Bisphosphonate Use and Risk of Atypical Femoral Fractures: A Danish Case-Cohort Study With Blinded Radiographic Review
An erratum to this article was published (J Clin Endocrinol Metab, 16 Sep 2026 ↗)
Main finding · AFFResult — go to the resultAdjusted hazard ratio 7.29 CI 3.07–17.30Authors' 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.
Study context
- Population
- Danish adults ≥50 with subtrochanteric or femoral shaft fractures 2010–2015 vs random sample; Danish National Healthcare system datacase-cohort · vs random sample 37,021
- Exposure
- Bisphosphonate (BP) use 5 to 7 years vs <1 year
- Outcome
- Atypical femoral fractures (AFF), identified by blinded radiologist review
Methodological detailsblinded radiographic review, Fracture radiographs (n = 4769) reviewed by blinded radiologists; Atypical femoral fractures (AFFs) n = 189, Hip fractures in random sample (n = 691) identified by ICD-10
- Blinded radiographic review
- Fracture radiographs (n = 4769) reviewed by blinded radiologists; AFFs n = 189
- Hip fractures in random sample (n = 691) identified by ICD-10
Main finding
AFF
Adjusted hazard ratio
7.29
CI 3.07–17.30
5 to 7 years of BP usevs <1 year of BP use
aHR 7.29 (CI 3.07–17.30)
As reported in the abstract
Observational data: associations, not effects.
Further findings
5-year NNT to prevent one hip fracture
- 5-year NNT to prevent one hip fracture
- 56
Other AFF risk factors
- Those with AFF with no BP exposure
- 31%
- Glucocorticoid and proton pump inhibitor use independently associated with increased AFF risk
Safety
AFF (harm of BP) · 5 years
- 5-year NNH for one AFF
- 1424
Original publication
Bisphosphonate Use and Risk of Atypical Femoral Fractures: A Danish Case-Cohort Study With Blinded Radiographic Review. J Clin Endocrinol Metab. Published 10 January 2024. doi:10.
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