The authors thank Dr Hideki Yamamoto and Dr Takahito Saito for their contributions to osteoporosis treatment. Cortical bone has been reported to be an important determinant of bone strength; so far, no genome-wide association studies (GWAS) have been … 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. Bisphosphonates in the treatment of osteoporosis: a review of skeletal safety concerns. On the basis of our results in the present study, patients with AFFs might have had abnormal cortical thickness before BP use. 1, points B and C). Near‐infrared photoimmunotherapy through bone. Second, almost all participants enrolled in this study were Japanese. There were no significant differences in cortical thickness between long‐term BP users and controls. Cancellous bone, also called trabecular or spongy bone, is the internal tissue of the skeletal bone and is an open cell porous network. For a type I error rate of 0.05 and a power of 0.8, with an expected prevalence of BP use of 10%, a difference in cortical thickness of 1.2 mm, and SD for cortical thickness of 2.6 mm, 49 cases would have been required. 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. I have read and accept the Wiley Online Library Terms and Conditions of Use, Change in bone turnover and hip, non‐spine, and vertebral fracture in alendronate‐treated women: the fracture intervention trial, Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research, Bisphosphonates and risk of subtrochanteric, femoral shaft, and atypical femur fracture: a systematic review and meta‐analysis, Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research, Association of low‐energy femoral fractures with prolonged bisphosphonate use: a case control study, Severely suppressed bone turnover: a potential complication of alendronate therapy, Atypical femoral fractures and bisphosphonate treatment: experience in two large United Kingdom teaching hospitals, Unusual mid‐shaft fractures during long‐term bisphosphonate therapy, A longitudinal HR‐pQCT study of alendronate treatment in postmenopausal women with low bone density: relations among density, cortical and trabecular microarchitecture, biomechanics, and bone turnover, The effect of long‐term alendronate treatment on cortical thickness of the proximal femur, Nonparametrics: statistical methods based on ranks, Burden of bisphosphonate‐associated femoral fractures, Absence of femoral cortical thickening in long‐term bisphosphonate users: implications for atypical femur fractures, Recasts in the adult L2 classroom: characteristics, explicitness, and effectiveness, Determinants associated with bone mineral density increase in response to daily teriparatide treatment in patients with osteoporosis, Atypical fractures and bisphosphonate therapy: a cohort study of patients with femoral fracture with radiographic adjudication of fracture site and features, Effects of denosumab on the geometry of the proximal femur in postmenopausal women in comparison with alendronate, Atypical fractures do not have a thicker cortex, Clinical correlates of atypical femoral fracture, Are women with thicker cortices in the femoral shaft at higher risk of subtrochanteric/diaphyseal fractures? The 2013 revised American Society for Bone and Mineral Research (ASBMR) case definition of AFF includes five major features and four minor features.2 Although none of the minor features is required for the diagnosis of an AFF, minor features are sometimes associated with AFFs. The 142 long‐term BP users were all patients who were under follow‐up at our institution. The intraclass correlation coefficients (r) for intraobserver and interobserver reliability were 0.96 (range 0.96 to 0.99) and 0.98 (range 0.96 to 0.99), respectively. Adding cortical porosity and thickness to FRAX or Garvan resulted in greater area under the receiver operating characteristic curves. Data collection: RN, TK, and AN. Washington, DC 20036-3309, USA | Measurement data are presented as mean (SD). However, whether thickening precedes BP use or results from BP use, as well as the role BPs may play in cortical thickening remain unclear. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. However, whether thickening precedes BP use or results from BP use, as well as the role BPs may play in cortical thickening remain unclear. Study conduct: RN, TK, AN, and TK. Two fibrovascular layers surround the cortical bone which contain cells that remain osteogenic. Using the distance tool in the software of the picture archiving and communication system (PACS; Konica Minolta I‐PACS FS with core software by V1.09R04, Tokyo, Japan), the FS and cortical diameters were obtained. Drafting manuscript: RN, MH, AM, and AS. Data interpretation: RN, TK, MH, AM, and AS. In a previous report, to our best knowledge, cortical thickness was measured on radiographs at several regions, such as at 3, 5, and 10 cm below the lesser trochanter.14, 21, 23 Because the effect of measuring cortical thickness at different locations has not been validated, we established three measurement points in consideration of previous reports and to increase the validity of our results. Our results are consistent with those of the previous studies mentioned above. Even after careful comparisons, we did not observe an increase in the femoral cortical thickness in long‐term BP users compared with controls. There also were no significant correlations between serum PINP 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). uNTX was measured by ELISA (Alere Medical Co., Ltd., Tokyo, Japan). 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