"name":"Bo Fan","orcid":"0000-0001-5487-1600","position":3,"is_corresponding":false},{"id":1218263,"name":"Christopher Smith","orcid":"0000-0002-1909-9245","position":4,"is_corresponding":false},{"id":1218264,"name":"Martin Ernst","orcid":"0000-0001-9003-3823","position":5,"is_corresponding":false},{"id":1218265,"name":"Anne Grethe Jurik","orcid":"0000-0003-2571-0466","position":6,"is_corresponding":false},{"id":1218266,"name":"Jens Brøndum Frøkjær","orcid":"0000-0001-8722-0070","position":7,"is_corresponding":false},{"id":1218267,"name":"Mikael Boesen","orcid":"0000-0002-8774-6563","position":8,"is_corresponding":false},{"id":252183,"name":"Eric Vittinghoff","orcid":"0000-0001-8535-0920","position":9,"is_corresponding":false},{"id":781794,"name":"Bo Abrahamsen","orcid":"0000-0002-2730-6080","position":10,"is_corresponding":false},{"id":315522,"name":"Douglas C. Bauer","orcid":"0000-0001-5261-7721","position":0,"is_corresponding":true}],"reference_count":37,"raw_metadata":null,"created_at":"2026-07-19T01:57:56.814994Z","pmid":"38198798","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}