Human femoral neck has less cellular periosteum, and more mineralized periosteum, than femoral diaphyseal bone

Allen, Matthew R.; Burr, David B.

doi:10.1016/j.bone.2004.10.013

Cited by 56 publications

(49 citation statements)

References 24 publications

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“…However, our histopathological findings (normal osteonal architecture and osteocyte lacunar density without any features of previous fractures or attempted healing) differ from those reported in the only histological case study to date (10). The femoral neck has previously been shown to contain significantly less cellular periosteum (due to far fewer osteprogenitor cells) and more mineralizing periosteum compared to the diaphyseal region (11). This renders the femoral neck periosteum thinner and at risk of fracture.…”

Section: @ C I C E D I Z I O N I I N T E R N a Z I O N A L Icontrasting

confidence: 73%

Atraumatic intracapsular neck of femur fractures after prolonged bisphosphonate treatment: a new atypical variant?

Khan

Savaridas

Hemers

et al. 2016

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SummaryWe present 2 cases of elderly females presenting with atraumatic, near-vertical (Pauwells grade 3), intracapsular neck of femur fractures. Following diagnosis of osteoporosis on DEXA scans, they had received alendronic acid for 7 and 10 years respectively. Routine blood tests and serum estimations of calcium, vitamin-D and thyroidstimulating hormone, done at admission, were within the normal ranges. These patients were managed with a hemiarthroplasty and a dynamic hip screw (DHS) respectively, following discontinuation of bisphos phonates. We present these 2 cases in light of emerging evidence that associates long-term bisphosphonate use with atypical low energy femoral fractures. Only subtrochanteric/diaphyseal fractures have been reported to date. We present a new variant of atypical femoral neck fractures in metaphyseal bone related to prolonged bisphosphonate therapy.

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Section: @ C I C E D I Z I O N I I N T E R N a Z I O N A L Icontrasting

confidence: 73%

Atraumatic intracapsular neck of femur fractures after prolonged bisphosphonate treatment: a new atypical variant?

Khan

Savaridas

Hemers

et al. 2016

ccmbm

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“…The periosteum of the femoral shaft is thick and highly vascularized. (67) An effective stress fracture healing response requires an increase in periosteal vascularity. Although some observations identify a direct suppression of vasculogenesis by BPs, (68) it can be difficult in bone to distinguish between inhibition of new vessel growth and suppression of osteoclastic activity because both are coupled.…”

Section: Insights Into the Pathogenesis Of Atypical Femoral Fracturesmentioning

confidence: 99%

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Shane

Burr

Ebeling

et al. 2010

Journal of Bone and Mineral Research

999

679

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Reports linking long-term use of bisphosphonates (BPs) with atypical fractures of the femur led the leadership of the American Society for Bone and Mineral Research (ASBMR) to appoint a task force to address key questions related to this problem. A multidisciplinary expert group reviewed pertinent published reports concerning atypical femur fractures, as well as preclinical studies that could provide insight into their pathogenesis. A case definition was developed so that subsequent studies report on the same condition. The task force defined major and minor features of complete and incomplete atypical femoral fractures and recommends that all major features, including their location in the subtrochanteric region and femoral shaft, transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution, be present to designate a femoral fracture as atypical. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions, and concomitant drug exposures, including BPs, other antiresorptive agents, glucocorticoids, and proton pump inhibitors. Preclinical data evaluating the effects of BPs on collagen cross-linking and maturation, accumulation of microdamage and advanced glycation end products, mineralization, remodeling, vascularity, and angiogenesis lend biologic plausibility to a potential association with long-term BP use. Based on published and unpublished data and the widespread use of BPs, the incidence of atypical femoral fractures associated with BP therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by BPs. Moreover, a causal association between BPs and atypical fractures has not been established. However, recent observations suggest that the risk rises with increasing duration of exposure, and there is concern that lack of awareness and underreporting may mask the true incidence of the problem. Given the relative rarity of atypical femoral fractures, the task force recommends that specific diagnostic and procedural codes be created and that an international registry be established to facilitate studies of the clinical and genetic risk factors and optimal surgical and medical management of these fractures. Physicians and patients should be made aware of the possibility of atypical femoral fractures and of the potential for bilaterality through a change in labeling of BPs. Research directions should include development of animal models, increased surveillance, and additional epidemiologic and clinical data to establish the true incidence of and risk factors for this condition and to inform orthopedic and medical management. ß

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“…The process finally leads to endochondral woven bone formation preceding organized, remodeled bone. The periosteal layer of the femoral neck is thin, incomplete, more mineralized and less cellular than in extracapsular parts of the femur (Allen and Burr 2005). Consequently, a fractured neck of femur must heal endosteally without the support of an external callus, which put great demand on the osteosynthesis to provide lasting stability.…”

Section: Fracture Healingmentioning

confidence: 99%

Internal fixation of fragility fracturesof the femoral neck

Basso¹

2015

Acta Orthopaedica

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Human femoral neck has less cellular periosteum, and more mineralized periosteum, than femoral diaphyseal bone

Abstract: Periosteal expansion enhances bone strength and is controlled by osteogenic cells of the 25 periosteum. The extent of cellular periosteum at the human femoral neck, a clinically 26 relevant site, is unclear. This study was designed to histologically evaluate the human 27

Cited by 56 publications

References 24 publications

Atraumatic intracapsular neck of femur fractures after prolonged bisphosphonate treatment: a new atypical variant?

Atraumatic intracapsular neck of femur fractures after prolonged bisphosphonate treatment: a new atypical variant?

Atypical subtrochanteric and diaphyseal femoral fractures: Report of a task force of the american society for bone and mineral Research

Internal fixation of fragility fracturesof the femoral neck

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