The bisphosphonate class of drugs, which are used to improve bone health, recently became controversial when data emerged showing the drugs can lead to severe bone, joint, or musculoskeletal pain. Now new cases have come to light that further complicate the controversy over using bisphosphonates to prevent and treat osteoporosis. A series of case reports describe unusual leg fractures, in which the upper thighbone breaks straight across, despite little or no trauma being suffered. Such fractures are rare, and are typically only suffered after car accidents or similar traumas, or in elderly and frail individuals. The cases that were being reported, however, were in patients who had been taking bisphosphonates to promote bone building for 5 or more years. Some of the patients experienced unexplained aches before their thighbones simply snapped. In these cases, the bisphosphonates appear to have been weakening the patients’ bones, rather than slowing the process of bone thinning, as the drug is designed to do. Researchers studying the cases are emphasizing that this is a rare problem, and there is not enough data to suggest the prevention of use of bisphosphonates to treat osteoporosis. These cases may lead some doctors to rethink how much they should rely on this class of drugs as preventative medicine, however. Since all of the fractures occurred in patients taking the drug for 5 or more years, this information may also influence prescribing long-term use of bisphosphonates in the future.

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