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The Correlation Between Lateral Bowing Angle of the Femur and the Location of Atypical Femur Fractures

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Abstract

This study is the first to report the use of data on incomplete atypical femur fracture (AFF) to evaluate the curvature of femur and explore the relationship between lateral femoral bowing angle (FBA) and AAF location. In this study, we obtained 17 cases of incomplete AFF and calculated the accurate lateral FBA and location ratio of the incomplete fracture. Incomplete fracture location was defined as a percentage (length from lesion to greater trochanter tip/entire femur length %; greater trochanter tip: 0 %; femoral condyles: 100 %). A lateral FBA of 7° was set as the point of demarcation. Eleven femurs had a lateral FBA ≤ 7° (group 1), with a median lateral FBA of 4.75° (IQR 2.5–5.9°) and a median of incomplete AFF location at 25.2 % (IQR 23.4–30.1 %). Another six femurs had a FBA > 7° (group 2) with a median of 1.8° (IQR 10.2–14.3°) and a median location at 47.7 % (IQR 38.6–54.5 %). There was a significant statistical difference in location (p < 0.05) between the two groups. The rate of BP use was 87.5 % in group 1 which was higher than 60 % in group 2. There was some degree of positive correlation between the bowing angle and location in simple linear regression (r 2 = 0.549, p < 0.001, ß = 1.789). AAFs located in diaphysis were associated with large lateral FBA. On the other hand, AAFs located in subtrochanteric region were more commonly found in femurs with smaller lateral FBA. In conclusion, the degree of the FBA was associated with AFF location.

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References

  1. Black DM et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348(9041):1535–1541

    Article  CAS  PubMed  Google Scholar 

  2. Harris ST et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282(14):1344–1352

    Article  CAS  PubMed  Google Scholar 

  3. Black DM et al (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356(18):1809–1822

    Article  CAS  PubMed  Google Scholar 

  4. Body JJ (2006) Bisphosphonates for malignancy-related bone disease: current status, future developments. Support Care Cancer 14(5):408–418

    Article  PubMed  Google Scholar 

  5. Black DM et al (2010) Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med 362(19):1761–1771

    Article  CAS  PubMed  Google Scholar 

  6. Lenart BA, Lorich DG, Lane JM (2008) Atypical fractures of the femoral diaphysis in postmenopausal women taking alendronate. N Engl J Med 358(12):1304–1306

    Article  CAS  PubMed  Google Scholar 

  7. Schilcher J, Michaelsson K, Aspenberg P (2011) Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med 364(18):1728–1737

    Article  CAS  PubMed  Google Scholar 

  8. Dell RM et al (2012) Incidence of atypical nontraumatic diaphyseal fractures of the femur. J Bone Miner Res 27(12):2544–2550

    Article  PubMed  Google Scholar 

  9. Meier RP et al (2012) Increasing occurrence of atypical femoral fractures associated with bisphosphonate use. Arch Intern Med 172(12):930–936

    Article  PubMed  Google Scholar 

  10. Shane E et al (2013) Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 29(1):1–23

    Article  PubMed  Google Scholar 

  11. Capeci CM, Tejwani NC (2009) Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy. J Bone Joint Surg Am 91(11):2556–2561

    Article  PubMed  Google Scholar 

  12. Goddard MS et al (2009) Atraumatic bilateral femur fracture in long-term bisphosphonate use. Orthopedics. doi:10.3928/01477447-20090624-27

    PubMed  Google Scholar 

  13. Lee JK (2009) Bilateral atypical femoral diaphyseal fractures in a patient treated with alendronate sodium. Int J Rheum Dis 12(2):149–154

    Article  PubMed  Google Scholar 

  14. Giusti A, Hamdy NA, Papapoulos SE (2010) Atypical fractures of the femur and bisphosphonate therapy: a systematic review of case/case series studies. Bone 47(2):169–180

    Article  CAS  PubMed  Google Scholar 

  15. Lo JC et al (2012) Clinical correlates of atypical femoral fracture. Bone 51(1):181–184

    Article  PubMed  Google Scholar 

  16. Sasaki S et al (2012) Low-energy diaphyseal femoral fractures associated with bisphosphonate use and severe curved femur: a case series. J Bone Miner Metab 30(5):561–567

    Article  PubMed  Google Scholar 

  17. Hsu RW et al (1990) Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res 255:215–227

    PubMed  Google Scholar 

  18. Yau WP et al (2007) Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning. J Orthop Surg (Hong Kong) 15(1):32–36

    CAS  Google Scholar 

  19. Koh JS et al (2011) Distribution of atypical fractures and cortical stress lesions in the femur: implications on pathophysiology. Singapore Med J 52(2):77–80

    CAS  PubMed  Google Scholar 

  20. Shane E et al (2010) Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 25(11):2267–2294

    Article  PubMed  Google Scholar 

  21. Allen MR, Burr DB (2007) Three years of alendronate treatment results in similar levels of vertebral microdamage as after one year of treatment. J Bone Miner Res 22(11):1759–1765

    Article  CAS  PubMed  Google Scholar 

  22. Brennan O et al (2011) Effects of estrogen deficiency and bisphosphonate therapy on osteocyte viability and microdamage accumulation in an ovine model of osteoporosis. J Orthop Res 29(3):419–424

    Article  PubMed  Google Scholar 

  23. Renders GA et al (2011) Mineral heterogeneity affects predictions of intratrabecular stress and strain. J Biomech 44(3):402–407

    Article  CAS  PubMed  Google Scholar 

  24. Saito M et al (2008) Collagen maturity, glycation induced-pentosidine, and mineralization are increased following 3-year treatment with incadronate in dogs. Osteoporos Int 19(9):1343–1354

    Article  CAS  PubMed  Google Scholar 

  25. Tang SY et al (2009) Changes in non-enzymatic glycation and its association with altered mechanical properties following 1-year treatment with risedronate or alendronate. Osteoporos Int 20(6):887–894

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Unnanuntana A et al (2013) Atypical femoral fractures: what do we know about them?: AAOS exhibit selection. J Bone Joint Surg Am 95(2):e8–e13

    Article  PubMed  Google Scholar 

  27. Mullaji AB, Marawar SV, Mittal V (2009) A comparison of coronal plane axial femoral relationships in Asian patients with varus osteoarthritic knees and healthy knees. J Arthroplast 24(6):861–867

    Article  Google Scholar 

  28. Nagamine R et al (2000) Anatomic variations should be considered in total knee arthroplasty. J Orthop Sci 5(3):232–237

    Article  CAS  PubMed  Google Scholar 

  29. Crossley K et al (1999) Ground reaction forces, bone characteristics, and tibial stress fracture in male runners. Med Sci Sports Exerc 31(8):1088–1093

    Article  CAS  PubMed  Google Scholar 

  30. Roschger P et al (2001) Alendronate increases degree and uniformity of mineralization in cancellous bone and decreases the porosity in cortical bone of osteoporotic women. Bone 29(2):185–191

    Article  CAS  PubMed  Google Scholar 

  31. Boskey AL, Spevak L, Weinstein RS (2009) Spectroscopic markers of bone quality in alendronate-treated postmenopausal women. Osteoporos Int 20(5):793–800

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Donnelly E et al (2012) Reduced cortical bone compositional heterogeneity with bisphosphonate treatment in postmenopausal women with intertrochanteric and subtrochanteric fractures. J Bone Miner Res 27(3):672–678

    Article  CAS  PubMed  Google Scholar 

  33. Roschger P et al (2008) Bone mineralization density distribution in health and disease. Bone 42(3):456–466

    Article  CAS  PubMed  Google Scholar 

  34. Huang TW et al (2011) Total knee replacement in patients with significant femoral bowing in the coronal plane: a comparison of conventional and computer-assisted surgery in an Asian population. J Bone Joint Surg Br 93(3):345–350

    Article  PubMed  Google Scholar 

  35. Maratt J et al (2014) Variation in the femoral bow: a novel high-throughput analysis of 3922 femurs on cross-sectional imaging. J Orthop Trauma 28(1):6–9

    Article  PubMed  Google Scholar 

  36. Mohan PC et al (2013) Radiographic features of multifocal endosteal thickening of the femur in patients on long-term bisphosphonate therapy. Eur Radiol 23(1):222–227

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank C.H Wang for his assistance in statistical analyses, C.T Liu and K.S Wang for data collection, and the Department of Radiology in Mackay Memorial Hospital for assistance with radiography.

Human and Animal Rights and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Authors and Affiliations

  1. Department of Orthopedic, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan

    Lei-Po Chen, Ting-Kuo Chang, Te-Yang Huang, Tiew-Guan Kwok & Yung-Chang Lu

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  1. Lei-Po Chen
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  2. Ting-Kuo Chang
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  3. Te-Yang Huang
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Correspondence to Ting-Kuo Chang.

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Lei-Po Chen, Ting-Kuo Chang, Te-Yang Huang, Tiew-Guan Kwok and Yung-Chang Lu declare that they have no conflicts of interest.

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Chen, LP., Chang, TK., Huang, TY. et al. The Correlation Between Lateral Bowing Angle of the Femur and the Location of Atypical Femur Fractures. Calcif Tissue Int 95, 240–247 (2014). https://doi.org/10.1007/s00223-014-9887-y

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  • DOI: https://doi.org/10.1007/s00223-014-9887-y

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