nach oben

Erschienen in:

24.08.2022 | Original Article

Risk factors for subchondral insufficiency fracture of the femoral head in renal transplant patients

verfasst von: Yoshitoshi Higuchi, Toshihide Tomosugi, Kenta Futamura, Manabu Okada, Taiki Kusano, Hideyoshi Sawada, Kazuyoshi Kobayashi, Shunji Narumi, Yoshihiko Watarai, Norihiko Goto, Toshihiro Ando, Koji Sato

Erschienen in: Journal of Bone and Mineral Metabolism | Ausgabe 6/2022

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Risk factors associated with subchondral insufficiency fracture (SIF) of the femoral head have not been established. The aim of the present study was to determine the incidence and risk factors for SIF of the femoral head following renal transplantation (RT).

Materials and methods

We analyzed the cases of 681 RT patients (mean age at surgery: 49.5 ± 13.6 years, 249 women, 432 men) to determine the incidence of SIF. Hip magnetic resonance imaging (MRI) was performed 6 months post-RT. The following potential predictors of SIF were evaluated: (1) patient’s condition at RT: bone mineral density (BMD), pre-RT laboratory values including calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca × P), and intact parathyroid hormone; the patient and donor’s blood relationship; and mismatching number of human leukocyte antigens (HLAs), and (2) post-RT dosage(s) of steroid(s), the immunosuppressive regimen, and the incidence of acute rejection.

Results

SIF was observed in 15 hips (13 patients, 1.9%). We successfully matched 39 patients without SIF. A multivariate logistic regression analysis adjusted for cumulative dosages of steroids, revealed the following were risk factors for SIF: osteoporosis (OR: 11.4, p = 0.046), lumbar BMD (OR: 0.003, p = 0.038), pre-RT serum P (OR 2.68, p = 0.004), and pre-RT serum Ca × P (OR: 1.11, p = 0.005).

Conclusion

Since osteoporosis, the lumbar BMD, serum P, and serum Ca × P were identified as risk factors for a post-RT SIF, these factors should be evaluated before RT for the prediction of the SIF risk.

Nur mit Berechtigung zugänglich

Bangil M, Soubrier M, Dubost JJ, Rami S, Carcanagues Y et al (1996) Subchondral insufficiency fracture of the femoral head. Rev Rhum Engl Ed 63:859–861PubMed

Ohtsuru T, Yamamoto T, Murata Y, Morita Y, Munakata Y et al (2019) Incidence of osteonecrosis and insufficiency fracture of the hip and knee joints based on MRI in 300 renal transplant patients. Hip Int 29:316–321CrossRefPubMed

Ohtsuru T, Yamamoto T, Murata Y, Morita Y, Munakata Y et al (2017) Bilateral subchondral insufficiency fractures of the femoral head in patients with living renal transplantation: a report of two cases. J Orthop Sci 22:972–975CrossRefPubMed

Ikemura S, Yamamoto T, Nakashima Y, Shuto T, Jingushi S et al (2005) Bilateral subchondral insufficiency fracture of the femoral head after renal transplantation: a case report. Arthritis Rheum 52:1293–1296CrossRefPubMed

Higuchi Y, Tomosugi T, Futamura K, Okada M, Narumi S et al (2020) Incidence and risk factors for osteonecrosis of the hip in renal transplant patients: a prospective single-centre study. Int Orthop 44:1927–1933CrossRefPubMed

Yamamoto T, Iwamoto Y, Schneider R, Bullough PG (2008) Histopathological prevalence of subchondral insufficiency fracture of the femoral head. Ann Rheum Dis 67:150–153CrossRefPubMed

Kim S-M, Oh S-M, Cho C-H, Lim S-J, Moon Y-W et al (2016) Fate of subchondral fatigue fractures of femoral head in young adults differs from general outcome of fracture healing. Injury 47:2789–2794CrossRefPubMed

Hackney LA, Lee MH, Joseph GB, Vail TP, Link TM (2016) Subchondral insufficiency fractures of the femoral head: associated imaging findings and predictors of clinical progression. Eur Radiol 26:1929–1941CrossRefPubMed

Kobayashi H, Ito N, Akiyama T, Okuma T, Kinoshita Y et al (2017) Prevalence and clinical outcomes of hip fractures and subchondral insufficiency fractures of the femoral head in patients with tumour-induced osteomalacia. Int Orthop 41:2597–2603CrossRefPubMed

10.

Lopez-Ben R, Mikuls TR, Moore DS, Julian BA, Bernreuter WK et al (2004) Incidence of hip osteonecrosis among renal transplantation recipients: a prospective study. Clin Radiol 59:431–438CrossRefPubMed

11.

Yamamoto T, Schneider R, Bullough PG (2001) Subchondral insufficiency fracture of the femoral head: histopathologic correlation with MRI. Skeletal Radiol 30:247–254CrossRefPubMed

12.

Soen S, Fukunaga M, Sugimoto T, Sone T, Fujiwara S et al (2013) Diagnostic criteria for primary osteoporosis: year 2012 revision. J Bone Miner Metab 31:247–257CrossRefPubMed

13.

Gaudiani MA, Samuel LT, Mahmood B, Sultan AA, Kamath AF (2020) Subchondral insufficiency fractures of the femoral head: systematic review of diagnosis, treatment and outcomes. J Hip Preserv Surg 7:85–94CrossRefPubMed

14.

Buckley L, Guyatt G, Fink HA, Cannon M, Grossman J et al (2017) 2017 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheumatol 69:1521–1537 ((Hoboken, NJ))CrossRefPubMed

15.

van Staa T-P, Geusens P, Pols HAP, Laet C-D, Leufkens H-G-M et al (2005) A simple score for estimating the long-term risk of fracture in patients using oral glucocorticoids. QJM 98:191–198CrossRefPubMed

16.

Boaz M, Weinstein T, Matas Z, Green SS (2005) Peripheral vascular disease and serum phosphorus in hemodialysis: a nested case-control study. Clin Nephrol 63:98–105CrossRefPubMed

17.

Laroche M (1996) [Arteriosclerosis and osteoporosis]. Presse Med 25(2):52–4PubMed

18.

Szulc P, Kiel DP, Delmas PD (2008) Calcifications in the abdominal aorta predict fractures in men: MINOS study. J Bone Miner Res 23:95–102CrossRefPubMed

19.

Campos-Obando N, Koek WNH, Hooker ER, Eerden BCVD, Pols HA et al (2017) Serum phosphate is associated with fracture risk: the rotterdam study and MrOS. J Bone Miner Res 32:1182–1193CrossRefPubMed

Titel: Risk factors for subchondral insufficiency fracture of the femoral head in renal transplant patients
verfasst von: Yoshitoshi Higuchi
Toshihide Tomosugi
Kenta Futamura
Manabu Okada
Taiki Kusano
Hideyoshi Sawada
Kazuyoshi Kobayashi
Shunji Narumi
Yoshihiko Watarai
Norihiko Goto
Toshihiro Ando
Koji Sato
Publikationsdatum: 24.08.2022
Verlag: Springer Nature Singapore
Erschienen in: Journal of Bone and Mineral Metabolism / Ausgabe 6/2022
Print ISSN: 0914-8779
Elektronische ISSN: 1435-5604
DOI: https://doi.org/10.1007/s00774-022-01360-4

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Risk factors for subchondral insufficiency fracture of the femoral head in renal transplant patients