AFF is the reason for interest in generalized femoral cortical thickness. The non-linear weighting coefficient, β, had a large effect on the accuracy and smoothness of the projected cortical bone thickness. Sixth, we did not perform the longitudinal study in the control group because almost all control patients underwent osteoporosis treatment after initial evaluation. We did not perform longitudinal evaluation in control groups. Fourth, although the femoral radiographs were obtained using a standardized method, the use of radiographs to accurately measure cortical thickness has not been validated. Baseline anteroposterior femoral radiographs were obtained for all patients. Cortical thickness was measured from radiographs at three regions: 5 cm below the lesser trochanter,14 12.5 cm below the lesser trochanter (midshaft area for almost all patients in this study), and at the position of maximal femoral cortical thickness (Fig. In this study, we evaluated the long‐term effects of BP use on femoral cortical thickness and compared the changes in cortical thickness between patients who received long‐term BP treatment and control osteoporosis patients who were not treated with BPs. In addition, after further use of BP for a minimum of 1 year, we observed no significant differences in the changes in cortical thickness at any level of the femur. Our study has several limitations. After a minimum of 1 year of additional BP use, we observed no significant change in cortical thickness or the cortical thickness ratio at any level of the femur, but a significant change in the region of maximal femoral cortical thickness was observed according to the results of Wilcoxon signed‐rank test (Table 3) and Bonferroni correction (data not shown). Thus, it was difficult to obtain follow‐up radiographs in the absence of osteoporosis treatment. asbmr@asbmr.org, 2025 M Street, NW No significant correlations were identified between uNTX concentration and the cortical thickness, cortical thickness ratio, and femoral diameter at any level of the femur according to calculated Spearman's rank correlation coefficients (data not shown). The authors thank Mr Koji Fukuda, Mr Hideki Ito, Mr Takeshi Kato, Ms Kana Nakanishi, Mr Kenji Kuroda, Mr Haruyoshi Mizuno, Mr Yohei Takigawa, Mr Yoshifumi Takahashi, and Mr Hiroaki Takeuchi for their cooperation with this study. A longitudinal study is an important approach to investigate the effects of long‐term BP treatment, but a longitudinal study would also have several disadvantages, including longitudinal age‐related changes in femoral properties21 and selection bias. 1, points B and C). Learn about our remote access options, Department of Orthopaedic Surgery, Tomidahama Hospital, Yokkaichi City, Japan, Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan. Cortical bone strength correlates negatively with Ct.Po, which is an important component of bone quality that deteriorates with aging, independent of BMD [45, 47, 48]. Study conduct: RN, TK, AN, and TK. Fifth, our results showed the absence of generalized femoral cortical thickening in long‐term BP users, but there is a possibility that idiosyncratic response may occur in certain individuals. Number of times cited according to CrossRef: Morphological profile of atypical femoral fractures: age‐related changes to the cross‐sectional geometry of the diaphysis. On the basis of our results in the present study, patients with AFFs might have had abnormal cortical thickness before BP use. As a result, we could perform this case‐control study with a patient/control ratio of 1:3. Physicians received training to standardize their approach to measuring cortical thickness using radiographs from 100 patients. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Femoral diameter was defined as the distance between the outer surfaces of the femoral cortices (Fig. When we matched control patients with BP users, the age difference was limited to within ± 2 years. Cancellous bone has a higher surface-area-to-volume ratio than cortical bone and it is less dense.This makes it weaker and more flexible. 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