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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

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Abstract

Summary

The incidence of beaking, which has been reported to precede atypical femoral fracture, was high and increased over 2 years in patients with autoimmune diseases who were taking bisphosphonates and glucocorticoids. Regular femoral X-rays are strongly recommended to screen for beaking, and bisphosphonate drug holidays should be considered.

Introduction

Atypical femoral fractures (AFFs) have been recently recognized as complications associated with bisphosphonate (BP) use. AFFs are considered to be stress fractures; localized periosteal thickening of the lateral cortex is often present at the fracture site; this thickening is termed “beaking.” Beaking has been reported to precede AFF. The aims of the present study were to evaluate the incidence of latent beaking in patients with autoimmune diseases taking BPs and glucocorticoids and to identify risk factors for beaking.

Methods

A total of 125 patients with autoimmune diseases who were taking BPs and glucocorticoids was included; 116 patients underwent X-rays and analysis of serum and urine bone metabolic markers annually for 2 years. Mean patient age was 54.5 years; there were 105 (90.5 %) females and the mean duration of disease was 13.2 years. Focal lateral cortical thickening in femoral X-rays was defined as beaking.

Results

Beaking was detected in 15 femora of 10 patients (8.0 %) at the time of recruitment. Over the 2-year observation period, the incidence of beaking increased to 21 femora of 12 patients (10.3 %), and a complete AFF at the location of beaking occurred in one patient. Beaking was associated with a longer duration of BP treatment (6.1 ± 1.0 years vs. 5.0 ± 2.9 years, p = 0.01). Age 40–60 years, BP therapy ≥4 years, and diabetes mellitus were significantly associated with beaking.

Conclusions

The incidence of beaking was high, and increased over 2 years, in patients with autoimmune diseases who were taking BPs and glucocorticoids. Regular femoral X-rays are strongly recommended to screen for beaking. Long-term BP/glucocorticoid use was a risk factor for beaking in patients with autoimmune diseases; BP drug holidays should be considered.

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Author notes

    Authors and Affiliations

    1. Division of Clinical Nephrology and Rheumatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan

      H. Sato, Y. Wada, T. Nakatsue, S. Iguchi, J. J. Kazama & I. Narita

    2. Division of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuoku, Niigata City, 951-8510, Japan

      N. Kondo, J. Fujisawa & N. Endo

    3. Health Administration Center, Niigata University, 2-8050 Ikarashi, Nishiku, Niigata City, 950-2181, Japan

      T. Kuroda

    4. Department of Medical Technology, School of Health Sciences, Faculty of Medicine, Niigata University, 2-746 Asahimachi-Dori, Chuoku, Niigata City, 951-8518, Japan

      M. Nakano

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    1. H. Sato
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    Correspondence to H. Sato.

    Ethics declarations

    The study protocol was approved by the ethics committee of Niigata University Hospital and executed according to the Declaration of Helsinki. Written informed consent was obtained from all participants.

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    None.

    Additional information

    H. Sato and N. Kondo contributed equally to this work.

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    Sato, H., Kondo, N., Wada, Y. et al. The cumulative incidence of and risk factors for latent beaking in patients with autoimmune diseases taking long-term glucocorticoids and bisphosphonates. Osteoporos Int 27, 1217–1225 (2016). https://doi.org/10.1007/s00198-015-3382-9

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    • DOI: https://doi.org/10.1007/s00198-015-3382-9

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