Femoral cortical stress lesions in long-term bisphosphonate therapy: A herald of impending fracture?

Journal of Orthopaedic Trauma

Volumn 24, Issue 2, 2010, Pages 75-81

  Koh, Joyce S B ^a   Goh, Seo Kiat ^a   Png, Meng Ai ^a   Kwek, Ernest B K ^b   Howe, Tet Sen ^a  

^a SINGAPORE GENERAL HOSPITAL   (Singapore)

^b TAN TOCK SENG HOSPITAL   (Singapore)

Author keywords

"dreaded black line"; Bisphosphonate therapy; Cortical stress reaction; Femoral insufficiency fractures; Prophylactic fixation

Indexed keywords

ALENDRONIC ACID; CALCIUM; RISEDRONIC ACID; VITAMIN D; ZOLEDRONIC ACID;

ADULT; AGED; ARTICLE; BONE LESION; BONE MINERAL; BONE RADIOGRAPHY; CALCIUM BLOOD LEVEL; CLINICAL ASSESSMENT; CORTICAL BONE; DEMENTIA; DIAPHYSIS; DISEASE ASSOCIATION; FEMALE; FEMORAL CORTICAL STRESS LESION; FOLLOW UP; GERIATRIC CARE; HIP FRACTURE; HUMAN; LEG PAIN; LONG TERM CARE; MAJOR CLINICAL STUDY; MALE; METAPHYSIS; OUTCOME ASSESSMENT; PRIORITY JOURNAL; RETROSPECTIVE STUDY; RISK FACTOR; STRESS FRACTURE; TERTIARY HEALTH CARE; THIGH; VITAMIN BLOOD LEVEL;

AGED; AGED, 80 AND OVER; DIPHOSPHONATES; DRUG ADMINISTRATION SCHEDULE; FEMALE; FOLLOW-UP STUDIES; FRACTURES, STRESS; FRACTURES, UNUNITED; HIP FRACTURES; HUMANS; MIDDLE AGED; PRODUCT SURVEILLANCE, POSTMARKETING; RETROSPECTIVE STUDIES;

EID: 77649093334     PISSN: 08905339     EISSN: None     Source Type: Journal    
DOI: 10.1097/BOT.0b013e3181b6499b     Document Type: Article

References (24)

1. National Osteoporosis Foundation (NOF) Physician's Guide to Prevention and Treatment of Osteoporosis. Available at: www.nof.org//physguide/risk- assessment.htm. Accessed March 12, 2006.
2. Liebermann UA, Weiss SR, Broll J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med. 1995;333:1437-1443.
3. Ravn P, Weiss SR, Rodriguez-Portales JA, et al. Alendronate in early postmenopausal women: Effects on bone mass during long-term treatment and after withdrawal. Alendronate Osteoporosis Prevention Study Group. J Clin Endocrinol Metab. 2000;85:1492-1497.
4. Fleisch H, Reszka A, Rodan G, et al. Bisphosphonates: mechanisms of action. In: Bilezikian JP, Raisz LG, Rodan GA, eds. Principles of Bone Biology, 2nd ed. San Diego: Academic Press; 2002:1361-1385.
5. Odvina CV, Zerwekh JE, Rao DS, et al. Severely suppressed bone turnover: A potential complication of alendronate therapy. J Clin Endocrinol Metab. 2005;90:1294-1301.
6. Schneider JP. Should bisphosphonates be continued indefinitely? An unusual fracture in a healthy woman on long-term alendronate. Geriatrics. 2006;61:31-33.
7. Goh SK, Yang KY, Koh JSB, et al. Subtrochanteric insufficiency fractures in patients on alendronate therapy-a caution. J Bone Joint Surg Br. 2007; 89:349-353.
8. Neviaser AS, Lane JM, Lenart BA, et al. Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma. 2008;22: 346-350.
9. Visekruna M, Wilson D, McKiernan FE. Severely suppressed bone turnover and atypical skeletal fragility. J Clin Endocrinol Metab. 2008;93: 2948-2952.
10. Kwek EB, Goh SK, Koh JS, et al. An emerging pattern of subtrochanteric stress fractures: A long-term complication of alendronate therapy? Injury. 2008;39:224-231.
11. Young AJ, McAllister DR. Evaluation and treatment of tibial stress fractures. Clin Sports Med. 2006;25:117-128.
12. Kwek EB, Koh JS, Howe TS. More on atypical fractures of the femoral diaphysis. N Engl J Med. 2008;359:316-317.
13. Roschger P, Rinnerthaler S, Yates J, et al. Alendronate increases degree and uniformity of mineralization in cancellous bone and decreases the porosity in cortical bone of osteoporotic women. Bone. 2001;29: 185-191.
14. Vandenput L, Swinnen JV, Boonen S, et al. Role of the androgen receptor in skeletal homeostasis: And androgen-resistant testicular feminized male mouse model. J Bone Miner Res. 2004;19:1462-1470.
15. Mashiba T, Mori S, Burr DB, et al. The effects of suppressed bone remodeling by bisphosphonates on microdamage accumulation and degree of mineralization in the cortical bone of dog rib. J Bone Miner Metab. 2005;23(Suppl):36-42.
16. Currey JD. Effects of differences in mineralization on the mechanical properties of bone. Philos Trans R Soc Lond B Biol Sci. 1984;304: 509-518.
17. Wasserman N, Yerramshetty J, Akkus O. Microcracks colocalize within highly mineralized regions of cortical bone tissue. Eur J Morphol. 2005; 42:43-51.
18. Dawson-Hughes B, Heaney RP, Holick MF, et al. Estimates of optimal vitamin D status. Osteoporos Int. 2005;16:713-716.
19. Steele B, Serota A, Helfet DL, et al. Vitamin D deficiency: A common occurrence in both high- and low-energy fractures. HSS J. 2008;4: 143-148.
20. Need AG, Horowitz M, Morris HA, et al. Vitamin D status: Effects on parathyroid hormone and 1, 25-dihydroxyvitamin D in postmenopausal women. Am J Clin Nutr. 2000;71:1577-1581.
21. McDonald MM, Dulai S, Godfrey C, et al. Bolus or weekly zoledronic acid administration does not delay endochondral fracture repair but weekly dosing enhances delays in hard callus remodeling. Bone. 2008;43: 653-662.
22. Verborgt O, Gibson GJ, Schaffler MB. Loss of osteocyte integrity in association with microdamage and bone remodeling after fatigue in vivo. J Bone Miner Res. 2000;15:60-67.
23. Follet H, Li J, Phipps RJ, et al. Risedronate and alendronate suppress osteocyte apoptosis following cyclic fatigue loading. Bone. 2007;40: 1172-1177.
24. Tang SY, Allen MR, Phipps R, et al. Changes in non-enzymatic glycation and its association with altered mechanical properties following 1-year treatment with risedronate or alendronate. Osteoporos Int. October 11, 2008. [Epub ahead of print].