Lateral cortical thickening and bone heterogeneity of the subtrochanteric femur measured with quantitative CT as indicators for early detection of atypical femoral fractures in long-term bisphosphonate users

Seung Hyun Lee, Young Han Lee, Jinsuck Suh

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2 Citations (Scopus)

Abstract

OBJECTIVE. The objective of our study was to compare subtrochanteric femur bone mineral density (BMD) and bone quality of long-term bisphosphonate (BP) users who sustained an atypical femoral fracture (AFF) with BP users who did not sustain a femoral fracture and BP-nave patients with no history of femoral fracture using quantitative CT (QCT). MATERIALS AND METHODS. Fourteen female BP users with an AFF (mean age, 72.6 years; mean duration of BP use, 6.2 years; mean body mass index, 21.9) who had undergone QCT before fracture events were sex-, age-, BP use duration-, and body mass index-matched to 14 BP users who did not sustain a fracture and 14 BP-naive patients. The lateral cortical thickness index (CTI) and the mean BMD (BMD mean ) and SD of the BMD (BMD SD ) within the lateral cortex and within the entire cross-sectional area of the subtrochanteric femur were measured on axial QCT. Femoral neck-shaft angles were measured on the QCT scout image. Parameters were analyzed using the Kruskal-Wallis test. RESULTS. Lateral CTIs were greater in the BP users with an AFF (median, 0.28) than in the BP users without a femoral fracture (median, 0.21) (p = 0.038) and the BP-naive group (median, 0.21) (p = 0.009). The lateral cortex BMD SD was significantly higher in the BP users with an AFF (median, 59.59 mg/cm3) than the BP users without a femoral fracture (median, 39.27 mg/cm3; p = 0.049) and the BP-naive group (median, 31.02 mg/cm3; p = 0.037). There was no significant difference among groups in lateral cortex BMD mean , BMD mean and BMD SD of the entire cross-sectional area, and femoral neck-shaft angle. CONCLUSION. Long-term BP users with a subsequent AFF had a thicker lateral cortex and higher lateral cortex BMDSD at the subtrochanteric area before the fracture on QCT than BP users who did not sustain a femoral fracture and BP-naive patients.

Original languageEnglish
Pages (from-to)867-873
Number of pages7
JournalAmerican Journal of Roentgenology
Volume209
Issue number4
DOIs
Publication statusPublished - 2017 Oct 1

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Femoral Fractures
Diphosphonates
Femur
Bone Density
Cortical Bone
Femur Neck
Body Mass Index

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

@article{b9ed38524d46450d82f51218049989b5,
title = "Lateral cortical thickening and bone heterogeneity of the subtrochanteric femur measured with quantitative CT as indicators for early detection of atypical femoral fractures in long-term bisphosphonate users",
abstract = "OBJECTIVE. The objective of our study was to compare subtrochanteric femur bone mineral density (BMD) and bone quality of long-term bisphosphonate (BP) users who sustained an atypical femoral fracture (AFF) with BP users who did not sustain a femoral fracture and BP-nave patients with no history of femoral fracture using quantitative CT (QCT). MATERIALS AND METHODS. Fourteen female BP users with an AFF (mean age, 72.6 years; mean duration of BP use, 6.2 years; mean body mass index, 21.9) who had undergone QCT before fracture events were sex-, age-, BP use duration-, and body mass index-matched to 14 BP users who did not sustain a fracture and 14 BP-naive patients. The lateral cortical thickness index (CTI) and the mean BMD (BMD mean ) and SD of the BMD (BMD SD ) within the lateral cortex and within the entire cross-sectional area of the subtrochanteric femur were measured on axial QCT. Femoral neck-shaft angles were measured on the QCT scout image. Parameters were analyzed using the Kruskal-Wallis test. RESULTS. Lateral CTIs were greater in the BP users with an AFF (median, 0.28) than in the BP users without a femoral fracture (median, 0.21) (p = 0.038) and the BP-naive group (median, 0.21) (p = 0.009). The lateral cortex BMD SD was significantly higher in the BP users with an AFF (median, 59.59 mg/cm3) than the BP users without a femoral fracture (median, 39.27 mg/cm3; p = 0.049) and the BP-naive group (median, 31.02 mg/cm3; p = 0.037). There was no significant difference among groups in lateral cortex BMD mean , BMD mean and BMD SD of the entire cross-sectional area, and femoral neck-shaft angle. CONCLUSION. Long-term BP users with a subsequent AFF had a thicker lateral cortex and higher lateral cortex BMDSD at the subtrochanteric area before the fracture on QCT than BP users who did not sustain a femoral fracture and BP-naive patients.",
author = "Lee, {Seung Hyun} and Lee, {Young Han} and Jinsuck Suh",
year = "2017",
month = "10",
day = "1",
doi = "10.2214/AJR.17.17938",
language = "English",
volume = "209",
pages = "867--873",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
publisher = "American Roentgen Ray Society",
number = "4",

}

TY - JOUR

T1 - Lateral cortical thickening and bone heterogeneity of the subtrochanteric femur measured with quantitative CT as indicators for early detection of atypical femoral fractures in long-term bisphosphonate users

AU - Lee, Seung Hyun

AU - Lee, Young Han

AU - Suh, Jinsuck

PY - 2017/10/1

Y1 - 2017/10/1

N2 - OBJECTIVE. The objective of our study was to compare subtrochanteric femur bone mineral density (BMD) and bone quality of long-term bisphosphonate (BP) users who sustained an atypical femoral fracture (AFF) with BP users who did not sustain a femoral fracture and BP-nave patients with no history of femoral fracture using quantitative CT (QCT). MATERIALS AND METHODS. Fourteen female BP users with an AFF (mean age, 72.6 years; mean duration of BP use, 6.2 years; mean body mass index, 21.9) who had undergone QCT before fracture events were sex-, age-, BP use duration-, and body mass index-matched to 14 BP users who did not sustain a fracture and 14 BP-naive patients. The lateral cortical thickness index (CTI) and the mean BMD (BMD mean ) and SD of the BMD (BMD SD ) within the lateral cortex and within the entire cross-sectional area of the subtrochanteric femur were measured on axial QCT. Femoral neck-shaft angles were measured on the QCT scout image. Parameters were analyzed using the Kruskal-Wallis test. RESULTS. Lateral CTIs were greater in the BP users with an AFF (median, 0.28) than in the BP users without a femoral fracture (median, 0.21) (p = 0.038) and the BP-naive group (median, 0.21) (p = 0.009). The lateral cortex BMD SD was significantly higher in the BP users with an AFF (median, 59.59 mg/cm3) than the BP users without a femoral fracture (median, 39.27 mg/cm3; p = 0.049) and the BP-naive group (median, 31.02 mg/cm3; p = 0.037). There was no significant difference among groups in lateral cortex BMD mean , BMD mean and BMD SD of the entire cross-sectional area, and femoral neck-shaft angle. CONCLUSION. Long-term BP users with a subsequent AFF had a thicker lateral cortex and higher lateral cortex BMDSD at the subtrochanteric area before the fracture on QCT than BP users who did not sustain a femoral fracture and BP-naive patients.

AB - OBJECTIVE. The objective of our study was to compare subtrochanteric femur bone mineral density (BMD) and bone quality of long-term bisphosphonate (BP) users who sustained an atypical femoral fracture (AFF) with BP users who did not sustain a femoral fracture and BP-nave patients with no history of femoral fracture using quantitative CT (QCT). MATERIALS AND METHODS. Fourteen female BP users with an AFF (mean age, 72.6 years; mean duration of BP use, 6.2 years; mean body mass index, 21.9) who had undergone QCT before fracture events were sex-, age-, BP use duration-, and body mass index-matched to 14 BP users who did not sustain a fracture and 14 BP-naive patients. The lateral cortical thickness index (CTI) and the mean BMD (BMD mean ) and SD of the BMD (BMD SD ) within the lateral cortex and within the entire cross-sectional area of the subtrochanteric femur were measured on axial QCT. Femoral neck-shaft angles were measured on the QCT scout image. Parameters were analyzed using the Kruskal-Wallis test. RESULTS. Lateral CTIs were greater in the BP users with an AFF (median, 0.28) than in the BP users without a femoral fracture (median, 0.21) (p = 0.038) and the BP-naive group (median, 0.21) (p = 0.009). The lateral cortex BMD SD was significantly higher in the BP users with an AFF (median, 59.59 mg/cm3) than the BP users without a femoral fracture (median, 39.27 mg/cm3; p = 0.049) and the BP-naive group (median, 31.02 mg/cm3; p = 0.037). There was no significant difference among groups in lateral cortex BMD mean , BMD mean and BMD SD of the entire cross-sectional area, and femoral neck-shaft angle. CONCLUSION. Long-term BP users with a subsequent AFF had a thicker lateral cortex and higher lateral cortex BMDSD at the subtrochanteric area before the fracture on QCT than BP users who did not sustain a femoral fracture and BP-naive patients.

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U2 - 10.2214/AJR.17.17938

DO - 10.2214/AJR.17.17938

M3 - Article

VL - 209

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EP - 873

JO - American Journal of Roentgenology

JF - American Journal of Roentgenology

SN - 0361-803X

IS - 4

ER -