From the Guidelines
Cortical thickening of the subtrochanteric region is not directly related to polymicrogyria, which is a cortical malformation affecting the brain, and therefore, the provided evidence does not apply to this condition. The question about cortical thickening of the subtrochanteric region seems to be related to orthopedic or osteologic conditions, rather than neurologic or cortical malformations like polymicrogyria discussed in the provided evidence 1.
Key Points to Consider
- The provided evidence focuses on polymicrogyria, a condition affecting the cerebral cortex, characterized by an excessive number of small gyri, giving the brain surface a thickened, irregular appearance 1.
- Polymicrogyria can result from various genetic and non-genetic causes, including infections, trauma, and exposure to teratogens, and it often involves the Sylvian fissures but can affect any part of the cerebral cortex 1.
- The management and evaluation of cortical thickening in the subtrochanteric region, which is likely related to bone health and orthopedic conditions, would require a different set of guidelines and evidence than what is provided for polymicrogyria.
Clinical Implications
Given the information provided and the context of the question, it's essential to consult orthopedic or osteologic guidelines for the evaluation and management of cortical thickening in the subtrochanteric region.
- This might involve assessing bone density, evaluating for conditions such as osteoporosis or atypical femoral fractures, and considering treatments aimed at improving bone health or reducing fracture risk.
- The evidence provided on polymicrogyria does not offer insights into the diagnosis, treatment, or management of cortical thickening in the subtrochanteric region, highlighting the need for condition-specific guidelines and expertise 1.
From the Research
Cortical Thickening of the Subtrochanteric Region
- The relationship between cortical thickening of the subtrochanteric region and long-term bisphosphonate use is complex and has been investigated in several studies 2, 3, 4, 5, 6.
- A study published in 2012 found that long-term alendronate treatment did not appear to cause thickened femoral cortices within the detection limits of their method 2.
- Another study published in 2012 found that women with thinner medial cortices were at a higher risk of subtrochanteric/diaphyseal fractures, and that thick femoral cortices did not place women at higher risk for low-energy subtrochanteric/diaphyseal femur fractures 3.
- A retrospective review of patients who sustained low-energy subtrochanteric fractures while on alendronate therapy found that cortical thickening in the lateral side of the subtrochanteric region was a characteristic feature of these fractures 4.
- A study published in 2017 found that long-term bisphosphonate users who sustained an atypical femoral fracture had a thicker lateral cortex and higher lateral cortex bone heterogeneity at the subtrochanteric area before the fracture compared to bisphosphonate users who did not sustain a femoral fracture and bisphosphonate-naive patients 5.
- A study published in 2015 found no significant differences in cortical thickness between long-term bisphosphonate users and controls, and no significant differences in the changes in cortical thickness after further use of bisphosphonates 6.
Key Findings
- Cortical thickening of the subtrochanteric region is not consistently associated with long-term bisphosphonate use 2, 6.
- Thin medial cortices may be a risk factor for subtrochanteric/diaphyseal fractures 3.
- Cortical thickening in the lateral side of the subtrochanteric region may be a characteristic feature of atypical subtrochanteric fractures in patients on alendronate therapy 4.
- Lateral cortical thickness and bone heterogeneity may be indicators for early detection of atypical femoral fractures in long-term bisphosphonate users 5.