In reply: We thank Falkenberg for his comments in reference to our article in the Journal.1 Two recent large-scale population-based studies have suggested that subtrochanteric femur fractures are rare both in the general population and among bisphosphonate users.2,3 While personal experience may often suggest otherwise, a cluster of atypical fractures cannot be used as an indicator of true incidence in the absence of data on the frequency of bisphosphonate use in a particular population.
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- 1. Girgis CM, Seibel MJ. Atypical femur fractures: a complication of prolonged bisphosphonate therapy [editorial]? Med J Aust 2010; 193: 196-198. <MJA full text>
- 2. Nieves JW, Bilezikian JP, Lane JM, et al. Fragility fractures of the hip and femur: incidence and patient characteristics. Osteoporos Int 2010; 21: 399-408.
- 3. Abrahamsen B, Eiken P, Eastell R. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study. J Bone Miner Res 2009; 24: 1095-1102.
- 4. Girgis CM, Sher D, Seibel MJ. Atypical femoral fractures and bisphosphonate use. N Engl J Med 2010; 362: 1848-1849.
- 5. Somford MP, Draijer F, Thomassen BJ, et al. Bilateral fractures of the femoral diaphysis in a patient with rheumatoid arthritis on long term treatment with alendronate. J Bone Miner Res 2009; 24: 1736-1740.
- 6. Visekruna M, Wilson D, McKiernan FE. Severely suppressed bone turnover and atypical skeletal fragility. J Clin Endocrinol Metab 2008; 93: 2948-2952.
Markus Seibel is a member of advisory boards for Merck Sharp and Dohme, Novartis, Amgen and Sanofi-Aventis. He has also received funding from these companies for institutional research.