title: Presence of pyrophosphate in bone from an atypical femoral fracture site: A case report.
abstract: Long-term antiresorptives use has been linked to atypical subtrochanteric and diaphyseal femoral fractures (AFF), the pathogenesis of which is still unknown. In the present case report we present the results of analysis of bone chips from a 74-year old female patient that had been on alendronate, ibandronate and denosumab treatment, and who sustained an atypical femoral fracture, by histology, quantitative backscattered electron imaging, and Raman spectroscopic analysis. The results indicate ongoing osteoclastic resorption, but also several abnormalities: 1) an altered arrangement of osteons; 2) impaired mineralization; 3) the presence of pyrophosphate, which might contribute to the impaired mineralization evident in the present case. Taken together, these changes may contribute to the focally reduced bone strength of this patient.
authors.affiliation: Institute of Odontology, Oslo University, Oslo, Norway.
authors.forename: Maziar
authors.initials: M
authors.lastname: Shabestari
authors.affiliation: Dept. of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
authors.forename: Erik Fink
authors.initials: EF
authors.lastname: Eriksen
authors.affiliation: Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria.
authors.forename: Eleftherios P
authors.initials: EP
authors.lastname: Paschalis
authors.affiliation: Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria.
authors.forename: Paul
authors.initials: P
authors.lastname: Roschger
authors.affiliation: Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria.
authors.forename: Sonja
authors.initials: S
authors.lastname: Gamsjaeger
authors.affiliation: Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria.
authors.forename: Klaus
authors.initials: K
authors.lastname: Klaushofer
authors.affiliation: Department of Forensic Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Andrea
authors.initials: A
authors.lastname: Berzlanovich
authors.affiliation: Dept. of Orthopedics, Institut Hospital del Mar d'Investigació Mèdica, Autonomous University of Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Nogues
authors.affiliation: Department of Orthopedic Surgery, Hospital del Mar, Barcelona, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Puig
authors.affiliation: Dept. of Orthopedics, Institut Hospital del Mar d'Investigació Mèdica, Autonomous University of Barcelona, Spain.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Diez-Perez
keywords: Atypical femoral fracture; Pyrophosphate