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Iizuka Y, Iizuka H, Kaneko T, Mieda T, Takechi R, Suzuki H, Sorimachi Y, Suto T, Tachibana M, Yoneyama T, Omodaka T, Hashimoto S, Hamano N, Sakane H, Shimoyama D, Kohama I, Ohshima A, Nozaki T, Kamiyama M, Moteki T, Ohshima A, Takamine S, Honda A, Ueno A, Tajika T, Okamura K, Warita T, Yonemoto Y, Shitara H, Ohsawa T, Takagishi K. Bone turnover markers and the factors associated with atypical femur fractures among Japanese patients. Injury 2016; 47:2484-2489. [PMID: 27670281 DOI: 10.1016/j.injury.2016.09.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 02/02/2023]
Abstract
Many previous reports have indicated that atypical femur fractures (AFFs) are associated with the administration of bisphosphonates (BPs). A number of risk factors and hypotheses regarding the pathogenesis of AFFs have been reported to date. The purpose of the present study was to identify the factors associated with AFFs in Japanese individuals and to elucidate the association between bone metabolism and AFFs by evaluating bone turnover markers (BTMs). We prospectively reviewed all patients with femur fractures and identified the patients with AFFs and typical femur fractures (TFFs). We collected the demographic and clinical data that were relevant to the present study, namely age, gender, affected side, affected site, concomitant medical history, and comorbid conditions, and measured the levels of BTMs within 24h after trauma. Welch's test and Fisher's exact probability test were used for the statistical analyses. A total of 338 patients, including 10 patients with AFFs and 328 patients with TFFs, were analyzed under the inclusion criteria. The use of BPs (p<0.001) and collagen disease and chronic granulomatous disease (CD/CGD) (p=0.025) were more frequently observed in patients with AFFs than in patients with TFFs, while the levels of BTMs, including N-terminal propeptides of type 1 procollagen (P1NP), isoform 5b of tartrate-resistant acid phosphatase (TRACP-5b) and undercarboxylated osteocalcin (ucOC) were significantly lower in patients with AFFs than in patients with TFFs. Furthermore, the level of TRACP-5b was found to be significantly lower in patients with atypical subtrochanteric fractures than in atypical diaphyseal fractures (p=0.025). Moreover, the levels of P1NP (p=0.016) and TRACP-5b (p=0.015) were found to be significantly lower in patients with AFFs than in patients with TFFs in a subgroup analysis of BPs users. The use of BPs was considered to be a factor associated with AFFs. Our comparison of the BTMs in patients with AFFs and TFFs indicated that the severe suppression of bone turnover was associated with the pathogenesis of AFFs. The extent of the influence of suppressed turnover on the pathogenesis of AFFs may differ depending on the fracture site.
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Affiliation(s)
- Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan.
| | - Haku Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Tetsuya Kaneko
- Department of Orthopaedic Surgery, Inoue Hospital, 55, Torimachi, Takasaki, Gunma 370-0053, Japan
| | - Tokue Mieda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Rumi Takechi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Gunma Cardiovascular Center, 3-12, Ko, Kameizumimachi, Maebashi, Gunma 371-0004, Japan
| | - Hideki Suzuki
- Department of Orthopaedic Surgery, Gunma Cardiovascular Center, 3-12, Ko, Kameizumimachi, Maebashi, Gunma 371-0004, Japan
| | - Yasunori Sorimachi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Maebashi Red Cross Hospital, 3-21-36 Asahimacho, Maebashi, Gunma 371-0014, Japan
| | - Takahito Suto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopedic Surgery, Isesaki Municipal Hospital, 12-1, Tsunatorihonmachi, Isesaki, Gunma 372-0817, Japan
| | - Masahiro Tachibana
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopedic Surgery, Isesaki Municipal Hospital, 12-1, Tsunatorihonmachi, Isesaki, Gunma 372-0817, Japan
| | - Tomotaka Yoneyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Takasaki General Medical Center, 36, Takamatsucho, Takasaki, Gunma 370-0829, Japan
| | - Takuya Omodaka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Fujioka General Hospital, 942-1, Fujioka, Fujioka, Gunma 375-8503, Japan
| | - Shogo Hashimoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Gunma Chuo Hospital, 1-7-13, Kouncho, Maebashi, Gunma 371-0025, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Gunmaken Saiseikai Maebashi Hospital, 564-1, Kamishindenmachi, Maebashi, Gunma 371-0821, Japan
| | - Hideo Sakane
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Tone Central Hospital, 1855-1, Higashiharashinmachi, Numata, Gunma 378-0053, Japan
| | - Daisuke Shimoyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Takasaki General Medical Center, 36, Takamatsucho, Takasaki, Gunma 370-0829, Japan
| | - Isaku Kohama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Maebashi Red Cross Hospital, 3-21-36 Asahimacho, Maebashi, Gunma 371-0014, Japan
| | - Atsufumi Ohshima
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Gunma Chuo Hospital, 1-7-13, Kouncho, Maebashi, Gunma 371-0025, Japan
| | - Tatsuya Nozaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Gunmaken Saiseikai Maebashi Hospital, 564-1, Kamishindenmachi, Maebashi, Gunma 371-0821, Japan
| | - Masataka Kamiyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, 6-3, Kiryu Kosei General Hospital, Orihimecho, Kiryu, Gunma 376-0024, Japan
| | - Tomohiko Moteki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopedic Surgery, Isesaki Municipal Hospital, 12-1, Tsunatorihonmachi, Isesaki, Gunma 372-0817, Japan
| | - Asuka Ohshima
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Fujioka General Hospital, 942-1, Fujioka, Fujioka, Gunma 375-8503, Japan
| | - Shuhei Takamine
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Saint Pierre Hospital, 786-7, Kamisanomachi, Takasaki, Gunma 370-0857, Japan
| | - Akira Honda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Public Tomioka General Hospital, 2073-1, Tomioka, Tomioka, Gunma 370-2393, Japan
| | - Akira Ueno
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Zenshukai Hospital, 1381, Ninomiyamachi, Maebashi, Gunma 379-2117, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Koichi Okamura
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Toshiro Warita
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Yukio Yonemoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Takashi Ohsawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
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