Presence of pyrophosphate in bone from an atypical femoral fracture site: A case report
Maziar Shabestari,
Erik Fink Eriksen,
Eleftherios P. Paschalis,
Paul Roschger,
Sonja Gamsjaeger,
Klaus Klaushofer,
Andrea Berzlanovich,
Xavier Nogues,
Lluis Puig,
Adolfo Diez-Perez
Affiliations
Maziar Shabestari
Institute of Odontology, Oslo University, Oslo, Norway
Erik Fink Eriksen
Dept. of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
Eleftherios P. Paschalis
Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
Paul Roschger
Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
Sonja Gamsjaeger
Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
Klaus Klaushofer
Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK, AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
Andrea Berzlanovich
Department of Forensic Medicine, Medical University of Vienna, Vienna, Austria
Xavier Nogues
Dept. of Orthopedics, Institut Hospital del Mar d'Investigació Mèdica, Autonomous University of Barcelona, Spain
Lluis Puig
Department of Orthopedic Surgery, Hospital del Mar, Barcelona, Spain
Adolfo Diez-Perez
Dept. of Orthopedics, Institut Hospital del Mar d'Investigació Mèdica, Autonomous University of Barcelona, Spain
Long-term antiresorptives use has been linked to atypical subtrochanteric and diaphyseal femoral fractures (AFF), the pathogenesis of which is still unknown. In the present case report we present the results of analysis of bone chips from a 74-year old female patient that had been on alendronate, ibandronate and denosumab treatment, and who sustained an atypical femoral fracture, by histology, quantitative backscattered electron imaging, and Raman spectroscopic analysis. The results indicate ongoing osteoclastic resorption, but also several abnormalities: 1) an altered arrangement of osteons; 2) impaired mineralization; 3) the presence of pyrophosphate, which might contribute to the impaired mineralization evident in the present case. Taken together, these changes may contribute to the focally reduced bone strength of this patient.