ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2016
The cumulative incidence of and risk factors for latent beaking in patients with autoimmune diseases taking long-term glucocorticoids and bisphosphonates.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 31 citations in OpenAlex.
- Bone fragility and atypical femoral fractures in SLE: role of disease activity, infection, and treatment.Journal of bone and mineral metabolism · 2026Article
- Association between femoral localized cortical thickening ("beaking" or "flaring") and bisphosphonate duration in glucocorticoid-induced osteoporosis.Journal of bone and mineral metabolism · 2026Article
- Radiographic Evolution of Contralateral Asymptomatic Incomplete Atypical Femoral Fractures in Autoimmune Disease Patients.Diagnostics (Basel, Switzerland) · 2026Article
- Article
- Prevalence of incomplete atypical femoral fractures using single energy absorptiometry after long-term anti-resorptive therapy.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2025Article
- Article
- Bilateral Subtrochanteric Complete Atypical Femoral Fracture in a Patient With Rheumatoid Arthritis: A Case Report.Cureus · 2022Article
- Lower trabecular bone score is associated with an increased incidence of localized femoral periosteal thickening.Journal of bone and mineral metabolism · 2021Article
- Differences in subtrochanteric and diaphyseal atypical femoral fractures in a super-aging prefectural area: YamaCAFe Study.Journal of bone and mineral metabolism · 2021Article
- Evaluation and management of atypical femoral fractures: an update of current knowledge.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2021Review
- Cumulative incidence of femoral localized periosteal thickening (beaking) preceding atypical femoral fractures in patients with rheumatoid arthritis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2021Article
- Clinical Features and Outcomes of Bilateral Atypical Femoral Fractures.Case reports in orthopedics · 2020Article
- High bisphosphonate treatment rates and the prevalence of atypical femoral fractures in patients with systematic lupus erythematosus: a single-center retrospective study performed in Japan.Rheumatology international · 2019Article
- Accumulation of microdamage at complete and incomplete fracture sites in a patient with bilateral atypical femoral fractures on glucocorticoid and bisphosphonate therapy.Journal of bone and mineral metabolism · 2019Article
- Current Understanding of Epidemiology, Pathophysiology, and Management of Atypical Femur Fractures.Current osteoporosis reports · 2018Review
- High and pointed type of femoral localized reaction frequently extends to complete and incomplete atypical femoral fracture in patients with autoimmune diseases on long-term glucocorticoids and bisphosphonates.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2017Article
- Chronic kidney disease and fragility fracture.Clinical and experimental nephrology · 2017Review
- Molecular Abnormalities Underlying Bone Fragility in Chronic Kidney Disease.BioMed research international · 2017Review
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Authors and funding
11 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
summaryThe 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.
introductionAtypical 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.
methodsA 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.
resultsBeaking 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.
conclusionsThe 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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