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Incidence and bone biopsy findings of atypical femoral fractures

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Abstract

Bisphosphonates are widely used in the treatment of osteoporosis. It has been suggested that bisphosphonate treatment may be associated with atypical femoral fractures (AFFs), severely suppressed bone turnover rate, and decreased mineralization. We studied bone properties using bone quantitative histomorphometry and Fourier transform infrared spectroscopic imaging (FTIRI) on patients with AFFs. Further, the incidence of AFFs was estimated. Patient records of Kuopio University Hospital, Finland from January 2007 to June 2009 were reviewed to identify all patients who had sustained and had been operated for AFF (n = 8). The incidence of AFFs among patients on bisphosphonates was 0.61 fractures/1,000 patients per year, compared to 0.0067/1,000 per year among untreated patients. The patients that underwent bone biopsy (n = 4) were postmenopausal women (aged 55.5–81.1 years) who had been treated with bisphosphonates for over 4 years. Histomorphometry revealed low trabecular bone volume. Bone formation and resorption parameters tended to be low. Trabecular bone single labels were detected in one patient in the region of interest. In the extended label search, trabecular bone double labels were found in two patients. Based on FTIRI results, higher phosphate-to-amide I ratio and collagen maturity were found compared to normal samples. The heterogeneity of phosphate-to-amide I ratio was low. Overall incidence of atypical femoral fractures is low. The poor fracture resistance in some patients on long-term bisphosphonate-therapy could be explained by low bone formation, and changes in bone composition, i.e., higher degree of mineralization, increased collagen maturity, and decreased heterogeneity of the degree of mineralization.

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Acknowledgments

The authors would like to acknowledge Ms. Ritva Sormunen, Ms. Eija Rahunen, and Ms. Aija Parkkinen for their assistance in sample preparation and financial support from Kuopio University Hospital, the Academy of Finland, National Doctoral Programme of Musculoskeletal Disorders and Biomaterials, the Finnish Cultural Foundation, Emil Aaltonen Foundation, Päivikki and Sakari Sohlberg Foundation, Sigrid Juselius Foundation, and the strategic funding of the University of Eastern Finland.

Conflict of interest

None of the authors have any conflicts of interest.

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Authors and Affiliations

  1. Bone and Cartilage Research Unit (BCRU), University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland

    Inari S. Tamminen, Xiaoyu Tong & Heikki Kröger

  2. Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland

    Inari S. Tamminen, Hanna Isaksson, Mikael J. Turunen, Xiaoyu Tong & Jukka S. Jurvelin

  3. Department of Orthopaedics, Traumatology, and Hand Surgery, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland

    Inari S. Tamminen, Tero Yli-Kyyny, Xiaoyu Tong & Heikki Kröger

  4. Department of Clinical Physiology, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland

    Mikael J. Turunen

  5. Division of Solid Mechanics, and Department of Orthopaedics, Lund University, Box 118, 221 00, Lund, Sweden

    Hanna Isaksson

Authors
  1. Inari S. Tamminen
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  2. Tero Yli-Kyyny
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  6. Jukka S. Jurvelin
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Correspondence to Inari S. Tamminen.

Additional information

I. S. Tamminen and T. Yli-Kyyny contributed equally to this work.

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Tamminen, I.S., Yli-Kyyny, T., Isaksson, H. et al. Incidence and bone biopsy findings of atypical femoral fractures. J Bone Miner Metab 31, 585–594 (2013). https://doi.org/10.1007/s00774-013-0448-7

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  • DOI: https://doi.org/10.1007/s00774-013-0448-7

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