Have you heard of Frozen Bone Syndrome?

Bismillah, Alhamdulillah.

Came across an interesting article via Medscape on atypical (subtrochanteric) femoral fractures in patients using bisphosphonates. It reviews a Swiss case control study of 477 patients aged 50 and over with hip fractures followed from 1999 to 2010 (11 years). Below are my take home messages:

  • Bisphosphonates are associated with a significant increase in the risk of an atypical fracture v classical, Odds Ratio (OR) of 69.
  • The longer bisphosphonates are used the higher the OR of atypical:classical fracture: 35 at 2y to 175 at 9y.
  • Long term bisphosphonate use results in “frozen bone” i.e. a decrease in the rate of bone turnover.
  • Bilateral fractures have an Odds Ratio of x42 in atypical cases compared to classic cases.
  • X-raying both legs is thus a sensible practice if an atypical fracture is noted or suspected.
  • We should be considering stopping bisphosphonates in low risk individuals after 3-5 years of therapy. A medication ‘holiday’.


  1. Dear Dr Taqi,Asalam Alaikum,I am a GP from Kashmir India presently in Dubai,I want to apply for MRCGP Int in Dubai and want your advise about the course for MCQ exam.I am planning to write MCQ exam first in April and then other part later.I am hoping to prepare by online courses like Onexamination or Pastest and request you to kindly advise which is the best way to prepare.will be grateful to you if you reply

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