Niimi Rui, Kono Toshibumi, Nishihara Atsushi, Hasegawa Masahiro, Matsumine Akihiko, Kono Toshihiko, Sudo Akihiro
Department of Orthopaedic Surgery, Tomidahama Hospital, Yokkaichi City, Japan.
J Bone Miner Res. 2015 Feb;30(2):225-31. doi: 10.1002/jbmr.2345.
Femoral cortical thickening has been mentioned in reports of atypical subtrochanteric/femoral shaft (ST/FS) fractures, which are associated with long-term bisphosphonate (BP) use. However, whether thickening precedes BP use or results from BP use, as well as the role BPs may play in cortical thickening remain unclear. The purpose of this study was to investigate the relationship between cortical thickness and BP use. We enrolled 142 patients (mean age 79 years) who had taken BPs for more than 5 years, and enrolled 426 osteoporosis patients who had not used BPs as controls. We performed a case-control study of patients with long-term BP use and controls matched for age, sex, and levels of activities of daily living (ADLs) (1:3 ratio). On femoral radiographs, we measured femoral cortical thickness in three regions: 5 cm and 12.5 cm below the lesser trochanter and in the region of maximal cortical thickness. We compared cortical thicknesses between patients taking BP and controls and evaluated longitudinal changes in cortical thickness. There were no significant differences in cortical thickness between long-term BP users and controls. In addition, after further use of BP for a minimum of 1 year, we observed no significant differences in the changes in cortical thickness at any level of the femur. In conclusion, our study did not find evidence of cortical thickening at the ST/FS area of the femur with long-term BP use.
在非典型转子下/股骨干（ST/FS）骨折的报告中提到了股骨皮质增厚，这与长期使用双膦酸盐（BP）有关。然而，增厚是在使用BP之前出现还是由BP使用导致，以及BP在皮质增厚中可能起的作用仍不清楚。本研究的目的是调查皮质厚度与BP使用之间的关系。我们纳入了142例服用BP超过5年的患者（平均年龄79岁），并纳入426例未使用BP的骨质疏松患者作为对照。我们对长期使用BP的患者和年龄、性别及日常生活活动（ADL）水平相匹配的对照进行了病例对照研究（1:3比例）。在股骨X线片上，我们在三个区域测量股骨皮质厚度：小转子下方5 cm和12.5 cm处以及皮质厚度最大的区域。我们比较了服用BP的患者和对照之间的皮质厚度，并评估了皮质厚度的纵向变化。长期使用BP的患者与对照之间的皮质厚度没有显著差异。此外，在进一步使用BP至少1年后，我们观察到股骨任何水平的皮质厚度变化均无显著差异。总之，我们的研究未发现长期使用BP会导致股骨ST/FS区域皮质增厚的证据。
