{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T20:49:39Z","timestamp":1781383779385,"version":"3.54.1"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012314","name":"Shinshu University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012314","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Osteoporos"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>\n                      <jats:italic>Summary<\/jats:italic>\n                    <\/jats:title>\n                    <jats:p>Atypical ulnar fractures (AUFs) are rare fractures associated with long-term bisphosphonate use; their progression pattern is not understood. This study classified AUFs based on imaging characteristics, revealing a progression from cortical bone thickening to complete fractures with osteosclerosis over time. This classification may assist in determining appropriate treatments for AUFs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The progression and characteristics of AUFs remain unclear, and no definitive treatment method has been established. This study aimed to classify AUFs based on imaging findings to elucidate their characteristic progression patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 12 AUFs in 11 patients who had used bisphosphonates in the long term. Based on imaging characteristics, we classified the fractures into 3 stages: Stage I (incomplete fractures with cortical thickening or fracture lines only in the dorsal cortex), Stage II (complete fractures with fracture lines extending to the ventral cortex), and Stage III (complete fractures with osteosclerosis).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At the initial examination, 2 AUFs were classified as Stage I, 8 as Stage II, and 2 as Stage III. Two fractures progressed from Stage I to Stage II during follow-up. Our imaging analysis showed a consistent pattern, suggesting that AUFs begin with cortical thickening in the dorsal cortex, progress to fractures extending to the ventral cortex, and develop sclerosis resembling pseudoarthrosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AUFs begin with cortical bone thickening and progress to complete fractures. Over time, these complete fractures can become sclerotic, resembling pseudoarthrosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11657-025-01569-6","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T21:35:15Z","timestamp":1750282515000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Staging classification of atypical ulnar fractures"],"prefix":"10.1007","volume":"20","author":[{"given":"Tetsushi","family":"Kinoshita","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumihiro","family":"Isobe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Yamazaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun","family":"Hashimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teruki","family":"Shirayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroko","family":"Iwakawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Hayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"issue":"3","key":"1569_CR1","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1210\/jc.2004-0952","volume":"90","author":"CV Odvina","year":"2005","unstructured":"Odvina CV, Zerwekh JE, Rao DS et al (2005) Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 90(3):1294\u20131301. https:\/\/doi.org\/10.1210\/jc.2004-0952","journal-title":"J Clin Endocrinol Metab"},{"issue":"19","key":"1569_CR2","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.1056\/NEJMoa1001086","volume":"362","author":"DM Black","year":"2010","unstructured":"Black DM, Kelly MP, Genant HK et al (2010) Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur. N Engl J Med 362(19):1761\u20131771. https:\/\/doi.org\/10.1056\/NEJMoa1001086","journal-title":"N Engl J Med"},{"key":"1569_CR3","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/9103412","volume":"2019","author":"H Ito","year":"2019","unstructured":"Ito H, Miyakoshi N, Kasukawa Y et al (2019) Treatment of atypical fracture of the ulnar diaphysis by open reduction and internal fixation with teriparatide. Case Rep Orthop 2019:9103412. https:\/\/doi.org\/10.1155\/2019\/9103412","journal-title":"Case Rep Orthop"},{"key":"1569_CR4","doi-asserted-by":"publisher","first-page":"798653","DOI":"10.3389\/fendo.2021.798653","volume":"12","author":"A Murai","year":"2022","unstructured":"Murai A, Tada K, Nakajima T et al (2022) Case report: prophylactic plate fixation for incomplete atypical ulnar fractures resulting from the use of denosumab for bone metastases. Front Endocrinol (Lausanne) 12:798653. https:\/\/doi.org\/10.3389\/fendo.2021.798653","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"9","key":"1569_CR5","doi-asserted-by":"publisher","first-page":"351","DOI":"10.47102\/annals-acadmedsg.V46N9p351","volume":"46","author":"MG Yam","year":"2017","unstructured":"Yam MG, Kwek EB (2017) A case of bilateral atypical ulnar fractures with bisphosphonate therapy in a walking aided elderly. Ann Acad Med Singap 46(9):351\u2013353","journal-title":"Ann Acad Med Singap"},{"issue":"6","key":"1569_CR6","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1007\/s00776-014-0589-0","volume":"20","author":"R Osada","year":"2015","unstructured":"Osada R, Zukawa M, Kimura T (2015) Atypical ulnar fracture associated with long-term bisphosphonate use. J Orthop Sci 20(6):1132\u20131135. https:\/\/doi.org\/10.1007\/s00776-014-0589-0","journal-title":"J Orthop Sci"},{"issue":"4","key":"1569_CR7","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1111\/ans.12536","volume":"84","author":"AJ Ng","year":"2014","unstructured":"Ng AJ, Yue B, Joseph S, Richardson M (2014) Delayed\/non-union of upper limb fractures with bisphosphonates: systematic review and recommendations. ANZ J Surg 84(4):218\u2013224. https:\/\/doi.org\/10.1111\/ans.12536","journal-title":"ANZ J Surg"},{"issue":"0 1","key":"1569_CR8","doi-asserted-by":"publisher","first-page":"S65","DOI":"10.1016\/S0020-1383(16)30015-8","volume":"47 Suppl 1","author":"SL Kates","year":"2016","unstructured":"Kates SL, Ackert-Bicknell CL (2016) How do bisphosphonates affect fracture healing? Injury 47 Suppl 1(0 1):S65\u2013S68. https:\/\/doi.org\/10.1016\/S0020-1383(16)30015-8","journal-title":"Injury"},{"issue":"3","key":"1569_CR9","doi-asserted-by":"publisher","first-page":"389","DOI":"10.4055\/cios.2018.10.3.389","volume":"10","author":"BH Oh","year":"2018","unstructured":"Oh BH, Heo YM, Yi JW, Kim TG, Lee JS (2018) Atypical fracture of the proximal shaft of the ulna associated with prolonged bisphosphonate therapy. Clin Orthop Surg 10(3):389\u2013392. https:\/\/doi.org\/10.4055\/cios.2018.10.3.389","journal-title":"Clin Orthop Surg"},{"issue":"2","key":"1569_CR10","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/s00198-014-2885-0","volume":"26","author":"SH Tan","year":"2015","unstructured":"Tan SH, Saseendar S, Tan BH, Pawaskar A, Kumar VP (2015) Ulnar fractures with bisphosphonate therapy: a systematic review of published case reports. Osteoporos Int 26(2):421\u2013429. https:\/\/doi.org\/10.1007\/s00198-014-2885-0","journal-title":"Osteoporos Int"},{"issue":"1","key":"1569_CR11","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1186\/s12891-020-03824-y","volume":"21","author":"K Abe","year":"2020","unstructured":"Abe K, Kimura H, Yamamoto N et al (2020) Treatment strategy for atypical ulnar fracture due to severely suppressed bone turnover caused by long-term bisphosphonate therapy: a case report and literature review. BMC Musculoskelet Disord 21(1):802. https:\/\/doi.org\/10.1186\/s12891-020-03824-y","journal-title":"BMC Musculoskelet Disord"},{"issue":"6","key":"1569_CR12","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.1016\/j.injury.2020.10.087","volume":"52","author":"SM Cha","year":"2021","unstructured":"Cha SM, Shin HD (2021) Risk factors for atypical forearm fractures associated with bisphosphonate usage. Injury 52(6):1423\u20131428. https:\/\/doi.org\/10.1016\/j.injury.2020.10.087","journal-title":"Injury"},{"issue":"7","key":"1569_CR13","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1007\/s00402-013-1760-3","volume":"133","author":"J Moon","year":"2013","unstructured":"Moon J, Bither N, Lee T (2013) Atypical forearm fractures associated with long-term use of bisphosphonate. Arch Orthop Trauma Surg 133(7):889\u2013892. https:\/\/doi.org\/10.1007\/s00402-013-1760-3","journal-title":"Arch Orthop Trauma Surg"},{"issue":"12","key":"1569_CR14","doi-asserted-by":"publisher","first-page":"2499","DOI":"10.1007\/s00198-020-05679-4","volume":"31","author":"Y Asano","year":"2020","unstructured":"Asano Y, Tajiri K, Yagishita S, Nakanishi H, Ishii T (2020) Correction to: Bilateral atypical ulnar fractures occurring after long-term treatment with bisphosphonate for 7 years and with teriparatide for 2 years: a case report. Osteoporos Int 31(12):2499\u20132500. https:\/\/doi.org\/10.1007\/s00198-020-05679-4","journal-title":"Osteoporos Int"},{"issue":"4","key":"1569_CR15","doi-asserted-by":"publisher","first-page":"393.e1","DOI":"10.1016\/j.jhsa.2021.02.012","volume":"47","author":"S Ohta","year":"2022","unstructured":"Ohta S, Ikeguchi R, Noguchi T, Kaizawa Y, Matsuda S (2022) Intractable fractures of the bilateral proximal ulnae after 8 years of zoledronate treatment for breast cancer bone metastasis. J Hand Surg Am 47(4):393.e1-393.e7. https:\/\/doi.org\/10.1016\/j.jhsa.2021.02.012","journal-title":"J Hand Surg Am"},{"key":"1569_CR16","doi-asserted-by":"publisher","DOI":"10.1155\/2017\/8602573","volume":"2017","author":"Y Shimada","year":"2017","unstructured":"Shimada Y, Ishikawa T, Endo J et al (2017) Treatment of atypical ulnar fractures associated with long-term bisphosphonate therapy for osteoporosis: autogenous bone graft with internal fixation. Case Rep Orthop 2017:8602573. https:\/\/doi.org\/10.1155\/2017\/8602573","journal-title":"Case Rep Orthop"},{"key":"1569_CR17","doi-asserted-by":"crossref","unstructured":"Bauer DC, Black DM, Dell R et al (2024) Bisphosphonate use and risk of atypical femoral fractures: a danish case-cohort study with blinded radiographic review. J Clin Endocrinol Metab 109(11):e2141-50","DOI":"10.1210\/clinem\/dgae023"},{"issue":"5","key":"1569_CR18","doi-asserted-by":"publisher","first-page":"302","DOI":"10.5312\/wjo.v14.i5.302","volume":"14","author":"BJ Shim","year":"2023","unstructured":"Shim BJ, Won H, Kim SY, Baek SH (2023) Surgical strategy of the treatment of atypical femoral fractures. World J Orthop 14(5):302\u2013311. https:\/\/doi.org\/10.5312\/wjo.v14.i5.302","journal-title":"World J Orthop"}],"container-title":["Archives of Osteoporosis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11657-025-01569-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11657-025-01569-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11657-025-01569-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T21:17:55Z","timestamp":1766524675000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11657-025-01569-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1569"],"URL":"https:\/\/doi.org\/10.1007\/s11657-025-01569-6","relation":{},"ISSN":["1862-3514"],"issn-type":[{"value":"1862-3514","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,19]]},"assertion":[{"value":"27 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"None.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"79"}}