06 February 2023

The fact that a common drug against osteoporosis can also cause bone fractures created major concern following a study at Linköping University. LiU researcher Jörg Schilcher will now lead the Swedish part of an international project to gain more knowledge about this.

Portrait of male scientist and x-ray photo of fracture. Jörg Schilcher.

“This is one of the finest research grants that you can get. I’m immensely grateful. Getting a chance like this is every researcher’s dream, although it comes with great responsibility,” says Jörg Schilcher, docent in orthopaedics at Linköping University.

He is referring to a collaboration with the University of California, San Francisco, which has been awarded the equivalent of SEK 50 million over a five-year period from the National Institutes of Health in the US, and where Linköping University is a part of the consortium of international higher education and research institutes. It is estimated that Linköping University will receive almost 15 per cent of the grant.

Led from UCSF

The project is called ”Pooling International Cohort Studies of Long-Term Bisphosphonate Use and Atypical Femur Fractures”. It is led from the University of California by endocrinologist Douglas Bauer. Its sub-studies are designed and run by different research groups, such as the one in Linköping.


“We’ve been studying this since 2007. This damage was not discovered in bisphosphonate clinical studies on 10,000 patients. It took an entire population. In 2010—11 we manually studied x-ray images of all femur fractures in Sweden and discovered a strong association with bisphosphonates and the risk of stress fractures in, for instance, older women,” says Jörg Schilcher.

Difficult to detect

Stress fractures are difficult to detect in x-ray images, even for experienced radiologists.
“Bisphosphonates are drugs that improve bone density and thereby reduce the risk of fractures. But long-term use can lead to stress fractures. We need more knowledge about which patients benefit from this drug, and which patients risk complications. International collaboration is needed, to enlarge the patient group. And this requires new methods for the sharing of data, says Jörg Schilcher.
The researchers will therefore develop a central analysis tool, a data script, for the analysis of data in each country separately.
“This is a huge task that is estimated to take two years. But then we’ll have a powerful tool. As we in Linköping have a long tradition of research into atypical stress fractures and bisphosphonates, we also have a data set that will attract AI researchers wanting to collaborate with us. We’ve already noted an interest in this,” says Jörg Schilcher.

What does this project mean to your research group?
“Cooperating internationally with renowned researchers in the same field means a lot to us. I’ll also be able to establish intense collaboration with statisticians. We can discuss things with them on a daily basis, which I’m not used to. This is very valuable and makes our methods much smarter. We also have radiologists and an AI researcher who’ll be able to work with the data obtained in the new project.”
Text: Ulrik Svedin – Linköping University

Facts: Osteoporosis

The skeleton has an amazing ability to mend itself with its own tissue. Simply put, two types of cells are involved in this process: ‘bone-eating cells’ (osteoclasts) which break down damaged bone, and another cell type (osteoblasts) which builds new bone.
Osteoporosis occurs when there is an imbalance between these two cell types. Osteoporosis can be treated with bisphosphonates, a group of drugs that slow bone loss.
Long-term use of such drugs increases the risk of fractures, as this can knock out the skeleton’s own healing mechanism.
Source: Jörg Schilcher, docent at Linköping University.

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