Conclusions  We propose stress risers as the mechanism for fractures that have occurred where bone mineral density abruptly changes as a result of cyclic administration of pamidronate. We show a theoretical example of how alternative dosing might reduce the ratio and therefore decrease the chance of formation of a stress riser. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00247-011-2198-9Authors H. Theodore Harcke, Alfred I. duPont Hospital for Children, P. O. Box 269, Wilmington, DE 19899, USAKimberly L. Stevenson, Alfred I. duPont Hospital for Children, P. O. Box 269, Wilmington, DE 19899, USAHeidi H. Kecskemethy, Alfred I. duPont Hospital for Children, P. O. Box 269, Wilmington, DE 19899, USASteven J. Bachrach, Alfred I. duPont Hospit...