AFF Bone Density and Structure with BP Use

AFF: Bone Density and Structure with BP Use Based on Poster FR 0030 “Bone Density and Structure of Patients on Bisphonates with Atypical Femur Fractures” Angela Cheung, Jonathan Adachi, Robert Josse, Robert Bleakney, Christian Viellette, Aliya Khan, Moira Kapral, Sophie Jamal, Heather Mc. Donald-Blumer, Earl Bogoch Friday, October 15, 2010 ASBMR 2010 Toronto, Ontario

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-p. QCT was also carried out at the distal radius and tibia HR-p. QCT=High-resolution peripheral quantitative computed tomography

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 bisphonate (BP) use was 7. 5 years (range 2 to 10. 6) • Chinese n=6, Indian n=2, European Canadian n=8 • 11 patients had comorbid conditions or medications (rheumatoid arthritis, pemphigus, liver transplant, diabetes, cancer, steroid or warfarin use

Results • Mean BMD T-score at the lumbar spine, total hip and femoral neck were -0. 68, -0. 48 and -0. 90, respectively • On HRp. QCT 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

HRp. QCT Scans of Patients on BPs with AFFs

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