IBMS BoneKEy | BoneKEy Watch
The biological mechanisms that underly BP-related atypical fractures
DOI:10.1038/bonekey.2015.91
In this detailed review, Geissler et al. explore the link between long-term bisphosphonate (BP) use and an increased risk of atypical fractures.
Although this association has been well established, and now limits the use of BPs, the underlying mechanisms that occur at bone level during long-term BP therapy remain unclear. Further information is required to inform the development of new drugs to avoid this advserse effect.
The authors suggest, on the basis of their own extensive research and that of others, that long-term BP treatment leads to a reduction in bone remodeling and increases tissue ageing, altering the way that cortical bone responds to cyclic loading. BP-treated bone becomes less able to resist the damage that this loading brings about.
They accept that drug holidays and dosing changes may help in the short-term but warn that important biological questions still remain and need to be answered before drug development can proceed.
Editor’s comment: This paper is a thorough review of the mechanisms underlying the increasing occurrence of atypical femoral fractures with time of exposure to bisphosphonate therapy. The authors received the American Society of Biomechanics Journal of Biomechanics Award and should be complimented for their mechanically and clinically relevant analysis.
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