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Menopause practitioner perspective on the American Society of Bone and Mineral Research Task Force report on atypical femoral fracture

Ettinger, Bruce MD1; Stuenkel, Cynthia A. MD2; Schnatz, Peter F. DO3

doi: 10.1097/GME.0b013e3182a7c57b
Clinical Corner: Clinical Article

Clinical Scenario: One of your patients, a 59-year-old postmenopausal Asian woman (menopause, age 52), took hormone therapy for about one year for her menopause symptoms. When she was 54, her mother (age 80) suffered a hip fracture, and she requested a bone density test at her next gynecology visit. The t-score results were spine, −1.1; total hip, −1.8; and femoral neck, −2.1, all in the osteopenic range. After some discussion, she was started on alendronate 70 mg once a week, together with calcium and vitamin D. Follow-up dual-energy x-ray absorptiometry testing after 2 and 5 years of therapy showed increases in bone mineral density, resulting in t-score improvements of about 0.3 to 0.5 units (spine was now normal; femoral neck was −1.8). The Fracture Risk Assessment Tool estimated her 10-year risk of hip fracture to be 0.4% and her 10-year risk of any of 4 major osteoporotic fractures to be 7.5%. During her most recent gynecology visit, she expressed concern about unusual femoral fractures being linked to long-term use of alendronate. She asks if there is reason for her to stop using this drug.

Author Information

From the 1Department of Medicine, University of California, San Francisco, San Francisco, CA; 2Department of Medicine, University of California, San Diego, La Jolla, CA; and 3Departments of ObGyn and Medicine, The Reading Hospital and Medical Center, Reading, PA; Departments of ObGyn and Internal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.

Received June 2, 2013; revised and accepted August 1, 2013.

Funding/support: None.

Conflicts of interest/financial disclosures: Dr. Ettinger has received paymentsfrom the law firm Robinson Calcagnie Robinson Shapiro Davis, Inc, for providing expert testimony in a lawsuit involving Fosamax. Drs. Stuenkel and Schnatz declare no conflicts.

Address correspondence to: Bruce Ettinger, MD, 156 Lombard Street #13, San Francisco, CA 94111. E-mail:

© 2013 by The North American Menopause Society.