A rational approach to management of alendronate-related subtrochanteric fractures

J Bone Joint Surg Br. 2010 May;92(5):679-86. doi: 10.1302/0301-620X.92B5.22941.


There have been recent reports linking alendronate and a specific pattern of subtrochanteric insufficiency fracture. We performed a retrospective review of all subtrochanteric fractures admitted to our institution between 2001 and 2007. There were 20 patients who met the inclusion criteria, 12 of whom were on long-term alendronate. Alendronate-associated fractures tend to be bilateral (Fisher's exact test, p = 0.018), have unique radiological features (p < 0.0005), be associated radiologically with a pre-existing ellipsoid thickening of the lateral femoral cortex and are likely to be preceded by prodromal pain. Biomechanical investigations did not suggest overt metabolic bone disease. Only one patient on alendronate had osteoporosis prior to the start of therapy. We used these findings to develop a management protocol to optimise fracture healing. We also advocate careful surveillance in individuals at-risk, and present our experience with screening and prophylactic fixation in selected patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alendronate / administration & dosage
  • Alendronate / adverse effects*
  • Asian People
  • Bone Density
  • Bone Density Conservation Agents / administration & dosage
  • Bone Density Conservation Agents / adverse effects*
  • Bone Remodeling / drug effects
  • Female
  • Femoral Fractures / chemically induced*
  • Femoral Fractures / surgery
  • Femur / diagnostic imaging
  • Femur / drug effects
  • Femur / pathology
  • Fracture Fixation, Intramedullary / methods
  • Fractures, Stress / chemically induced*
  • Fractures, Stress / surgery
  • Humans
  • Male
  • Middle Aged
  • Osteoporosis, Postmenopausal / drug therapy
  • Practice Guidelines as Topic
  • Radiography
  • Retrospective Studies


  • Bone Density Conservation Agents
  • Alendronate