AFF: Bone Density and Structure with BP Use

1

• AFF Bone Density and Structure with BP Use
• Based on Poster FR0030
• Bone Density and Structure of Patients on
  Bisphosphonates
• with Atypical Femur Fractures
• Angela Cheung, Jonathan Adachi, Robert Josse,
  Robert Bleakney, Christian Viellette, Aliya
  Khan, Moira Kapral, Sophie Jamal, Heather
  McDonald-Blumer, Earl Bogoch
• Friday, October 15, 2010
• ASBMR 2010
• Toronto, Ontario

2
Method

• A cross-sectional study of 16 patients (15
  female, 1 male) referred to the University
  Health Network Osteoporosis (OP) Clinic for
  assessment of atypical femoral fractures (AFFs)
• Each patient was assessed by an OP physician
  and all radiographs were independently reviewed
  by a musculoskeletal radiologist as well as an OP
  expert
• Areal BMD by DXA was performed at the lumbar
  spine, total hip and femoral neck
• HR-pQCT was also carried out at the distal
  radius and tibia
• HR-pQCTHigh-resolution peripheral quantitative
  computed tomography

3
Patient Characteristics

• Mean age was 67.2 years (range 46.4 to 88.1)
• Mean serum 25-(OH)-D close to the time of
  fracture was 93 nmol/L
• (within the range felt to be sufficient)
• Mean duration of bisphosphonate (BP) use was
  7.5 years (range 2 to 10.6)
• Chinese n6, Indian n2, European Canadian n8
• 11 patients had comorbid conditions or
  medications (rheumatoid arthritis, pemphigus,
  liver transplant, diabetes, cancer, steroid or
  warfarin use

4
Results

• Mean BMD T-score at the lumbar spine, total
  hip and femoral neck were -0.68, -0.48 and -0.90,
  respectively
• On HRpQCT scans, there was decreased cortical
  thickness
• Marked cortical porosity and a lack of
  trabecular structure with empty holes on many
  of the scans
• These bone defects were not at the site of the
  fracture but at the wrist and the ankle
• On biopsy, there was low bone turnover but it
  was not adynamic bone disease per se

5
HRpQCT Scans of Patients on BPs with AFFs
6
Conclusions

• Patients on BP with AFFs have poor bone
  quality and structure as measured by HRpQCT
• Results suggest that low bone turnover and
  increased mineralization may not be the only
  explanation for AFFs