title: Localized cortical thickening of the femoral diaphysis captured on an X-ray before alendronate therapy in two cases of atypical femoral fracture.
abstract: We herein report two cases of atypical femoral fracture (AFF). X-ray examinations at the first visit of these two female patients showed a complete fracture of the femoral diaphysis diagnosed as an atypical femoral fracture (AFF). X-rays of these two cases also showed localized cortical thickening of the femoral diaphysis. Both patients had been taking alendronate for more than 3 years because of postmenopausal osteoporosis. We assumed that both of the fractures were associated with the long-term use of alendronate. However, we retrospectively identified localized cortical thickening of the femoral diaphysis on an X-ray taken before the alendronate therapy in both of these cases. Therefore, we suspected a pathogenesis of AFFs in which preexisting stress or an insufficient fracture unrelated to bisphosphonate (BP) therapy and subsequent suppression of bone turnover due to BP administration led to the occurrence of an AFF. The patient underwent surgery using intramedullary nails in both of these cases, followed by the administration of teriparatide, and they were able to walk without any support at the final follow-up examination.
authors.affiliation: Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan. yoiizuka@gunma-u.ac.jp.|Department of Orthopedic Surgery, Shibukawa General Hospital, 1338-4, Osaki, Shibukawa, Gunma, 377-0008, Japan. yoiizuka@gunma-u.ac.jp.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Iizuka
authors.affiliation: Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan.|Department of Orthopaedic Surgery, Gunma Cardiovascular Center, 3-12, Ko, Kameizumimachi, Maebashi, Gunma, 371-0004, Japan.
authors.forename: Rumi
authors.initials: R
authors.lastname: Takechi
authors.affiliation: Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Haku
authors.initials: H
authors.lastname: Iizuka
authors.affiliation: Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan.|Department of Orthopedic Surgery, Gunma Central Hospital, 1-7-13, Koun, Maebashi, Gunma, 371-0025, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Omodaka
authors.affiliation: Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Takagishi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D018483:Diaphyses / Q000000981:diagnostic imaging / Q000187:drug effects; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D005269:Femur / Q000000981:diagnostic imaging* / Q000187:drug effects; D015775:Fractures, Stress / Q000000981:diagnostic imaging* / Q000517:prevention & control; D006801:Humans; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate
keywords: Atypical femoral fractures; Bisphosphonate; Localized cortical thickening