title: A large amount of microdamages in the cortical bone around fracture site in a patient of atypical femoral fracture after long-term bisphosphonate therapy.
abstract: A breast cancer patient developed an atypical femoral fracture after 9 years of bisphosphonate therapy for the treatment of multiple bone metastases. We histopathologically analyzed the femoral cortical bone at the fracture site and the iliac cancellous bone. Four months prior to the fracture, the patient had experienced pain in the right femur and underwent plain radiography and bone scintigraphy which revealed cortical thickening and radioisotope accumulation at each site, respectively. The patient had also experienced a non-traumatic fracture at the same site on the contralateral side 2 years earlier. Based on these findings, atypical femoral fracture was diagnosed and intramedullary nailing performed. A cortical bone specimen taken from near the fracture site during surgery showed marked microdamages, and analysis of the iliac cancellous bone specimen revealed severely suppressed bone turnover. These findings suggest that microdamage and severely suppressed bone turnover are associated with atypical femoral fracture reported in this patient with long-term bisphosphonate therapy.
authors.affiliation: Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe Mikicho, Kitagun, Kagawa 761-0793, Japan. Electronic address: kiwata@med.kagawa-u.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Iwata
authors.affiliation: Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe Mikicho, Kitagun, Kagawa 761-0793, Japan. Electronic address: task@med.kagawa-u.ac.jp.
authors.forename: Tasuku
authors.initials: T
authors.lastname: Mashiba
authors.affiliation: Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe Mikicho, Kitagun, Kagawa 761-0793, Japan. Electronic address: thitora@med.kagawa-u.ac.jp.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Hitora
authors.affiliation: Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe Mikicho, Kitagun, Kagawa 761-0793, Japan. Electronic address: yokkun@med.kagawa-u.ac.jp.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Yamagami
authors.affiliation: Department of Orthopaedic Surgery, Kagawa University Faculty of Medicine, 1750-1 Ikenobe Mikicho, Kitagun, Kagawa 761-0793, Japan. Electronic address: sanutetu@med.kagawa-u.ac.jp.
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Yamamoto
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000473:pathology*; D005269:Femur / Q000000981:diagnostic imaging / Q000473:pathology / Q000648:ultrastructure; D006801:Humans; D008875:Middle Aged; D011859:Radiography
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Atypical femoral fracture; Bisphosphonate; Bone turnover; Microdamage