Complications
The incidence of osteoporotic hip fractures is increasing; osteoporotic hip fractures are associated with significant disability and reduced quality of life.[212]
After fracture, pharmacologic treatment is indicated. Fall-prevention measures remain important. In the US, mortality is 20% in the first year after a hip fracture and institutionalization for long-term care is about 20%. Approximately two-thirds of people do not return to their prior level of function after a hip fracture.[3]
Rib fractures are common among older women with osteoporosis.[213]
There is evidence to suggest that atypical subtrochanteric and femoral fractures are associated with long-term bisphosphonate use.[120][121][122] Atypical subtrochanteric and diaphysial femoral fractures may occur with prolonged bisphosphonate treatment with a median duration of 7 years. Major characteristics include spontaneous fractures without trauma, transverse or short oblique orientation, and medial spike when the fracture is complete. Minor characteristics include cortical thickening; periosteal reaction of the lateral cortex; and concomitant use of other antiresorptive drugs, glucocorticoids, or proton-pump inhibitors. In 50% of individuals, fracture is preceded by thigh or inguinal pain.
Osteoporosis with fractures is a common cause of chronic pain in older people.
There is evidence to suggest that atypical osteonecrosis of the jaw is associated with long-term bisphosphonate use.[121][217] Jaw necrosis occurs specifically in those patients receiving intravenous bisphosphonate treatment who have poor dental hygiene or following dental extractions, dental implants, and/or root canal work.
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