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Histology of 8 atypical femoral fractures

Schilcher, Jorg; Sandberg, Olof; Isaksson, Hanna LU and Aspenberg, Per (2014) In Acta Orthopaedica 85(3). p.280-286
Abstract
Background and purpose - The pathophysiology behind bis-phosphonate-associated atypical femoral fractures remains unclear. Histological findings at the fracture site itself may provide clues. Patients and methods - Between 2008 and 2013, we collected bone biopsies including the fracture line from 4 complete and 4 incomplete atypical femoral fractures. 7 female patients reported continuous bisphosphonate use for 10 years on average. 1 patient was a man who was not using bisphosphonates. Dual-energy X-ray absorptiometry of the hip and spine showed no osteoporosis in 6 cases. The bone biopsies were evaluated by micro-computed tomography, infrared spectroscopy, and qualitative histology. Results - Incomplete fractures involved the whole... (More)
Background and purpose - The pathophysiology behind bis-phosphonate-associated atypical femoral fractures remains unclear. Histological findings at the fracture site itself may provide clues. Patients and methods - Between 2008 and 2013, we collected bone biopsies including the fracture line from 4 complete and 4 incomplete atypical femoral fractures. 7 female patients reported continuous bisphosphonate use for 10 years on average. 1 patient was a man who was not using bisphosphonates. Dual-energy X-ray absorptiometry of the hip and spine showed no osteoporosis in 6 cases. The bone biopsies were evaluated by micro-computed tomography, infrared spectroscopy, and qualitative histology. Results - Incomplete fractures involved the whole cortical thickness and showed a continuous gap with a mean width of 180 m. The gap contained amorphous material and was devoid of living cells. In contrast, the adjacent bone contained living cells, including active osteoclasts. The fracture surfaces sometimes consisted of woven bone, which may have formed in localized defects caused by surface fragmentation or resorption. Interpretation - Atypical femoral fractures show signs of attempted healing at the fracture site. The narrow width of the fracture gap and its necrotic contents are compatible with the idea that micromotion prevents healing because it leads to strains within the fracture gap that preclude cell survival. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
85
issue
3
pages
280 - 286
publisher
Taylor & Francis
external identifiers
  • wos:000337845000013
  • scopus:84902688300
ISSN
1745-3682
DOI
10.3109/17453674.2014.916488
language
English
LU publication?
yes
id
7a4c5672-b8ed-4feb-b966-0e9e21bfacf5 (old id 4609174)
date added to LUP
2014-09-01 07:39:30
date last changed
2017-09-24 04:00:40
@article{7a4c5672-b8ed-4feb-b966-0e9e21bfacf5,
  abstract     = {Background and purpose - The pathophysiology behind bis-phosphonate-associated atypical femoral fractures remains unclear. Histological findings at the fracture site itself may provide clues. Patients and methods - Between 2008 and 2013, we collected bone biopsies including the fracture line from 4 complete and 4 incomplete atypical femoral fractures. 7 female patients reported continuous bisphosphonate use for 10 years on average. 1 patient was a man who was not using bisphosphonates. Dual-energy X-ray absorptiometry of the hip and spine showed no osteoporosis in 6 cases. The bone biopsies were evaluated by micro-computed tomography, infrared spectroscopy, and qualitative histology. Results - Incomplete fractures involved the whole cortical thickness and showed a continuous gap with a mean width of 180 m. The gap contained amorphous material and was devoid of living cells. In contrast, the adjacent bone contained living cells, including active osteoclasts. The fracture surfaces sometimes consisted of woven bone, which may have formed in localized defects caused by surface fragmentation or resorption. Interpretation - Atypical femoral fractures show signs of attempted healing at the fracture site. The narrow width of the fracture gap and its necrotic contents are compatible with the idea that micromotion prevents healing because it leads to strains within the fracture gap that preclude cell survival.},
  author       = {Schilcher, Jorg and Sandberg, Olof and Isaksson, Hanna and Aspenberg, Per},
  issn         = {1745-3682},
  language     = {eng},
  number       = {3},
  pages        = {280--286},
  publisher    = {Taylor & Francis},
  series       = {Acta Orthopaedica},
  title        = {Histology of 8 atypical femoral fractures},
  url          = {http://dx.doi.org/10.3109/17453674.2014.916488},
  volume       = {85},
  year         = {2014},
}