Evidence map›Paper›PMID 41486280›Full record

ArticleJournal of bone and mineral metabolism2026

Association between femoral localized cortical thickening ("beaking" or "flaring") and bisphosphonate duration in glucocorticoid-induced osteoporosis.

Yudai Yano, Sachiko Kawasaki, Takaaki Kosugi, Takahiro Mui, Hiroyuki Tamaki, Hikari Tasaki, Masatoshi Nishimoto, Kaori Tanabe, Masahiro Eriguchi, Ken-Ichi Samejima and 5 more

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Article in Journal of bone and mineral metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

15 authors.

Yudai YanoDepartment of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Sachiko Kawasaki *Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan. sachi-kawa@naramed-u.ac.jp.ORCID http://orcid.org/0000-0002-2710-9677
Takaaki Kosugi *Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan. taka_kosugi25@naramed-u.ac.jp.
Takahiro MuiDepartment of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Hiroyuki TamakiDepartment of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Hikari TasakiDepartment of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Masatoshi NishimotoDepartment of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Kaori TanabeDepartment of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Masahiro EriguchiDepartment of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Ken-Ichi SamejimaDepartment of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Yoshinobu UchiharaDepartment of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Masakazu OkamotoDepartment of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Yasuhiro AkaiDepartment of Community Medicine, Nara Medical University, Nara, Japan.
Kazuhiko TsuruyaDepartment of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
Kenji KawamuraDepartment of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionGlucocorticoid-induced osteoporosis (GIOP) is the most common form of secondary osteoporosis, and bisphosphonates (BPs) are widely used for treatment. Localized cortical thickening (LCT, "beaking" or "flaring") is a characteristic radiographic finding and a potential precursor of atypical femoral fracture, a known complication of long-term BP use. The incidence of LCT and its association with BP duration in GIOP remain unclear. MATERIALS AND

methodsIn this cross-sectional study, 86 outpatients with GIOP (mean age, 60.6 years; 62.8% women) were included. Femoral radiographs were evaluated for LCT, cortical thickness index (CTI; diaphyseal/subtrochanteric), and lateral bowing angle (LBA). Patients were stratified by BP duration (≥2 or ≥4 years), and 1:1 propensity score matching was used to evaluate the association with LCT. Associations of BP duration with CTI and LBA were analyzed using linear mixed-effects models; correlations with bone turnover markers (BTMs) and bone mineral density (BMD) were also examined.

resultsLCT was observed in 11 (12.8%) patients, including 10 undergoing BP therapy. Patients with LCT had a significantly longer duration of BP use (median: 8.0 years vs. 1.2 years, p <0.01). After matching, BP use for ≥4 years was significantly associated with LCT (odds ratio=11.29, p=0.01), whereas that for ≥2 years was not. Diaphyseal CTI significantly increased with BP duration; no associations were found with subtrochanteric CTI, LBA, BTMs, or BMD.

conclusionIn GIOP, prolonged BP use, especially for ≥4 years, was associated with LCT and greater diaphyseal cortical thickness. Radiographic assessment is essential in patients with GIOP and long-term BP use.

Indexed as

Cortical BoneDiphosphonatesFemurGlucocorticoidsOsteoporosisAgedBone DensityCross-Sectional StudiesFemaleHumansMaleMiddle AgedDiphosphonatesGlucocorticoidsAtypical femoral fractureBisphosphonatesGlucocorticoid-induced osteoporosisLocalized cortical thickening

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.