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Atypical fractures of the femur below the lesser trochanter have been reported in patients treated with bisphosphonates. We performed a systematic literature search of case/case series studies to better define the clinical presentation and to identify characteristics that may predispose patients to such fractures. We considered only women treated with a bisphosphonate at a dosing regimen used for the prevention or treatment of osteoporosis and we included also eight own unpublished cases. We identified 141 women with atypical fractures of the femur, mean age of 67.8+/-11.0 years, who were treated with bisphosphonate for 71.5+/-40.0 months (range=3-192 months). The results of this analysis allow identification of patients on bisphosphonate treatment at risk of developing atypical fractures, define fractures better as predominantly insufficiency fractures, illustrate that long-term bisphosphonate treatment is not a prerequisite for their development, recognize the use of glucocorticoids and proton pump inhibitors as important risk factors, but do not provide insights in the pathogenesis of these fractures and raise questions that need to be addressed in properly designed studies.

Atypical fractures of the femur below the lesser trochanter have been reported in patients treated with bisphosphonates. We performed a systematic literature search of case/case series studies to better define the clinical presentation and to identify characteristics that may predispose patients to such fractures. We considered only women treated with a bisphosphonate at a dosing regimen used for the prevention or treatment of osteoporosis and we included also eight own unpublished cases. We identified 141 women with atypical fractures of the femur, mean age of 67.8+/-11.0 years, who were treated with bisphosphonate for 71.5+/-40.0 months (range=3-192 months). The results of this analysis allow identification of patients on bisphosphonate treatment at risk of developing atypical fractures, define fractures better as predominantly insufficiency fractures, illustrate that long-term bisphosphonate treatment is not a prerequisite for their development, recognize the use of glucocorticoids and proton pump inhibitors as important risk factors, but do not provide insights in the pathogenesis of these fractures and raise questions that need to be addressed in properly designed studies.

A well-known in vivo mouse model for postmenopausal osteoporosis is the ovariectomized (OVX)mousemodel, commonly used to study the effect of treatments. Although many studies have investigated the treatment of osteoporosis with parathyroid hormone (PTH), some information is lacking about several histomorphometric parameters, non-collagen protein expression, Ca/P ratio, and mechanical properties in this particular model. The aim of this study was to investigate the effect of PTH through histological, biochemical, histomorphometric and mechanical analyses in OVX mice. To simulate postmenopausal osteoporosis, forty C57BL/6 female mice (15 w old) were ovariectomized. A subcutaneous injection of PTH (hPTH 1–34, Bachem AG, Switzerland) or just vehicle was administered daily. To explore structural changes and bone loss with time in vivo, microtomographic scans of the sixth caudal vertebra (C6) were performed from the day of surgery till the end of the experiment. Histomorphometric, histological, western blotting (wb), immunohistochemical and energy dispersive X-ray (EDX) analyses were performed on one femur to investigate trabecular and cortical thickness, the mineral apposition rate (MAR), osteoid and osteoclast surface, osteocytes apoptosis, osteopontin (OP) and osteocalcin (OC) expression and Ca/P ratio. On the contralateral bone one 4-point bending tests were performed to determine the mechanical stiffness in four directions and the failure strength of the diaphysis. Furthermore, a fracture test of the femoral neck was performed. Comparing the PTHgroup to thevehicle: themicroCTanalysis demonstratedaweak increase over time only in trabecular thickness in the C6, up to ~10% at the time of sacrifice; histology and histomorphometry revealed significant increase in trabecular and cortical thickness (~45% and ~15%, respectively), the MAR increased (~20%), the osteoid surface strongly increased (~60%) together with the osteoclast surface and the number of apoptotic osteocytes greatly decreased (~60%); wb showed no significant difference in OP content, while immunohistochemistry revealed a strong increase of OC (~80%); EDX showedno significant variation in Ca/P content. All mechanical properties significantly increased (10–20%). These findings demonstrate that PTH treatment positively affects biochemical, histomorphometric and mechanical properties of this mouse model. This work was funded by the European Community (project no.: FP7-223865, acronym VPHOP). This article is part of a Special Issue entitled ECTS 2011. Disclosure of interest: None declared. doi:10.1016/j.bone.2011.03.489 PP359-M Sustained increase in bone mineral density with alendronate in combination with indapamide in postmenopausal women with idiopathic hypercalciuria associated to osteoporosis: A 1-year randomized trial followed by a 2-year extension A. Giusti ⁎, A. Barone , G. Girasole , M. Razzano , M. Plzzonia , E. Palummeri , M. Pedrazzoni , G. Bianchi , G. Pioli d a Gerontology, Galliera Hospital, Genoa, Italy b Rheumatology, La Colletta Hospital, Arenzano, Italy c Internal Medicine, Parma University, Parma, Italy d Geriatrics, ASMN Hospital, Reggio nell'Emilia, Italy Abstract: Introduction: A recent 1-year randomized trial (Giusti A et al., NDT 2009) demonstrated the beneficial effect of alendronate (ALN)+indapamide (IND) in the treatment of women with idiopathic hypercalciuria (IHC) and associated bone loss. Methods: To evaluate the effect of ALN alone or in combination with IND on bone mineral density (BMD) and 24-hour urinary calciumexcretion (CaU), 77 postmenopausalwomenwith CaU>4mg/ kg/die and low BMD were randomized to receive for 1-year: indapamide 2.5 mg/daily alone (24 patients, IND group), alendronate 70mg/weekly alone (27 patients, ALN group) or the combination therapy (26 patients, ALN+IND group). 50 women (IND: 14, ALN: 17, ALN+IND: 19) who completed the first yearandconsented toparticipatewereenrolled ina2-yearextension.All subjects received daily calcium supplements to maintain a daily input of 1000mg, and were instructed to increase water intake up to 2000ml daily. The percentage change of BMD at lumbar spine (LS), femoral neck (FN) and total hip (TH) after 3-year, and the variation of 24-hour CaU from baseline at 2-year were the primary outcomes. Serum calcium, PTH and bone alkaline phosphatase were also measured. Results: After 2-year CaU values significantly decreased from baseline in all groups (IND, 210±89vs382±54,p

Introduction.We explored the prevalence of vitamin D deficiency and secondary hyperparathyroidism(sHPTH) ina case–control studyof100HIV-infectedpatients (HIV) and100 matched controls.Methods. HIVwere included if theywere naive to antiretroviral therapy (ART) or receiving first line ART. Healthy controls were matched for age (age range 25–65 years) and gender. Subjects, recruited between February–April 2009, underwent a standardized assessment to evaluate demographic and anthropometric characteristics, bone mineral density (BMD), serum calcium, phosphate, 25-hydroxy-vitamin D (25OHD), PTH, markers of bone turnover, clinical history and ART regimens (HIV only). The proportion of patientswith 25OHD 65 pg/ml was calculated. Secondary analyses were undertaken to evaluate variables associated with vitamin D deficiency in HIV. Results. The two groups were comparable with regard to baseline characteristics, except for alcohol intake, level of physical activity and prevalence of fractures. A significantly greater proportion (p =20), reclassification analyses showed that the GFRC reclassified more patients who sustaineda fracture to higher risk categories (85.4%), but alsomorepatientswhodidnot sustain a fracture (68.7%). Therefore, net reclassification was not significant (p>0.05, Table 1). Even after correction of the 10-year risk of FRAX (1/(major fractures/all fractures)=1/(36/ 48)=1.33) the results remained the same, and also when BMD was not included (data not shown). Discussion: GFRC, compared with FRAX, resulted in significantly higher fracture risks for women who did and did not sustain a fracture after baseline. GFRC reclassified significantly more women who did sustain a fracture to higher risk categories. However, the net reclassification was not significant. This article is part of a Special Issue entitled ECTS 2011. Disclosure of interest: None declared. doi:10.1016/j.bone.2011.03.054 OC03/AHP03 Adherence to recommendations for fall prevention significantly affects the risk of falling after hip fracture in older women M. Di Monaco , C. Castiglioni ⁎, F. Vallero , E. De Toma , L. De Lauso , R. Tappero c a Osteoporosis Research Center, Presidio Sanitario San Camillo, Torino, Italy