Diphosphonates remain among the most common drug treatments for osteoporosis. Recent evidence has implicated diphosphonate therapy, specifically, alendronate, with low-energy fractures of the subtrochanteric region of the femur. The general conclusion is that prolonged suppression of bone remodelling with alendronate may be associated with a new form of insufficiency fracture of the femur.

Three case reports of patients with alendronate related insufficiency are discussed here with their treatment modalities and lessons learnt. One of the three patients had bilateral subtrochanteric stress fracture. A comprehensive review of the literature is presented with the best evidence for investigating, treating and preventing these fractures

Our experience in Launceston has increased awareness amongst the local medical community regarding the long term use of Diphosphnates and the fractures they may cause. Changes to our practice have included: Increased suspicion of patients with hip pain on diphosphonate therapy, imaging the contralateral femur to rule out stress fractures, reassuring GP's and Patients that benefits of Diphosphonate therapy far outweigh the potential risks.

There are many unresolved questions about the prolonged use of diphosphonates, but there is sufficient evidence to show subtrochanteric stress fractures do occur. We, as Orthopaedic Surgeons, must be able to recognize this new entity and educate our medical colleagues appropriately.

We retrospectively reviewed the results of patients having undergone single or two level Anterior Cervical Discectomy and Fusion with the use of the Cervios Cage (SYNTHES).

Participants were sent a questionnaire which included generic questions relating to ACDF such as dysphagia, hoarseness of voice and resolution of arm pain in addition to Oswestry Disability scores. Most patients underwent AP/Lateral and flexion/extension radiographs.

Introduction Men will account for 30% of hip fractures in the next decade and men have a higher mortality after hip fracture than women. Men with osteoporosis often have secondary aetiological conditions. Our aim was to prospectively define secondary causes of osteoporosis in a group of men presenting with hip fracture.

Methods Forty-two men presenting with hip fracture were prospectively recruited and compared with 19 male controls that had primary hip arthroplasty for osteoarthritis. Bone mineral density (BMD) was measured by DEXA of unaffected hip and spine. Secondary causes of osteoporosis were identified from history and by biochemical and hormonal assays. Bone turnover was assessed by urinary deoxypyridinoline (DPD). Bone biopsy was taken to confirm or exclude osteomalacia.

Results Secondary factors were identified in 86% of hip fracture patients. Eighteen patients (42%) had hypogonadism (serum Testosterone < 7nmol/L), nine (21%) had vitamin D deficiency, thirteen (31%) had elevated parathyroid hormone (PTH), eight (19%) had a history of glucocorticoid use (equivalent prednisolone > 5mg/d), seven (17%) had heavy alcohol intake, and four (9%) had rheumatoid arthritis. Compared with controls, hip fracture patients had lower BMD (p=0.002), higher urinary DPD (p=0.004), lower serum Insulin-like Growth Factor-I (IGF-I) (p=0.02), and elevated PTH (p=0.008).

Conclusions Secondary causes of osteoporosis are common in men with hip fractures. Investigation and treatment of underlying conditions should be part of hip fracture management in men. Low BMD, high bone resorption, high PTH levels, and low serum IGF-I were associated with hip fractures when compared to men with hip osteoarthritis.

In relation to the conduct of this study, one or more of the authors is in receipt of a research grant from a non-commercial source.