The cumulative incidence of and risk factors for latent beaking in patients with autoimmune diseases taking long-term glucocorticoids and bisphosphonates

Sato, Hiroki; Kondo, Naoki; Wada, Yoko; Nakatsue, Takeshi; Iguchi, Seitaro; Fujisawa, Junichi; Kazama, Junichiro James; Kuroda, Takeshi; Nakano, Masaaki; Endo, Naoto; Narita, Ichiei

doi:10.1007/s00198-015-3382-9

Cited by 23 publications

(18 citation statements)

References 33 publications

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“…Bisphosphonate, which is most commonly applied for treatment against primary osteoporosis, is eliminated through urinary extraction, and there is a risk of bisphosphonate accumulating in bone when it is used for dialysis patients [53]. Accumulated bisphosphonate in bone has the potential to reduce viscoelastic properties [54], which could increase the risk of atypical femoral fracture [55–57]. Because bisphosphonate is highly selectively distributed to bone tissue, it is difficult to monitor its accumulation clinically.…”

Section: Fragility Fracture Prevention In Ckd Patientsmentioning

confidence: 99%

Chronic kidney disease and fragility fracture

Kazama

2016

Clin Exp Nephrol

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Osteoporosis is defined simply as “a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. Thus, any bone lesion that causes fragility fracture is osteoporosis, which has quite heterogeneous backgrounds. Chronic kidney disease-related bone and mineral disease (CKD-MBD) is defined as “a systemic disorder of mineral and bone metabolism due to CKD, which is manifested by abnormalities in bone and mineral metabolism and/or extra-skeletal calcification”. Although CKD-MBD is one of the possible causes of osteoporosis, we do not have evidences that CKD-MBD is the only or crucial determinant of bone mechanical strength in CKD patients. The risk of hip fracture is considerably high in CKD patients. Drugs that intervene in systemic mineral metabolism, indeed, lead to the improvement on bone histology in CKD patients. However, it remains unclear whether the intervention in systemic mineral metabolism also improves bone strength, today. Thus, the use of drugs that directly act on bone and the introduction of fracture liaison concept are promising strategies for fragility fracture prevention among CKD patients, as well as treatment for CKD-MBD.

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Section: Fragility Fracture Prevention In Ckd Patientsmentioning

confidence: 99%

Chronic kidney disease and fragility fracture

Kazama

2016

Clin Exp Nephrol

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“…Hyodo et al indicated that LupusAFF located in the mid femur was signiicantly related to femoral bowing, whereas AFF in the proximal femur was related to glucocorticoid use [68]. In our previous study of patients with autoimmune diseases taking BP and glucocorticoid, the femoral beaking was mostly located at the subtrochanter, and was not related to lateral bowing of the femur [73]. Therefore, AFF and beaking in patients taking BP and glucocorticoid may generally occur irrespective of lateral femoral bowing.…”

Section: Minor Featuresmentioning

confidence: 68%

“…In a fracture location-, age-, and gender-matched case-control study, Saita et al reviewed 2238 hip and femoral shaft fractures and diagnosed 10 of them as AFF, concluding that glucocorticoid therapy and complicating connective tissue disease were signiicant risk factors for AFF [67]. We recently evaluated the incidence of latent femoral beaking (Figure 2), which may precede AFF, in 125 patients with autoimmune diseases [65 (52%) with SLE] taking BP and glucocorticoid [73].…”

Section: Minor Featuresmentioning

confidence: 99%

“…A case of complete AFF from the tip of the beaking occurred in one patient. The risk factors for beaking were BP therapy for a period of >4 years, age 40-60 years, and presence of diabetes mellitus [73]. Although few studies have investigated AFF in patients with SLE, the frequency of beaking in our study was thought to be higher than in conventional reports of AFF, possibly because all of the patients were taking BP (mean therapy duration 5.1 ± 2.7 years) and glucocorticoid (mean dose 10.0 ± 3.8 mg).…”

Section: Minor Featuresmentioning

confidence: 99%

“…For patients with GIO, few studies have investigated the safety and efectiveness of temporary drug withdrawal, and further studies are required. Because of the high frequency of beaking in patients taking BP and glucocorticoid [73], regular femoral X-ray screening for beaking is strongly recommended for AFF prevention, and once beaking is detected, a BP drug holiday should be considered.…”

Section: Minor Featuresmentioning

confidence: 99%

See 2 more Smart Citations

Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus

Kuroda¹,

Sato²

2017

Lupus

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Osteonecrosis and osteoporosis are frequent adverse efects of glucocorticoid therapy of systemic lupus erythematosus (SLE). Idiopathic osteonecrosis (ION) of the femoral head occurs in 3-40% of patients receiving glucocorticoid, and can also develop in other bones. Higher doses of glucocorticoid and steroid pulse therapy are considered to be risk factors for ION of the femoral head. To analyze these risk factors, it seems important to detect early changes in the femoral head by magnetic resonance imaging and to monitor early clinical events atributable to steroid therapy. Prophylaxis with statins and warfarin remains debatable. The use of glucocorticoid is increase the risk of bone fractures. Bisphosphonate (BP) is used for its prevention and treatment of osteoporosis. Atypical femoral fracture (AFF) has been recently recognized as a complication associated with BP use. AFF is considered to be a form of stress fracture; localized periosteal thickening of the lateral cortex is often present at the fracture site. The thickening has been recently recognized as a complication associated with the use of antiresorptive agents such as BP and denosumab. As long-term BP/glucocorticoid use is a risk factor for beaking in patients with SLE , temporary withdrawal of BP administration should be considered.

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Atypical Femur Fractures

Miedany

2022

New Horizons in Osteoporosis Management

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The cumulative incidence of and risk factors for latent beaking in patients with autoimmune diseases taking long-term glucocorticoids and bisphosphonates

Cited by 23 publications

References 33 publications

Chronic kidney disease and fragility fracture

Chronic kidney disease and fragility fracture

Idiopathic Osteonecrosis and Atypical Femoral Fracture in Systemic Lupus Erythematosus

Atypical Femur Fractures

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