Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
Eur Radiol. 2013 Jan;23(1):222-7. doi: 10.1007/s00330-012-2587-y. Epub 2012 Jul 20.
To describe the characteristics of multifocal endosteal thickening in patients on bisphosphonate therapy.
A retrospective study of 68 patients with atypical femoral fractures (as defined by ASBMR) whilst on bisphosphonate therapy was performed. Femoral radiographs were assessed for: focal endosteal thickening, number of lesions, lesion location, femoral bowing, periosteal beak and black line. Medical records were reviewed to obtain relevant clinical data.
Forty-eight lesions with multifocal endosteal thickening were detected in seven patients (2 unilateral, 5 bilateral), affecting 11.8 % of femora. Location was mainly diaphyseal (95.8 %), upper (10.4 %), middle (58.3 %) and lower femur (31.3 %), involving the lateral (85.4 %), anterior (6.3 %), anterolateral (2.1 %) and posterior cortices (6.3 %). Femoral bowing was present in 85.7 %. Associated findings of a periosteal beak and/or a black line, seen in 14.6 %, were associated with increased fracture risk (100.0 % sensitivity, 93.2 % specificity).
Multifocal endosteal thickening is a new finding seen in patients with low bone mineral density on bisphosphonate therapy. They are rare, frequently bilateral, predominantly diaphyseal in location involving the lateral cortex and often associated with bowing. Caution is advised when seen in association with periosteal beak and/or black line because of a high rate of progression to complete fracture.
描述接受双膦酸盐治疗的患者中多发骨内骨膜增厚的特征。
对 68 例接受双膦酸盐治疗的非典型股骨骨折（ASBMR 定义）患者进行回顾性研究。评估股骨 X 线片：局灶性骨内膜增厚、病变数量、病变位置、股骨弯曲、骨膜喙和黑线。查阅病历以获取相关临床资料。
7 例患者（2 例单侧，5 例双侧）共发现 48 处多发骨内骨膜增厚病变，累及 11.8%的股骨。位置主要为骨干（95.8%）、上段（10.4%）、中段（58.3%）和下段（31.3%），累及外侧（85.4%）、前侧（6.3%）、前外侧（2.1%）和后侧皮质（6.3%）。85.7%存在股骨弯曲。14.6%可见骨膜喙和/或黑线等相关表现，与骨折风险增加相关（100.0%敏感性，93.2%特异性）。
在接受双膦酸盐治疗的低骨密度患者中发现了一种新的多发骨内膜增厚表现。它们很少见，常为双侧，主要位于骨干，累及外侧皮质，常伴弯曲。当与骨膜喙和/或黑线并存时，由于进展为完全骨折的风险较高，应谨慎处理。
