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Trabecular Bone Score and Hip Structural Analysis in Patients With Atypical Femur Fractures.

Sanne K C Buitendijk1, Denise M van de Laarschot1, Alexandra A A Smits1

  • 1Bone Center, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.

Journal of Clinical Densitometry : the Official Journal of the International Society for Clinical Densitometry
|April 18, 2018
PubMed
Summary

Trabecular bone score and hip structural analysis do not appear to identify patients at risk for atypical femur fractures (AFFs). These methods are not valuable for predicting AFF complications in bisphosphonate users.

Keywords:
Atypical femur fracturesbone microarchitecturehip geometryhip structural analysistrabecular bone score

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Area of Science:

  • Orthopedics
  • Radiology
  • Pharmacology

Background:

  • Bisphosphonate use has declined due to concerns about rare side effects like atypical femur fractures (AFFs).
  • A diagnostic method to identify individuals at risk of AFF is needed to prevent this complication.

Purpose of the Study:

  • To compare trabecular microarchitecture and hip geometry between patients with AFF and controls.
  • To evaluate the utility of Trabecular Bone Score (TBS) and Hip Structural Analysis (HSA) in identifying individuals at risk for AFF.

Main Methods:

  • Compared 30 patients with AFF and 141 bisphosphonate-using controls using TBS and HSA from DXA scans.
  • Analyzed general characteristics, TBS, and HSA, adjusting for multiple confounding factors.
  • Used Student's t tests and chi-square statistics for comparisons.

Main Results:

  • Patients with AFF had higher BMI, longer bisphosphonate use, and more frequent use of glucocorticoids and proton pump inhibitors.
  • No significant differences were found in TBS or most HSA geometric variables between AFF patients and controls.
  • AFF patients showed lower buckling ratio and higher centroid position at the narrow neck, suggesting lower risk of classical fragility hip fractures.

Conclusions:

  • TBS and HSA do not appear to be valuable tools for detecting patients at risk of AFF.
  • The observed differences in narrow neck geometry may be related to bisphosphonate use for glucocorticoid-induced osteoporosis.