Individual thigh muscle and proximal femoral features predict displacement in femoral neck Fractures: An AI-driven CT analysis

INTRODUCTION

Hip fractures, particularly among the elderly, impose a significant public health burden due to increased morbidity and mortality. Femoral neck fractures, commonly resulting from low-energy falls, can lead to severe complications such as avascular necrosis, and often necessitate total hip arthroplasty. This study harnesses AI to enhance musculoskeletal assessments by performing automatic muscle segmentation on whole thigh CT scans and detailed cortical measurements using the StradView program. The primary aim is to improve the prediction and prevention of severe femoral neck fractures, ultimately supporting more effective rehabilitation and treatment strategies.

METHODS

This study measured anatomical features from whole thigh CT scans of 60 femoral neck fracture patients. An AI-driven individual muscle segmentation model (a dice score of 0.84) segmented 27 muscles in the thigh region, to calculate muscle volumes. Proximal femoral bone parameters were measured using StradView, including average cortical thickness, inner density and FWHM at four regions. Correlation analysis evaluated relationships between muscle features, cortical parameters, and fracture displacement. Machine learning models (Random Forest, SVM and Multi-layer Perceptron) predicted displacement using these variables.

RESULTS

Correlation analysis showed significant associations between femoral neck displacement and trabecular density at the femoral neck/intertrochanter, as well as volumes of specific thigh muscles such as the Tensor fasciae latae. Machine learning models using a combined feature set of thigh muscle volumes and proximal femoral parameters performed best in predicting displacement, with the Random Forest model achieving an F1 score of 0.91 and SVM model 0.93.

CONCLUSION

Decreased volumes of the Tensor fasciae latae, Rectus femoris, and Semimembranosus muscles, coupled with reduced trabecular density at the femoral neck and intertrochanter, were significantly associated with increased fracture displacement. Notably, our SVM model-integrating both muscle and femoral features-achieved the highest predictive performance. These findings underscore the critical importance of muscle strength and bone density in rehabilitation planning and highlight the potential of AI-driven predictive models for improving clinical outcomes in femoral neck fractures.

Metal(oid) profiling of the common site of osteoporotic fractures with bone microarchitecture correlation analysis: a comparative study of hip fracture patients and healthy individuals

Increased urine and blood concentrations of heavy metals are linked to an elevated hip fracture risk, but studies dedicated to directly measuring metal(oid) concentrations in the femoral neck are limited. We investigated whether individuals with fractures exhibit a different pattern of metal(oid) bioaccumulation in the femoral neck and examined potential correlations between the concentrations of various metal(oid)s in the femoral neck and trabecular microarchitecture. To address these objectives, we collected femoral neck specimens from 23 individuals, namely 11 individuals with a positive history of contralateral hip fracture (9 women and 2 men, mean age 77.7 ± 8.1 years) and 12 individuals without fractures (10 women and 2 men, mean age 79.5 ± 5.6 years). All samples were subject to microcomputed tomography (micro-CT) to evaluate bone microarchitecture and inductively coupled plasma-mass spectrometry to determine tissue concentrations of metal(oid)s. In the fully adjusted model (adjusted for bone volume, age, and calcium tissue concentration), individuals with hip fractures exhibited higher aluminum levels (p = 0.047) and lower vanadium levels (p < 0.001). Individuals who sustained fragility fractures also showed lower BV/TV, Tb.Th, Tb.N, and higher Tb.Sp in the femoral neck trabeculae compared with the control group. Several different metal(oid)s were associated with altered patterns of trabecular microarchitecture. In summary, higher aluminum and lower vanadium concentrations in the trabeculae of the femoral neck provide a potential background for the gradual increase in fracture risk. Correlational analysis revealed an association between exposure to certain metals and deteriorated trabecular microarchitecture; however, larger studies are needed to determine the elements independently affecting bone microarchitecture.

Period prevalence and timing of contralateral hip fractures: An eighteen year retrospective cohort study, systematic review and meta-analysis of the literature

PURPOSE

Second contralateral hip fractures (SCHF) are relatively uncommon. The overall prevalence of this is poorly reported in literature.

METHODS

We performed a single centre retrospective cohort study in patients >50 years old who sustained a SCHF between 1st of January 2005 and 30th of April 2023. A systematic search of the literature was then performed by searching PubMed, Embase, and Web of Science from the date of inception of each database through to the 22nd of February 2024. A meta-analysis was conducted to estimate the prevalence of SCHF and hip fracture pattern symmetry, incorporating both our results and that previously reported in literature.

RESULTS

Our cohort study showed a period prevalence of 1.7 % within 1 year and 2.8 % within 2 years following a hip fracture. 65 studies were identified using our search strategy. The overall prevalence of SCHF was 7.3 % [95 % CI: 6.3-8.4]. Meta-regression suggested that studies conducted in Europe and North America showed higher prevalence than studies conducted in Asia. A similar fracture pattern was seen in 72.1 % [95 % CI: 69.7-74.4] of patients with SCHF.

CONCLUSION

SCHF are relatively uncommon. When they do occur, it is usually within 2 years of the index fracture. Asian populations had lower prevalence of SCHF when compared to their European and North American counterparts. Hip fracture pattern is symmetrical in most patients with a SCHF.

Age- and sex-specific deterioration on bone and osteocyte lacuno-canalicular network in a mouse model of premature aging

Age-related osteoporosis poses a significant challenge in musculoskeletal health; a condition characterized by reduced bone density and increased fracture susceptibility in older individuals necessitates a better understanding of underlying molecular and cellular mechanisms. Emerging evidence suggests that osteocytes are the pivotal orchestrators of bone remodeling and represent novel therapeutic targets for age-related bone loss. Our study uses the prematurely aged PolgD257A/D257A (PolgA) mouse model to scrutinize age- and sex-related alterations in musculoskeletal health parameters (frailty, grip strength, gait data), bone and particularly the osteocyte lacuno-canalicular network (LCN). Moreover, a new quantitative in silico image analysis pipeline is used to evaluate the alterations in the osteocyte network with aging. Our findings underscore the pronounced degenerative changes in the musculoskeletal health parameters, bone, and osteocyte LCN in PolgA mice as early as 40 weeks, with more prominent alterations evident in aged males. Our findings suggest that the PolgA mouse model serves as a valuable model for studying the cellular mechanisms underlying age-related bone loss, given the comparable aging signs and age-related degeneration of the bone and the osteocyte network observed in naturally aging mice and elderly humans.

CCN Proteins as Matricellular Regulators of Bone in Aging and Disease

PURPOSE OF REVIEW

This review explores the role of cell communication network (CCN) proteins in regulating skeletal physiology, aging, and disease, particularly within the context of balanced bone remodeling.

RECENT FINDINGS

Recent conceptualization of paracrine and endocrine networks in bone marrow as a form of osteoimmunological crosstalk suggests a significant role for matricellular signaling in regulating bone homeostasis. As multifunctional adapters of cell-matrix interactions, CCNs are emerging as a focal point for parathyroid hormone (PTH) signaling and regulation of the RANKL/RANK/OPG axis in skeletal aging. Altered bone marrow CCN expression creates a permissive environment for accelerated postmenopausal bone loss and may contribute to the pathogenesis of osteoporosis and other diseases related to skeletal aging. CCNs modulate fundamental signaling mechanisms in bone development, homeostasis and repair. During aging, dysregulation of CCNs may negatively affect skeletal health and contribute to disease progression. As a result, CCNs may constitute promising therapeutic targets for improving and maintaining aging bone health.

Osteochondral Alterations in Patients Treated with Total Knee Arthroplasty Due to Rheumatoid Arthritis and Primary Osteoarthritis: Cross-Sectional Study with Focus on Elucidating Effects of Knee Malalignment

Micro-computed tomography assessment of osteochondral microstructural properties of the distal femur and proximal tibia was comprehensively conducted to compare adult patients with knee rheumatoid arthritis (RA) and primary knee osteoarthritis (KOA), with special focus on the effects of knee malalignment. This study encompassed 402 bone samples divided into three groups: the RA group [patients who were subjected to total knee arthroplasty (TKA) due to RA, n = 23, age: 61 ± 10 years], the KOA group [individuals subjected to TKA due to KOA, n = 24, age: 71 ± 9 years] and the control group [sex-matched cadavers without degenerative knee diseases, n = 20, age: 67 ± 11 years]. Our data revealed that the RA, KOA, and control groups differ significantly in osteochondral microstructural properties depending on the knee alignment. Specifically, increasing femoral and tibial cortical porosity, coupled with thinner articular cartilage, were noted in the RA and KOA groups, compared to the controls. Furthermore, larger femoral and tibial cortical pores, lower tibial and femoral subchondral trabecular bone fraction, and thinner tibial articular cartilage were noted in the RA group in comparison to the KOA group, implying that the medial-to-lateral load distribution in the knee joint could be most affected in these patients. Our data illustrated that the thinnest cartilage, a thicker and less porous cortex, along with lower trabecular bone volume, were present in the lateral femoral and tibial condyles of RA individuals with valgus knee alignment. Observed subchondral trabecular microarchitectural alterations could be morphological factors contributing to different effects of surgical treatment and variable implant stability in individuals with RA, warranting further research.

Myosteatosis and the survival of patients with hepatocellular carcinoma: a meta-analysis

Myosteatosis, characterized by fat infiltration into skeletal muscle, is increasingly recognized as a prognostic factor in hepatocellular carcinoma (HCC), although the results were not consistent. This meta-analysis aimed to summarize impact on overall survival (OS) and progression-free survival (PFS) in patients with HCC.A systematic search of PubMed, Embase, and Web of Science was conducted to identify observational studies reporting survival outcomes in HCC patients with and without myosteatosis. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. A total of 24 retrospective cohort studies involving 7436 HCC patients were included. Myosteatosis was significantly associated with poorer OS (HR: 1.60, 95% CI: 1.40-1.83, p < 0.001, I2 = 65%) and PFS (HR: 1.53, 95% CI: 1.33-1.76, p < 0.001, I2 = 36%). Subgroup analysis revealed a stronger association in Asian studies (HR: 1.74 for OS; 1.57 for PFS) compared to European studies (HR: 1.08 for OS; 1.05 for PFS). The prognostic impact remained significant regardless of anticancer treatment type, myosteatosis assessment method, sex-specific or universal cutoff values, and follow-up duration (p for subgroup differences all > 0.05). The results remained significant in studies adjusting for sarcopenia (HR: 1.89 for OS; 1.50 for PFS). Meta-regression analyses did not suggest any of the following variables may affect the results, including sample size, mean ages of the patients, proportions of men, follow-up durations, and study quality scores (p all > 0.05).Myosteatosis is independently associated with worse survival in HCC patients, particularly in Asian populations. These findings highlight the significance of assessing muscle quality as a prognostic factor in HCC.

Bone mineral tessellation: Atomic force microscopy of the volume-filling mineralization pattern in hydrated and dehydrated states

Bone is a specialized hard connective tissue with a hierarchical organization of its components. At the micrometer scale, mineral entities of roughly uniform shape tessellate in 3D within an organized, crosslinked and hydrated scaffold of mostly type I collagen. Here we report on the visualization by atomic force microscopy (AFM) of the volume-filling mineralization pattern of tesselles in lamellar bone, in hydrated and dehydrated conditions (for human, bovine, porcine and ovine bone). Microscale mineral tessellation was clearly visible when bulk lamellar bone was hydrated, whereas dry bone showed submicron nanogranularity instead of tesselle boundaries. Time-lapse AFM experiments of gradual passive dehydration of bone revealed topographical changes for all bone species with the tessellation appearance vanishing after two weeks of dehydration. AFM adhesion forces dropped within the first days of dehydration in all bone species, indicating that surface stickiness is more sensitive to passive dehydration than is stiffness. Irrespective of the bone species, AFM stiffness measurements found that hydrated bone was more compliant than dehydrated bone. AFM Young's modulus measurements of more recently formed osteonal lamellae intersecting with older interstitial lamellae found that the modulus in both hydrated and dehydrated states was lower in the osteonal lamellae. Modelling of water sorption to the surface of stochiometric hydroxyapatite showed that the presence of rigid hydration shells delineates the tesselle boundaries and smoothens the nanogranularity, confirming the AFM observations. This study highlights the importance of regarding water as a fundamental architecting component of bone. STATEMENT OF SIGNIFICANCE: Here we report on visualization of the mineral tessellation pattern in lamellar bone by atomic force microscopy (AFM) in hydrated and dehydrated conditions. We show that lamellar bone (human, bovine, porcine and ovine) contains a universal volume-filling mineral tessellation. The visibility of the tessellation pattern by AFM strongly depends on the state of bone hydration. Modelling water sorption to the surface of stochiometric hydroxyapatite indicated that mechanical and morphological characteristics of lamellar bone (e.g., stiffness, adhesion, contours of tesselle boundaries) can be attributed to the presence of rigid hydration shells. This study highlights the importance of water incorporation as a fundamental component of bone, on par with the mineral and the organic extracellular matrix.

A case of bilateral thinning of the cranial bones in an elderly individual

BACKGROUND

Bilateral thinning of the parietal bone is a condition that has been known since the 18th century, with several names being given since its discovery. The aetiology is unknown but there are numerous theories. Although this condition is rarely encountered, its clinical significance may be relevant to traumatic cases.

OBJECTIVES

This study aims to present a case of bilateral thinning observed in the cranium of an 87-year elderly female, which was assessed macroscopically and radiologically to visualize the exact parameters of the thinned areas to discuss a plausible cause and aetiology of the condition.

METHODS

During maceration for teaching purposes, the cranium was removed and assessed macroscopically. A micro-CT was then taken to determine the exact size and cranial thickness of the lesions.

RESULTS

A differential diagnosis was established which included an unknown aetiology or Gorham-Stout disease. In addition, it was noted that metabolic factors, such as malnutrition and metabolic acidosis, should be considered as factors for increasing its severity.

CONCLUSION

Case studies on the presence of bilateral thinning of the parietal bones has been reported in various countries, while no case studies could be found reporting the presence of bilateral thinning on both the parietal and occipital bones. The combination of thinning reported in this study may suggest increased severity of a more advanced state of the condition.

Human cortical bone intrinsic permeability distribution based on 3D canalicular morphology

Bone permeability is a key parameter that drives osteocyte-based mechanobiological modelling and remodelling. While previous experimental and numerical studies have estimated bone permeability based on the morphology of the lacuno-canalicular network, these studies often relied on simplified geometries. In the current study, bone permeability was characterized using more realistic canalicular geometry for the morphological data. Bone samples harvested from 27 human femoral bones were investigated using synchrotron radiation-based nano-computed tomography with a voxel size of 100 nm. After segmenting the canaliculi and lacunae, each canaliculus was investigated individually by applying a distance map and watershed algorithms. Bone permeability based on canalicular morphology was then assessed using the Kozeny relation, which defines the permeability of a porous medium with capillary-like pores. An averaged intrinsic permeability value of 8.8 10-18 m2 was obtained. It should be noted that this study considered an empty canalicular network, however in vivo, both cellular and peri-cellular matrices decrease space for interstitial fluid flow and thus permeability. Furthermore, a voxel size of 100 nm does not allow for the detection of smaller canaliculi, which may also modify average permeability. With the current data set and the analytic process applied, the results showed a heterogeneous permeability distribution within bone tissue, both when comparing osteonal and interstitial tissues and within an individual osteon. A difference was observed between male and female samples, and permeability appeared to significantly decrease with age. Finally, a significant correlation was found between permeability and canalicular length density, defined as canalicular length per unit bone volume. This study proposes a new form of the Kozeny law to express bone canalicular permeability as a proportional relationship with the canalicular length density. Importantly, this parameter can be directly quantified through confocal fluorescence microcopy, which is more convenient than synchrotron radiation-based nano-computed tomography. In conclusion, the current study confirms that confocal microscopy can be serve as a reliable tool to estimate bone permeability. However, the permeability values calculated here are solely based on canalicular morphology and do not consider cellular and peri-cellular intra-canalicular features.

MLO-Y4 fluid flow shear stress conditioned media enhances cardiac contractility and intracellular Ca2

The skeleton is in complex interplay with the other systems of the body and is highly responsive to input from the external environment. Bone mechanical loading results in interstitial fluid flow via the lacunar-canalicular system, generating fluid flow sheer stress (FFSS). FFSS variably stresses osteocytes, subsequently causing the release of metabolites and protein factors that function locally to increase bone formation and may play a role in cross talk between various organ systems, for instance between bone and skeletal muscle. Therefore, we hypothesized that this cross talk includes altering cardiac function. To test this hypothesis, media conditioned by MLO-Y4 osteocyte-like cell culture line under FFSS was used to model the endocrine effects of bone during mechanical loading on contraction of ex vivo Langendorf-perfused isolated hearts. When hearts were externally paced at a fixed rate, FFSS osteocyte conditioned media (CM) induced significant premature contractions compared with vehicle (control). FFSS osteocyte CM administration to self-paced hearts increased total contraction force by 31%. To determine whether the mechanism involved intracellular Ca2+, vehicle and FFSS bone CM were perfused over cultured H9C2 cardiomyocytes while undergoing Ca2+ imaging using Fluo-8. We observed an increase in intracellular Ca2+ with FFSS CM perfusion of cardiomyocytes compared with vehicle. These increases were only present with exogenous electrical pacing. Our findings demonstrate that FFSS bone CM enhances cardiac contractility by increasing intracellular cardiomyocyte Ca2+. The results obtained in this study suggest that the skeleton, responding to mechanical strain, has the potential to augment cardiac output and provide evidence for bone-heart cross talk.NEW & NOTEWORTHY The skeletal system operates as an endocrine organ, releasing factors that impact multi-tissue physiology. The results obtained in this study demonstrate that conditioned media collected from MLO-Y4 osteocytes exposed to fluid flow shear stress increases cardiomyocyte intracellular calcium and enhances cardiac contractility in vitro. These results support the concept of bone-heart cross talk that may have implications in exercise training, reduced-function settings such as bedrest, and the interplay between bone and heart health.

Conventional and machine learning-based analysis of age, body weight and body height significance in knot position-related thyrohyoid and cervical spine fractures in suicidal hangings

The thyrohyoid complex and cervical spine fracture distribution patterns may reflect the knot position as the force distribution by the noose to different neck regions may vary depending on it. Recently, machine learning models (MLm) were used to classify knot position through these fractures. The contribution of aging on the fracture susceptibility is better demonstrated, but data on body weight (BW) and height (BH) significance on this is more doubtful and MLm did not consider them. A retrospectively obtained autopsy data on sex, age, BW, BH and distribution of greater hyoid bone horn (GHH), superior thyroid cartilage horn (STH), and cervical spine fractures in 368 suicidal hangings were analyzed by standard statistics to determine association of the anthropometrics (age, BW, and BH) with the fracture occurrence, and by machine learning algorithms to determine if body weight and height improved MLm classification of hanging cases with typical and atypical knot positions. In the sample, unilateral GHH fracture was significantly more common in atypical hangings, while isolated STH fractures were more common in typical hangings. Age was a predictor of GHH fractures and BW of STH fractures, but BW poorly correlated with their number. BH was not a predictor of any thyrohyoid fracture. On the ROC curve analysis, the MLm that considered BW and BH did not perform statistically better than MLm that did not consider them. The study indicates that body weight and height are of no detrimental value in assessing the thyrohyoid and cervical spine fracture patterns in suicidal hangings.

Fat embolism: a systematic review to facilitate the development of standardised procedures in pathology

Fat embolism (FE) is a historically recognised but still actively researched topic in forensic pathology. Several aspects remain not fully elucidated, such as its aetiopathogenesis, its causal role in death determination, the impact of interfering factors (e.g. cardiopulmonary resuscitation or other medical procedures) and both qualitative and quantitative diagnostic methodologies in clinical and forensic contexts. These issues are further underscored by the potential involvement of FE in the causal determination of non-traumatic deaths, which often raises questions of professional liability. The present study aims to provide a comprehensive and up-to-date overview of the most recent scientific evidence relevant to forensic pathology. Our systematic research has included 58 articles from 1990 to the present on the topic of FE and fat embolism syndrome (FES). From these articles, we identified 45 case reports, from which the authors' descriptions were extracted to provide information on individual cases and the operational methods of forensic pathologists. Additionally, 21 experimental studies were identified, and their key findings have been summarised narratively. It has emerged that both traumatic and non-traumatic cases are frequently reported in the forensic context, with orthopaedic and cosmetic surgery being among the highest-risk specialities. Experimental studies have re-evaluated the role of a patent foramen ovale in the pathogenesis of FE, as well as the impact of cardiopulmonary resuscitation in causing FE severe enough to result in death. Additionally, there are new findings regarding diagnostic techniques, including radiological and immunohistological methods; however, they have not yet fully bridged the reliability gap compared to an accurate autopsy-histological evaluation. The major critical points that emerged include the lack of complete and detailed information on premortem clinical conditions, the underutilisation of grading systems and the methodological heterogeneity applied, resulting in considerable variability regarding the organs studied histologically and the diagnostic techniques used. Despite the limitations associated with the analysis of case reports and the heterogeneity of included experimental studies, we believe that this study can provide a comprehensive overview of the FE topic. It furnishes pathologists with an updated overview useful for clinical practice and guiding future research trends, as well as facilitating the development of standardised procedures.

Novel aortic lesions in hanging deaths

In response to a recent case report published in the International Journal of Legal Medicine entitled "A case of hemorrhage at the junctions of the posterior intercostal arteries-a vital sign?", we wish to corroborate the findings of periadventitial hemorrhages at the junctions of the posterior intercostal arteries in cases of suicidal hanging and to reveal two other novel aortic lesions associated with hanging. In our ongoing prospective study, we identified six cases of aortic intimal ruptures among 257 suicidal hanging deaths, along with the novel observation of subintimal hemorrhages-both of which have not been previously documented in the forensic literature. Our findings suggest that the complex anatomy of the aorta and surrounding structures may increase the vulnerability of vascular structures during hanging, particularly under conditions of complete suspension. We propose that reported aortic lesions may serve as significant morphological indicators of hanging, thereby enriching its medicolegal investigation. To establish the diagnostic relevance of these findings, further prospective autopsy studies with larger sample sizes are warranted.

Allografts promote skeletal regeneration of periprosthetic femoral bone loss

Background

Periprosthetic bone loss is a common clinical problem in hip arthroplasty that must be addressed during revision surgery to achieve adequate implant stability. Although bone allografts represent the clinical standard among substitute materials used, evidence of their regenerative potential at the microstructural, cellular, and compositional level is lacking.

Methods

A multiscale imaging approach comprising contact radiography, undecalcified histology, scanning electron microscopy, and nanoindentation was employed on human femoral explants obtained postmortem many years after allograft use during revision surgery.

Results

The degree of skeletal regeneration through allograft incorporation between host bone and allograft bone was highly dependent on the defect depth (R2 = 0.94, p < 0.001), while no association between the allograft time in situ and incorporation (R2 = 0.06, p = 0.61) was apparent. The host bone-allograft interface showed a high overlap of 4.0 ± 2.9 mm and was characterized by active bone remodelling, as indicated by osteoid accumulation, high abundance of bone cells and vasculature. While bone cement generally limited the incorporation process, the osteocytic canalicular system of the host bone reached the allograft interface to guide bone remodelling.

Conclusion

This is the first multiscale, histomorphometry-based evaluation of bone allografts used in revision hip arthroplasty for femoral bone loss in humans, demonstrating that they adequately facilitate skeletal regeneration through osteoconduction and subsequent remodelling.

The translational potential of this article

This study identified the mechanisms and determinants of femoral defect regeneration through allografts on the basis of a unique sample collection. While our results support their favourable clinical outcomes, the scientific basis for incomplete incorporation is also demonstrated.

Research on the analysis of morphological characteristics in pediatric femoral neck fractures utilizing 3D CT mapping

Proximal femoral fractures in children are challenging in clinical treatment due to their unique anatomical and biomechanical characteristics. The distribution and characteristics of fracture lines directly affect the selection of treatment options and prognosis. Pediatric proximal femur fractures exhibit distinctive features, with the distribution and characteristics of the fracture line playing a crucial role in deciding optimal treatment. The study aims to investigate the morphological characteristics of pediatric femoral neck fracture (FNF) from clinical cases by fracture mapping technology and to analyze the relationship between fracture classifications and age. The CT data were collected from 46 consecutive pediatric inpatients' diagnoses of FNF from March 2009 to December 2022. The fracture imaging was reconstructed in three dimensions and performed the simulated anatomical reduction by Mimics and 3-matic. Both Delbet classification and Pauwels angle classification were documented according to the fracture line in each patient. Furthermore, all of the fracture lines in these patients were superimposed to form a fracture map and a heat map. This study included 24 boys and 22 girls (average age, 9.61 ± 3.17 years (4 to 16 years)). The fracture lines of the anterior and superior femoral neck were found to be mainly located in the middle and lower regions of the femoral neck, while fracture lines of the posterior and inferior neck were mainly concentrated in the middle region. Most children younger than 10 years had Delbet type III of fracture (69%), whereas those older than 10 years had Delbet type II of fracture (73%). Furthermore, most children had Pauwels angle type III of fracture (63%), especially in those over 10 years old (80%) (p = 0.0001). FNF in children is predominantly located in the middle and lower regions of the neck. Older children may be prone to be affected with higher fracture location of FNF or unstable type of fracture.

Accuracy and precision of segmentation and quantification of wrist bone microarchitecture using photon-counting computed tomography ex vivo

The quantification of bone microarchitecture provides insight into bone health and the effects of disease or treatment, and is therefore highly relevant clinical information. Nonetheless, in vivo quantification of bone microarchitecture is mostly limited to high-resolution peripheral quantitative CT (HR-pQCT). This is a small field of view CT modality of which the gantry size only allows scanning of distal radius and tibia. Photon-counting CT (PCCT) is a novel clinical full-body CT with improved image resolution and quality compared to other clinical CT modalities, yet data on its capabilities in quantifying bone microarchitecture are limited. The aim of this study was to quantify the accuracy of two methods for trabecular bone segmentation on PCCT images as compared to the segmentations on micro-CT (μCT) and to use these segmentations to quantify the accuracy and agreement of trabecular bone morphometry measurements as compared to μCT, as well as the short-term precision. This study analysed multimodal CT data, obtained from eight cadaveric forearms; the data includes two repeated PCCT scans, as well as a single HR-pQCT scan from the forearm, and μCT scans of all individual carpal bones. For each carpal bone, trabecular volumes of interest (VOI) were delineated on the μCT images, and the μCT reference segmentations and VOIs were resampled onto the PCCT and HR-pQCT images. HR-pQCT images were segmented with a global threshold of 320 mgHA/cm3; PCCT images were segmented with either an identical global threshold or with an adaptive thresholding algorithm. Trabecular bone-volume fraction (Tb.BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N) and trabecular separation (Tb.Sp) were quantified for all segmented VOIs. Accuracy and agreement were calculated relative to μCT as the gold standard, short-term precision was calculated from the repeated PCCT scan. For PCCT, adaptive threshold segmentation had significantly increased sensitivity compared to global threshold segmentation, along with a lower variance in its sensitivity and specificity. Concerning the microarchitecture quantification, for global threshold segmentation of PCCT images, correlations with μCT were significant, except for Tb.Sp. Correlation coefficients of Tb.BV/TV and Tb.N were not significantly different from those between HR-pQCT and μCT. Adaptive threshold segmentation led to higher correlation coefficients between PCCT and μCT of Tb.Th, Tb.N and Tb.Sp, although correlations of Tb.N remained poor for both PCCT and HR-pQCT. Moreover, adaptive thresholding led to a constant bias of Tb.BV/TV, Tb.Th and Tb.Sp, unlike the bias of HR-pQCT which was proportionally increasing with the size of the measurement. Finally, adaptive threshold segmentation led to a higher short-term precision than global threshold segmentation, with a root-mean-squared coefficient of variation below 0.65 % for all parameters. We conclude that adaptive threshold segmentation is well-suited for the segmentation of PCCT images. Despite measurement error, our results indicate that these segmentations can be used for bone microarchitecture analyses of carpal bones with agreement and short-term precision comparable to HR-pQCT.

The extrahepatic markers in postmenopausal women with metabolic dysfunction-associated steatotic liver disease: A systematic review

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent, multifactorial systemic metabolic disorder, now recognized as the most common chronic liver disease globally. Female susceptibility to MASLD varies across menstrual states, influenced by genetic factors, age, menopausal status, and physical activity. Postmenopausal women, experiencing a significant reduction in estrogen, are particularly vulnerable to metabolic imbalances, increasing their risk of MASLD, disease progression, liver fibrosis, insulin resistance, and adverse cardiovascular events compared to premenopausal women and age-matched men. This review systematically synthesizes current research on extrahepatic abnormalities associated with MASLD in postmenopausal women. This review identifies key extrahepatic markers associated with MASLD in postmenopausal women, highlighting gaps in current research and proposing targeted screening and management strategies. (Graphical Abstract).

Skeletal age-at-death estimation: validating the Suchey-Brooks method using 3D reconstructed models in a contemporary Indonesian population

The Suchey-Brooks (S-B) standard is one of the most frequently applied approaches for age-at-death estimation in modern forensic practice. However, classification accuracy is known to vary across different populations. At present, there is a paucity of research related to the assessment of biological attributes in Indonesia, particularly the estimation of age-at-death. The use of computed tomography (CT) in S-B phase assignments has been validated in the literature. In considering further validating the use of CT, transition analysis (TA), and Bayesian statistics in age-at-death estimation, this study evaluated the accuracy of the S-B standard on a sample obtained from Indonesia. TA and Bayesian statistics are incorporated to address methodological issues such as age mimicry. A total of 378 multi-slice CT scans were analysed in OsiriX®. TA and Bayesian statistics were used to derive age-at-death estimation models. Overall bias values were at - 6.0 years for females and - 13.1 years for males, while inaccuracy was at 9.6 years for females and 14.6 years for males. When applying the original S-B age ranges, 92.0% of females and 73.3% of males were correctly classified. Likewise, mean ages per S-B phase were higher in the Indonesian sample, except for females assigned to Phase VI. TA and Bayesian statistics derived age-at-death distribution models specific to the Indonesian population. The dissemination of an appropriate age-at-death estimation standard in the literature is of considerable benefit to casework conducted domestically in Indonesia, and also serves to further inform aspects of general forensic practice globally.

Prognostic impact of body composition in hepatocellular carcinoma patients undergoing interventional and systemic therapy

Background

Primary liver cancer, predominantly hepatocellular carcinoma (HCC), is a leading cause of cancer-related deaths globally. Despite advances in targeted therapy and immunotherapy, survival rates for advanced HCC remain low. Combining hepatic artery infusion chemotherapy (HAIC) with systemic therapies shows potential, but identifying patients who benefit most is challenging. Body composition, including sarcopenia and myosteatosis, has been linked to cancer prognosis, but its role in HCC patients receiving HAIC with targeted and immunotherapies is unclear.

Methods

This retrospective study analyzed 158 HCC patients treated with HAIC, tyrosine kinase inhibitors, and anti-PD-1 immunotherapy from January 2021 to October 2024. Body composition was assessed via CT scans at the L3 level, with sarcopenia defined by skeletal muscle index (SMI) and myosteatosis by skeletal muscle density (SMD). Progression-free survival (PFS) and overall survival (OS) were evaluated, and Cox regression analyses identified prognostic factors.

Results

Sarcopenia cutoffs were 47.1 cm2/m2 (males) and 38.2 cm2/m2 (females); myosteatosis cutoffs were 40.8 HU (males) and 38.9 HU (females). Sarcopenic patients had lower BMI (p < 0.001) and higher ALBI scores (p = 0.006). Tumor response rates (ORR 53.4%, DCR 77.9%) were similar between sarcopenic and non-sarcopenic groups (p = 0.531 and p = 0.699). Myosteatosis showed no significant differences in ORR (54.0%) or DCR (77.0%) (p = 0.693 and p = 0.872). Median PFS did not differ between sarcopenic (9.53 months) and non-sarcopenic (13.87 months) patients (p = 0.536). However, sarcopenic patients had significantly shorter OS (20.80 vs. 35.97 months, p = 0.005). Myosteatosis also correlated with shorter OS (20.80 vs. 35.97 months, p = 0.021). Multivariate analysis identified sarcopenia as an independent risk factor for OS (HR: 0.527, p = 0.017), alongside AFP levels and tumor number.

Conclusion

Sarcopenia and myosteatosis predict poor prognosis in HCC patients receiving HAIC with targeted therapy and immunotherapy. Sarcopenia is an independent risk factor for OS, highlighting the importance of body composition in prognosis. No significant associations were found between body composition and tumor response or PFS.

A finite element study of the biomechanics of aging osteocyte model

Aging lacuna-canalicular system (LCS) has osteocyte size reduction, cell process number loss, and canaliculus blockage. This study built four osteocyte aging models for various aging features. These models have processes, collagen hillocks, and primary cilia mechanoreceptors for signal comparison. A triaxial displacement load on the piezoelectric bone matrix was utilized to explore mechanical signal changes in the absence of different processes, canaliculi blockage, and the effects of aging on osteocyte mechanoreceptor signals. Osteocyte age doesn't affect piezoelectric effect electric field strength. The aging model flows slower than the normal model. Blocking canaliculi raises fluid pressure. Aging osteocytes lack processes, reducing primary cilia and process stress-strain. Osteocyte volume reduction and canaliculi blockage exacerbate this alteration.

Rheological Investigation of Polydimethylsiloxane with Glass Beads: A Model for Compression-Stiffening Effects in Soft Tissue Engineering

This study explores the rheological properties of polydimethylsiloxane (PDMS) composites with glass beads (GBs) to replicate the compression-stiffening behavior of biological tissues. The mechanical properties of soft tissues arise from interactions between the extracellular matrix (ECM) and embedded cells. To mimic this, PDMS was used as a polymeric matrix, while rigid GBs acted as non-deformable inclusions facilitating stress redistribution. PDMS composites with 10%, 20%, and 30% GB concentrations were fabricated. Rheological analysis revealed that GBs significantly enhanced the storage modulus (G'), with stiffness increasing linearly under compression. The stiffening rate rose from 300 Pa/% (pure PDMS) to 387 Pa/%, 836 Pa/%, and 2035 Pa/% for 10%, 20%, and 30% GB, respectively, marking a sevenfold increase at the highest concentration. Similarly, the apparent Young's modulus increased from 150 kPa (pure PDMS) to 200 kPa, 300 kPa, and 380 kPa for composites with 10%, 20%, and 30% GB, respectively. PDMS-GB composites successfully reproduce the compression-stiffening effect observed in biological tissues, which may aid research in mechanobiology and tissue engineering.

Mapping the landscape: Analysis of publication trends in forensic anthropology. Insights from Poland

Academic research in forensic anthropology is a crucial aspect for the development of this highly applied science, especially considering its social impact. The interdisciplinary character of forensic anthropology and very diversified caseload create a context in which theoretical and practical challenges emerge. This requires a swift response from the scientific community to develop new solutions or improve existing approaches. Although much is being produced worldwide in the field of forensic anthropology, there are only a few countries that lead this trend. In this article, the authors attempted to critically examine academic research within forensic anthropology in Poland by analysing its knowledge production over the last decades. A meticulous bibliographic analysis resulted in the discovery of 220 relevant academic records published between 1952 and 2023. Almost 70 % of identified papers were published in national journals and 58 % appeared in Polish. In total, 36 different institutions participate in knowledge production in this field. International collaboration is very low (∼6 %) and over 50 % of records did not involve any academic partnership. The most common type of paper is case report, primarily related to mass grave exhumations of war and totalitarian crimes. We conclude that Polish forensic anthropology research is derivative rather than original (with case reports and review papers as most frequent) and Poland remains a relatively insignificant actor when considering the overall knowledge production in forensic anthropology. In the discussion we try to understand these outcomes in the light of Polish historical context and current academic, and socio-political conjuncture.

Automatic segmentation of cortical bone microstructure: Application and analysis of three proximal femur sites

Osteoporosis is the most common bone metabolic unbalance, leading to fragility fractures, which are known to be associated with structural changes in the bone. Cortical bone accounts for 80 % of the skeleton mass and undergoes remodeling throughout life, leading to changes in its thickness and microstructure. Although many studies quantified the different cortical bone structures using CT techniques (3D), they are often realised on a small number of samples. Therefore, the work presented here proposes a method to quantify cortical bone microstructure using 2D histology, shows its application on a set of 94 samples and compares to 3D methods. Fresh frozen human femur pairs from 47 donors aged between 57 and 96 years were obtained from the Medical University of Vienna. Bone samples were cut from 3 sites: proximal part of the diaphysis, inferior and superior segments of the neck. The samples were stained with toluidine blue and imaged under light microscopy. After manual segmentation of a few regions of interest by multiple operators, a convolutional neural network was trained in combination with a random forest for automatic segmentation. The segmentation analysis compares morphology and structure distribution of Haversian canals, osteocyte lacunae, and cement lines with literature, between anatomical sites, sex, left and right sides, and relation to ageing. Morphological analysis of the segmentation gives results similar to the literature. Comparison between male and female donors shows no significant differences. There is no significant difference between left and right femur on paired samples but significant differences are observed between anatomical locations. The structures' relative amounts do not present significant changes with age but only weak tendencies. Nevertheless, a strong correlation was observed between osteocyte lacunae density and bone areal fraction. This study presents a full process to stain and automatically segment digital cortical bone images. Its application to a large sample set of proximal femora provides strong statistics on the cortical bone structures morphology and distribution. Similarities observed between sides and sexes together with differences observed between sites could indicate that mechanical loading might be a main driver for bone microstructure. Additionally, the relationship between osteocyte lacunae density and bone areal fraction could suggest that bone porosity is regulated by osteocyte survival.

Investigating hyperostosis frontalis interna: a computed tomography analysis and predictive model for Hershkovitz classification

BackgroundAxial computed tomography (CT) cross-sections offer an accessible model for assessing diverse pathologies associated with hyperostosis frontalis interna (HFI) based on the Hershkovitz classification.PurposeTo delineate the CT characteristics of HFI, emphasizing a radiological description using the Hershkovitz classification. It investigated whether the Hershkovitz classification can be predicted using density, a variable unexplored in the literature. HFI thickness and the presence of concurrent hyperostosis beyond the frontal bone (HBFB) were evaluated across varying degrees of the Hershkovitz classification.Material and MethodsThis retrospective study evaluated characteristics of HFI on CT. Each case was assigned a Hershkovitz classification. Density and thickness of the HFI along with the presence of concurrent HBFB were evaluated and correlated with the Hershkovitz classification.ResultsAxial CT of 77 patients with HFI was evaluated. Patient characteristics including sex were uncorrelated with CT measurements (P > 0.25) and Hershkovitz classification (P > 0.06). Increasing HFI thickness was associated with a higher Hershkovitz classification (odds ratio [OR] = 1.863, 95% confidence interval [CI] = 1.452-2.389; P < 0.001), and increasing density of HFI was associated with a lower Hershkovitz classification (OR = 0.995, 95% CI = 0.992-0.998; P = 0.002). Higher Hershkovitz classification was also found to be associated with the presence of concurrent HBFB (OR = 31.694, 95% CI = 6.483-154.938; P < 0.001).ConclusionIn our cohort, Hershkovitz classification on axial CT correlated with increased HFI thickness, presence of HBFB, and lower HFI density.

Revisiting the physical and chemical nature of the mineral component of bone

The physico-chemical characteristics of bone mineral remain heavily debated. On the nanoscale, bone mineral resides both inside and outside the collagen fibril as distinct compartments fused together into a cohesive continuum. On the micrometre level, larger aggregates are arranged in a staggered pattern described as crossfibrillar tessellation. Unlike geological and synthetic hydroxy(l)apatite, bone mineral is a unique form of apatite deficient in calcium and hydroxyl ions with distinctive carbonate and acid phosphate substitutions (CHAp), together with a minor contribution of amorphous calcium phosphate as a surface layer around a crystalline core of CHAp. In mammalian bone, an amorphous solid phase has not been observed, though an age-dependent shift in the amorphous-to-crystalline character is observed. Although octacalcium phosphate has been postulated as a bone mineral precursor, there is inconsistent evidence of calcium phosphate phases other than CHAp in the extracellular matrix. In association with micropetrosis, magnesium whitlockite is occasionally detected, indicating pathological calcification rather than a true extracellular matrix component. Therefore, the terms 'biomimetic' or 'bone-like' should be used cautiously in descriptions of synthetic biomaterials. The practice of reporting the calcium-to-phosphorus ratio (Ca/P) as proxy for bone mineral maturity oversimplifies the chemistry since both Ca2+ and PO43- ions are partially substituted. Moreover, non-mineral sources of phosphorus are ignored. Alternative compositional metrics should be considered. In the context of bone tissue and bone mineral, the term 'mature' must be used carefully, with clear criteria that consider both compositional and structural parameters and the potential impact on mechanical properties. STATEMENT OF SIGNIFICANCE: Bone mineral exhibits a unique hierarchical structure and is classified into intrafibrillar and extrafibrillar mineral compartments with distinct physico-chemical characteristics. The dynamic nature of bone mineral, i.e., evolving chemical composition and physical form, is poorly understood. For instance, bone mineral is frequently described as "hydroxy(l)apatite", even though the OH- content of mature bone mineral is negligible. Moreover, the calcium-to-phosphorus ratio is often taken as an indicator of bone mineral maturity without acknowledging substitutions at calcium and phosphate sites. This review takes a comprehensive look at the structure and composition of bone mineral, highlighting how experimental data are misinterpreted and unresolved concerns that warrant further investigation, which have implications for characterisation of bone material properties and development of bone repair biomaterials.

Effects on Mass Transfer in the Bone Lacunar-Canalicular System under Different Radial Extracorporeal Shock Waves

BACKGROUND

The bone lacunar-canalicular system (LCS) is an important microscopic infrastructure for signaling and solute transport in bone tissue, which guarantees the normal physiological processes of bone tissue, and there is a direct relationship between osteoporosis and intrabody mass transfer; however, the mass transfer pattern of the LCS has not yet been clarified under different intensities of in extracorporeal shock waves. The present study aims to assess the effect of extracorporeal shock waves on mass transfer in LCS.

METHODS

Sodium fluorescein tracer was taken as the transport substance, and the fluorescence intensities of osteocytes at lacuna in bovine cortical bone were used to indicate the mass transfer effect. The free diffusion and different extracorporeal shock waves were performed in LCS experiments and the fluorescence intensities of the superficial, shallow, middle, and deep layers of osteocytes, which were arranged in a proximity-to-distant order away from the Haversian canal, were detected by laser scanning confocal microscopy.

RESULTS

The results showed that, under different shock waves, the fluorescence intensities of superficial lacunae were the highest in an osteon, followed by shallow and middle layers, and the fluorescence intensities of deep lacunae furthest from the Haversian canal were the lowest, with a decreasing trend and a decreased range of 44.75-97.11%. Relative to free diffusion, the fluorescence intensities of the lacunae in each layer increased by 33.16%, 20.56%, 16.11%, and 26.64% in the superficial, shallow, middle, and deep layers of osteocytes, respectively, under the effect of the extracorporeal shock waves at 1 bar; the fluorescence intensities of the middle layer increased by 100.03% when the intensity was 5 bar, and average fluorescence intensities increased the most with an incremental value of 81.34% in all different shock waves; the fluorescence intensities of the lacunae of each layer was enhanced with a range of 110.93-161.03% by 8 bar.

CONCLUSION

Extracorporeal shock waves promoted tracer mass transfer within the LCS, and the higher the shock wave magnitudes, the larger the mass transfer in LCS. The transport of solute molecules, nutrients, and signaling molecules within the LCS was facilitated by the extracorporeal shock waves, which may help to address bone diseases such as osteoporosis from the direction of mass transfer in LCS.

Hyperostosis frontalis interna and association of disease control with frontal bone thickness in acromegaly

PURPOSE

Studies investigating hyperostosis frontalis interna (HFI) in acromegaly are limited. We aimed to investigate HFI and the association of disease control with frontal bone thickness (FBT) in acromegaly.

METHODS

Adult patients with acromegaly were grouped according to the presence of HFI on the baseline MRI: Group 1 absent, Group 2 present. We measured FBT, parietal bone thickness (PBT) and occipital bone thickness (OBT) in the mid-sagittal plane on MRI. The changes between first and last measurements were analyzed. We grouped the patients as controlled vs. uncontrolled acromegaly, and as established disease control for at least 5-year vs. 1-5-years.

RESULTS

Group 1/Group 2 comprised of 23/29 patients, female/male ratio was 34/18, and mean age 55.41(± 14.21) years. Median follow-up duration was 108 months (6-408). FBTfirst (p = 0.001), FBTlast (p < 0.001), PBTlast (p = 0.025), and OBTlast (p = 0.028) were higher in Group 2 than in Group 1. FBTchange, PBTchange, and OBTchange were positive in Group 2 (p < 0.001, p = 0.008, and p = 0.008; respectively). The ratio of patients with FBT(increased) was higher in Group 2 than in Group 1 (p = 0.001). FBTfirst, FBTlast, PBTfirst, PBTlast, OBTfirst, OBTlast, FBTchange, PBTchange and OBTchange were similar in controlled or uncontrolled acromegaly groups. FBTchange and OBTchange were positive in patients with disease control established for at least 5 years (n = 30) (p = 0.027 and p = 0.002, respectively).

CONCLUSION

HFI was common in patients with acromegaly. HFI is associated with a continuous increase in FBT, PBT and OBT. HFI, bone thickness, or increase in bone thickness seems independent of disease activity. Since headaches can be related to an increase in bone thickness, patients should be evaluated and graded during baseline imaging.

Mitochondrial oxidative stress or decreased autophagy in osteoblast lineage cells is not sufficient to mimic the deleterious effects of aging on bone mechanoresponsiveness

Exercise-induced mechanical load stimulates bone cells, including osteocytes, to promote bone formation. The bone response to loading is less effective with aging, but the cellular and molecular mechanisms responsible for the impaired mechanoresponsiveness remain unclear. Excessive mitochondrial reactive oxygen species (mtROS) and deficient autophagy are common aging mechanisms implicated in decreased bone formation in old mice. Here, we confirmed that the osteogenic effects of tibia compressive loading are lower in old versus young female mice. We also examined whether an increase in mtROS or decreased autophagy in osteoblast-lineage cells of adult female mice could mimic the deleterious effects of aging. To this end, we loaded mice lacking the antioxidant enzyme superoxide dismutase 2 (Sod2) or autophagy-related 7 (Atg7) in cells targeted by Osterix1 (Osx1)-Cre. Osteocytes in Atg7ΔOsx1 exhibited altered morphology and decreased osteocyte dendrite projections. Two weeks of loading increased cortical bone mass and bone formation rate at both periosteal and endosteal surfaces of Osx1-Cre control mice. Nonetheless, in both Atg7ΔOsx1 and Sod2ΔOsx1 mice the response to loading was identical to that observed in control mice, indicating that compromised Atg7-dependent autophagy or excessive mtROS are not sufficient to impair the bone response to tibial compressive loading. Thus, alternative mechanisms of aging might be responsible for the decreased response of the aged skeleton to mechanical stimuli. These findings also suggest that an intact osteocyte dendrite network is not required for the osteogenic response in this model of bone loading.

What imaging characteristics are suggestive of malignancy in patients with femoral neck fractures? A look at calcar impaction lesions

INTRODUCTION

Femoral heads are often sent for histological analysis when malignancy is suspected following a neck of femur (NOF) fracture. Anecdotally, a commonly seen lytic appearance on plain radiographs prompts suspicion of malignancy but does not correlate with histology results.

AIM

To evaluate the radiographic patterns of NOF fractures deemed suspicious for malignancy, and correlate those patterns with their subsequent histology results.

METHODS

We performed a retrospective study of all NOF fracture patients who had femoral head histopathological analysis (N =376), across five hospitals in Yorkshire, over three years (2017-2019). Included were patients whose radiographs were deemed suspicious for malignancy by their clinicians (N = 79). All radiographs were evaluated, and their patterns categorized. Chi-Square test was used to analyse the relationship between each radiographic pattern and histology outcome (benign vs malignant disease). A p - value < 0.05 was deemed statistically significant.

RESULTS

79 eligible patients were identified, comprising 51 females and 28 males, with a mean age of 77 years. Radiographic patterns most associated with malignancy were 'multiple sclerotic lesions' (9 patients, 7 malignant, p < 0.01), and 'single lytic central neck lesion' (8 patients, 6 malignant, p = 0.01). 26 patients had an eccentric lesion with lytic appearance in the superolateral aspect of the femoral head/neck, all of which were benign (p < 0.01).

CONCLUSION

Being familiar with radiographic patterns of disease will help clinicians decide when to investigate a femoral head for malignancy. We identified a discrete pseudopathological pattern that commonly prompts clinicians to investigate for malignancy. We named this the 'calcar impaction lesion' as we posit that this 'lytic' appearance is due to mechanical impaction of osteoporotic bone during injury. Recognizing this pattern can save time and resources by avoiding unnecessary investigations.

Mechanisms and targeted prevention of hepatic osteodystrophy caused by a low concentration of di-(2-ethylhexyl)-phthalate

Objectives

Hepatic osteodystrophy (HOD) is an important public health issue that severely affects human health. The pathogenesis of HOD is complex, and exposure to environmental pollutants plays an important role. Di-(2-ethylhexyl) phthalate (DEHP) is a persistent environmental endocrine toxicant that is present in many products, and the liver is an important target organ for its toxic effects. Our research aimed to investigate the effects of DEHP on HOD, and to reveal the underlying mechanisms and the potential key preventive approaches.

Methods

The daily intake EDI of DEHP and bone density indicators for men and women from 2009 to 2018 were screened and organized from the NHANES database to reveal the population correlation between EDI and BMD; C57BL/6 female and male mice were selected to construct an animal model of DEHP induced HOD, exploring the fuchtions and mechanisms of DEHP on osteoporosis; the novel small molecule inhibitor imICA was used to inhibit the process of DEHP induced osteoporosis, further exploring the targeted inhibition pathway of DEHP induced HOD.

Results

Male and female populations were exposed to a relatively lower concentration of DEHP, and that only the male population exhibited a negative correlation between DEHP exposure and bone mineral density. An in vivo study confirmed that a low dose of DEHP caused liver lesions, disrupted liver function, and induced osteoporosis in male but not female C57BL/6J mice. Regarding the molecular mechanisms, a low dose of DEHP activated the hepatic 14-3-3η/nuclear factor κB (NF-κB) positive feedback loop, which in turn modified the secretory proteome associated with bone differentiation, leading to HOD. Finally, we revealed that targeting the 14-3-3η/ NF-κB feedback loop using our novel 14-3-3η inhibitor (imICA) could prevent DEHP-induced HOD.

Conclusion

A low dose of DEHP activated the hepatic 14-3-3η/ NF-κB positive feedback loop, which in turn modified the secretory proteome associated with bone differentiation and elevated IL-6 and CXCL1 levels, leading to HOD. Targeted 14-3-3η/NF-κB feedback loop using our novel 14-3-3η inhibitor, imICA, prevented DEHP-induced HOD.

Bone quality analysis of the mandible in alcoholic liver cirrhosis: Anatomical, microstructural, and microhardness evaluation

OBJECTIVES

Alcoholic bone disease has been recognized in contemporary literature as a systemic effect of chronic ethanol consumption. However, evidence about the specific influence of alcoholic liver cirrhosis (ALC) on mandible bone quality is scarce. The aim of this study was to explore microstructural, compositional, cellular, and mechanical properties of the mandible in ALC individuals compared with a healthy control group.

MATERIALS AND METHODS

Mandible bone cores of mаle individuаls with ALC (n = 6; age: 70.8 ± 2.5 yeаrs) and age-matched healthy controls (n = 11; age: 71.5 ± 3.8 yeаrs) were obtаined postmortem during аutopsy from the edentulous аlveolаr bone in the mandibular first molаr region аnd the mаndibulаr аngulus region of each individual. Micro-computed tomogrаphy wаs used to аssess bone microstructure. Analyses based on quаntitаtive bаckscаttered electron microscopy included the characterization of osteon morphology, osteocyte lаcunаr properties, and bone mаtrix minerаlizаtion. Composition of bone minerаl аnd collаgen phаses was assessed by Rаmаn spectroscopy. Histomorphometry wаs used to determine cellulаr аnd tissue chаrаcteristics of bone specimens. Vickers microhardness test was used to evaluate cortical bone mechanical properties.

RESULTS

The ALC group showed higher closed cortical porosity (volume of pores thаt do not communicаte with the sаmple surfаce) (p = 0.003) and smaller lacunar area in the trabecular bone of the molar region (p = 0.002) compared with the Control group. The trabecular bone of the angulus region showed lower osteoclast number (p = 0.032) in the ALC group. There were higher carbonate content in the buccal cortex of the molar region (p = 0.008) and lower calcium content in the trabecular bone of the angulus region (p = 0.042) in the ALC group. The cortical bone showed inferior mechanical properties in the ALC cortical bony sites (p < 0.001), except for the buccal cortex of the molar region (p = 0.063). There was no significant difference in cortical thickness between the groups.

CONCLUSIONS

Bone quality is differentially altered in ALC in two bony sites and compartments of the mandible, which leads to impaired mechanical properties.

CLINICAL RELEVANCE

Altered mandible bone tissue characteristics in patients with ALC should be considered by dental medicine professionals prior to oral interventions in these patients. Knowledge about mandible bone quality alterations in ALC is valuable for determining diagnosis, treatment plan, indications for oral rehabilitation procedures, and follow-up procedures for this group of patients.

Multi-scale inferomedial femoral neck bone quality in type 2 diabetes patients with fragility fracture

Both trabecular and cortical bone undergo changes at multiple scales. We previously demonstrated the multi-scale changes in trabecular bone quality that contribute to bone fragility in type 2 diabetes (T2D). The link between increased fragility in T2D and multi-scale changes in cortical bone and their interaction with glycation remains unclear. This study presents, first-ever, multi-scale cortical bone quality parameters in T2D patients after their first hip fracture. The study objective was to determine the association between cortical porosity (Ct.Po.), mechanical, material, and bone compositional properties in T2D. Inferomedial femoral neck (FN) bone tissue specimens were collected from patients (n = 10 with T2D, n = 25 age- and sex-matched non-diabetes controls) who underwent hip replacement surgery following the first hip fragility fracture. Bone mineral density at FN was found to be similar between groups. In T2D, Ct.Po was higher (p = 0.038), while ultimate stress (p = 0.021), ultimate strain (p = 0.040), post-yield strain (p = 0.011), toughness (p = 0.005), yield energy (p = 0.003), and post-yield energy (p = 0.004) were notably lower. Tissue compositional differences included lower gravimetric mineral/matrix (p = 0.017), higher non-enzymatic collagen cross-link ratio (NE-xLR) (p = 0.049) and higher sugar/matrix ratio (p = 0.042) in T2D. Fluorescent advanced glycation end-products (fAGEs) content was higher in T2D bone (p = 0.043). At the mesoscale, the fAGEs in the bone matrix are inversely related to the yield- and ultimate strain of T2D bone, and NE-xLR is negatively correlated with yield- and ultimate- stress in the T2D group. In conclusion, study findings demonstrate that elevated glycation weakens the mechanical integrity of cortical bone by reducing its ability to absorb energy and resist deformation, thereby contributing to bone fragility in T2D. The strong association of fAGEs with lower yield strain, along with the association of NE-xLR with lower yield- and ultimate stress, establishes a causal link between AGEs and the deterioration of cortical bone mechanical properties. These findings underscore the need for strategies targeting glycation and collagen quality to mitigate fracture risk in T2D patients.

Humanitarian forensic medicine: a systematic review

Various concerns relating to international humanitarian law and human rights were risen by natural catastrophes (tsunamis, floods, fires), the Covid-19 pandemic, the epidemic breakouts of Ebola, as well as the significant migrant wave observed in the Mediterranean region. Forensic Medicine has direct interactions with both domestic and international law, and thus is frequently asked to provide solutions for these issues. The term "Humanitarian Forensic Action" (HFA), which refers to the application of forensic science to serve humanitarian endeavors, was created. The management of crises including armed conflicts, natural disasters, and humanitarian crises is therefore related to HFA. HFA is a specialized field of forensic sciences that is used to handle the identification of the deceased and human remains, as well as to contribute to the management of the dead, the management of mass disasters, and the investigation of abuse and torture. The psychosocial effects that these tragic events have on the victims, their loved ones, and society at large represent another HFA-related field. Firstly this systematic review aims to present all available international literature that discusses HFA as a unique forensic discipline. Secondly, through this review, it is hoped that HFA awareness will be risen among forensic practitioners, thus allowing improved adoption in general and future development as a branch of forensic sciences. As far as we are aware, there isn't another systematic study that presents the entirety of HFA's branches at once.

Prevalent osteoporosis and fracture risk in patients with hepatic cirrhosis: a systematic review and meta-analysis

BACKGROUND

Hepatic liver cirrhosis can lead to significant systemic complications, including the deterioration of bone health. The resulting bone complications can contribute to a decreased quality of life and increased healthcare burden. This study aimed to systematically review and analyze the risk of osteoporosis, fracture, and changes in bone mineral density (BMD) among patients with hepatic cirrhosis compared to non-cirrhotic healthy controls.

METHODS

Adhering to PRISMA guidelines, studies were sourced from MEDLINE/PubMed, Scopus, Web of Science, and Embase up to July 2024, including observational studies that assessed osteoporosis, fracture, and BMD in cirrhotic versus non-cirrhotic patients. Meta-analyses were performed by calculating odds ratios (OR) and standardized mean differences (SMD) of outcomes. Sensitivity analyses and meta-regression were also conducted to explore the robustness and sources of heterogeneity.

RESULTS

The analysis included 21 studies with 76,521 cirrhotic and 695,330 control patients. Cirrhotic patients demonstrated significantly higher odds of osteoporosis (OR = 1.93 [1.84 to 2.03]). Fracture was notably elevated, with cirrhotic patients showing an OR of 2.30 [1.66 to 3.18]. Reductions in BMD were observed in both the lumbar spine (SMD = -0.57[-0.79 to -0.35]) and femoral neck (SMD = -0.41 [-0.71 to -0.12]). Sensitivity analyses confirmed these findings, and meta-regression highlighted that male prevalence impacted these associations in various ways.

CONCLUSIONS

Patients with hepatic cirrhosis are at heightened risk for osteoporosis and fractures, underlining the need for proactive screening and preventive strategies. Integrating cirrhosis into current fracture-risk models could enhance the assessment and management of bone health in these patients.

The Importance of a Hierarchical Approach in Investigating the Connection Between Peripheral Artery Disease and Risk for Developing Low-Trauma Fractures: A Narrative Literature Review

Considering that skeletal changes are often asymptomatic during routine clinical examination, these disorders are frequently overlooked in patients with peripheral artery disease (PAD). Keeping in mind the inclining prevalence of PAD and bone fragility, especially in older individuals, this narrative literature review aimed to provide a comprehensive overview of skeletal alterations in patients with PAD, focusing on the importance of the multi-scale and multidisciplinary approach in the assessment of the bone hierarchical organization. Several observational studies have shown a connection between PAD and the risk of developing low-trauma fractures, but numerous ambiguities remain to be solved. Recent data indicate that evaluating additional bone properties at various levels of bone hierarchical structure may help in understanding the factors contributing to bone fragility in individuals with PAD. Further research on bone structural alterations (especially on micro- and nano-scale) may enhance the understanding of the complex etiopathogenesis of skeletal disorders in patients with PAD, which may lead to advancements in optimizing the clinical management of these individuals. Since osteoporosis and PAD have numerous overlapping risk factors, it is meaningful to evaluate vascular status in individuals with osteoporosis and examine bone health in individuals with PAD to identify individuals who require treatment for both diseases.

Multifaceted environmental factors linked to metabolic dysfunction-associated fatty liver disease: an environment-wide association study

BACKGROUND

Environmental factors, or exposome, are non-negligible contributors to the occurrence and progression of metabolic dysfunction-associated fatty liver disease (MAFLD). Therefore, this environment-wide association study (EWAS) aimed to investigate the associations between multifarious environmental factors and MAFLD among the general adult population in the United States.

METHODS

Eligible participants were obtained from the National Health and Nutrition Examination Survey 2005-2020 cycles. Survey-weighted multivariate logistic regression models were constructed to identify and tentatively validate MAFLD-associated environmental factors. The least absolute shrinkage and selection operator (LASSO) regression was conducted to identify tentatively validated environmental factors with stronger associations with MAFLD. Moreover, the importance, discrimination power, correlation patterns, subgroup-specific differences, and survey cycle heterogeneity of the identified factors were further examined by multiple statistical strategies.

RESULTS

A total of 14,416 participants were included in this EWAS. Among 511 candidate environmental factors, 167 were identified and tentatively validated, and 45 were preserved after the LASSO selection and correlation evaluation. In this study, most previously known factors were replicated with reduced bias, and several poorly studied environmental factors were discovered, for example, upper leg length, access to care, mid-upper arm circumference, and total trabecular bone score. Their importance, discrimination ability, pairwise correlations, subgroup variations, and heterogeneity across survey cycles were further systematically and rigorously evaluated.

CONCLUSIONS

This EWAS comprehensively explored the associations between environmental factors and MAFLD in the general adult population from a panoramic perspective. The findings may provide clues for further understanding this disease and promote early prevention and risk prediction strategies in the future.

Association between body mass index and lumbar spine volumetric bone mineral density in diabetic and non-diabetic patients

BACKGROUND

The association between body mass index (BMI) and bone mineral density (BMD) has shown inconsistent results, varying by sex and skeletal site. Despite normal or elevated bone mass, individuals with type 2 diabetes have an increased risk of hip and vertebral fractures.

AIM

To assess lumbar spine trabecular volumetric BMD (vBMD) across different BMI categories in individuals with and without diabetes.

METHODS

This cross-sectional study included 966 men over 50 years old and 1001 postmenopausal women from the Pinggu Metabolic Disease Study. The vBMD of lumbar vertebrae 2 through 4 was measured using quantitative computed tomography. Total adipose tissue, subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and lumbar skeletal muscle area were also quantified.

RESULTS

In men with obesity (P = 0.038) and overweight (P = 0.032), vBMD was significantly higher in the diabetes group compared to non-diabetic men. After adjusting for age and sex, no significant saturation effect between BMI and BMD was found in participants with diabetes or in women without diabetes. However, a BMI threshold of 22.33 kg/m² indicated a saturation point for vBMD in non-diabetic men. Independent predictors of vBMD in men included age (r = -0.387, P < 0.001), BMI (r = 0.130, P = 0.004), and VAT (r = -0.145, P = 0.001). For women, significant predictors were age (r = -0.594, P < 0.001), BMI (r = 0.157, P = 0.004), VAT (r = -0.112, P = 0.001), and SAT (r = -0.068, P = 0.035).

CONCLUSION

The relationship between BMI and trabecular vBMD differs in individuals with and without diabetes. Overweight and obese men with diabetes exhibit higher vBMD.

Oversecretion of CCL3 by Irradiation-Induced Senescent Osteocytes Mediates Bone Homeostasis Imbalance

Various stressors such as ionizing radiation (IR), chemotherapeutic agents, oxidative stress, and inflammatory responses can trigger the stress-induced premature senescence (SIPS) of cells in the bone microenvironment, including osteocytes. However, little is known about the mechanisms underlying the senescent cellular regulation of the differentiation potential and bone homeostasis. Here, we report a secretory change in senescent osteocytes activated by IR, its subsequent impact on osteogenic and osteoclastic differentiation, and the inflammatory cascade response. It was observed that osteocytes exhibited altered biological function, persistent and incomplete DNA damage repair, and characteristic senescence phenotypes after exposure to IR in vitro. Meanwhile, a concomitant increase in the CC chemokine ligand 3 (CCL3), a key component of the senescence-associated secretory phenotype (SASP), was observed in the IR-induced senescent osteocytes, which could further downregulate the osteogenic differentiation and enhance the osteoclastic differentiation in cell supernatant co-culture experiments. Notably, the enhancement of the PI3K/Akt/NF-κB signaling pathway in IR-induced senescent osteocytes appears to be an essential driver of the imbalance between the osteogenic and osteoclastic differentiation potentials. Taken together, these data suggest a novel role of CCL3 in IR-induced bone homeostatic imbalance through SASP cascade secretion, mediated by the PI3K/Akt/NF-κB signaling pathway.

Bone-seeking tumor cells alter bone material quality parameters on the nanoscale in mice

Bone metastases related to breast and prostate cancer present with multiple challenges and skeletal related events like fragility fractures impair the quality of life of the patients significantly. To determine local alterations in bone material quality with bone metastasis, we subjected murine tibial specimens, generated after intratibial injections of either RM1 prostate cancer cells or EO771 breast cancer cells into male and female mice respectively, to high-resolution imaging modalities. Small and wide-angle X-ray scattering showed unaltered mineral characteristics in the more osteosclerotic prostate cancer model, while the quantification of calcium weight percentage via backscattered electron microscopy determined minor differences along the perilacunar bone matrix. Further analyses of mineral and collagen characteristics were performed using Raman spectroscopy and focused ion beam electron microscopy. Our study indicates that alterations in nanochannel properties occur due to the presence of bone seeking tumor cells with more prevalent nanopores in the perilacunar matrix.

The Ontogeny of the Human Calcaneus: Insights From Morphological and Trabecular Changes During Postnatal Growth

OBJECTIVES

To investigate the developmental changes in the human calcaneal internal and external morphology linked to the acquisition of mature bipedal locomotion.

METHODS

Seventy seven micro-CT scans of modern juvenile calcanei (from perinates to 15 years old) are employed. The chronological period spans from the Middle/Late Neolithic (4800-4500 BCE) to the 20th century. Through a comprehensive approach that comprises geometric morphometric methods and whole-bone trabecular analysis, the calcaneal growing morphology has been explored.

RESULTS

Morphological changes reflect the development of bipedal locomotion, showing its potential when tracking the major locomotor milestones. The calcaneal shape is immature and almost featureless during the first year of life. The internal architecture is dense and isotropic with numerous thin trabeculae closely packed together. The internal architecture changes to better adapt to variations in load stimulated by a more mature gait by increasing bone mass and alignment, with fewer and thicker struts. The external morphology shows its plasticity by increasing the surface area where greater strain is expected and changing the orientation of the articular facets.

CONCLUSIONS

Analysis of morphological changes in the growing calcaneus highlights the importance of an integrative methodology when exploring developmental bone plasticity. The changes in calcaneal internal and external morphologies reflect the different loading patterns experienced during growth, gradually shifting from a more generalized morphology to a more adult-like one, reflecting major locomotor achievement. Our research shows that although initially genetically driven, calcaneal plasticity may display mechanical influences and provide precious information on tracking the main locomotor milestones.

A retrospective review of the circumstances and characteristics of 72 adult autoerotic neck compression deaths in Australia, between 2000 and 2022

Autoerotic asphyxial deaths are a rare but recurring phenomenon, the most common modality of which involves neck compression. Autoerotic neck compression can involve any compression to the neck during individual sexual activity performed to heighten arousal. This retrospective study examines 72 such deaths occurring in Australia between 2000 and 2022. The study aims to provide detailed medico-legal interpretation of such deaths and recommendations for investigation within Australian contexts, and globally. Demographic analysis reveals a predominance of Caucasian males under 50 years of age, with diverse employment and health status. Pathological examination uncovers a spectrum of injuries, from superficial abrasions to rare skeletal and cartilaginous injuries, providing insights into the mechanics and characteristics of these fatalities. Contextual examination highlights sexual paraphernalia, evidence of genital stimulation, and isolation are consistent features in most autoerotic deaths within the sample. There was a wide variety of tool usage (ropes, belts, etc.), and geo-temporal features associated with autoerotic neck compression. The study provides comprehensive examination of the circumstances and characteristics of autoerotic neck compression which may assist in differentiation between suicidal and homicidal neck compression deaths such as hanging or ligature strangulation respectively. This study is an Australian first and is the first study of autoerotic asphyxial deaths to focus solely on deaths with a neck compression component. The study incorporates new variables and suggests ways these should be considered in future death investigations. The authors argue for delineation and subcategorization of autoerotic neck compression from other autoerotic asphyxial death due to their distinct injury characteristics and mechanism of injury.

Severe Hyperostosis Frontalis Interna in a 91-Year-Old Female Cadaver: A Case Report

Hyperostosis frontalis interna (HFI) is characterized by benign thickening of the frontal bone and most commonly affects postmenopausal elderly women. While the exact cause remains unknown, its prevalence is thought to be multifactorial. This case report presents a discovery of extensive HFI during routine dissection of a 91-year-old female cadaver in the Clinical Anatomy Laboratory of Sam Houston State University College of Osteopathic Medicine. The patient's (donor) death was reported as systolic heart failure, and complete bilateral invasion of the frontal and temporal bones, with lesser involvement of the parietal bone, was observed. This condition extended from the crista galli anteriorly to the coronal suture posteriorly and to the sphenoid bone (SB) inferiorly. The greater and lesser wings of the SB were covered by the hyperostotic processes and the foramina (rotundum, ovale, spinosum, and lacerum) bilaterally. The cranial vault demonstrated an irregular surface with numerous nodular, trabeculated, and spiculated bony projections, creating a cobblestone-like appearance, a feature commonly referred to in pathology as bosselated lesions. A mild expansion into the superior sagittal sinus (SSS) and the dura mater was observed, which is uncommon for this condition. Based on postmortem pathology, a suspected diagnosis of advanced type D HFI was made. This report discusses a unique case of HFI that may contribute to a better understanding, classification, evaluation, and treatment of patients affected by this condition.

Relationship between autophagy and NLRP3 inflammasome during articular cartilage degradation in oestrogen-deficient rats with streptozotocin-induced diabetes

BACKGROUND

Estrogen deficiency and Diabetes mellitus (DM) cause joint tissue deterioration, although the mechanisms are uncertain. This study evaluated the immunoexpression of autophagy and NLRP3-inflammasome markers, in rat articular cartilage with estrogen deficiency and DM.

METHODS

Twenty rats were sham-operated (SHAM) or ovariectomized (OVX) and equally allocated into four groups: SHAM and OVX groups administered with vehicle solution; SHAM and OVX groups treated with 60 mg/kg/body weight of streptozotocin, intraperitoneally, to induce DM (SHAM-DM and OVX-DM groups). After seven weeks, the rats were euthanized, and their joint knees were processed for paraffin embedding. Sections were stained with haematoxylin-eosin, toluidine blue, safranin-O/fast-green or subjected to picrosirius-red-polarisation method; immunohistochemistry to detect beclin-1 and microtubule-associated protein 1B-light chain 3 (autophagy markers), NLRP3 and interleukin-1β (IL-1β) (inflammasome activation markers), along with matrix metalloproteinase-9 (MMP-9), Nuclear factor-kappa B (NFκB), and Vascular endothelial growth factor A (VEGF-A) were performed.

RESULTS

Deterioration of articular cartilage and subchondral bone were greater in SHAM-DM and OVX-DM groups. Higher percentages of immunolabeled chondrocytes to NLRP3, IL-1β, MMP-9, NFκB, and VEGF-A, as well as lower percentages of chondrocytes immunolabeled to autophagy markers, were noticed in estrogen-deficient and diabetic groups. These differences were greater in the OVX-DM group. Percentages of immunolabeled chondrocytes showed negative correlation between autophagy markers v.s IL-1β, NLRP-3, MMP-9, NFκB, and VEGF-A, along with positive correlation between VEGF-A vs. MMP-9, NFκB, IL-1β, and NLRP3, and MMP-9 vs. NFκB.

CONCLUSIONS

In conclusion, autophagy reduction and NLRP3 inflammasome activation in chondrocytes may be implicated in articular cartilage degradation, under estrogen-deficient and DM conditions. Moreover, the combination of estrogen deficiency and DM may potentiate those effects.

Exploring the Logic and Conducting a Comprehensive Evaluation of the Adiponectin Receptor Agonists AdipoRon and AdipoAI's Impacts on Bone Metabolism and Repair-A Systematic Review

INTRODUCTION

Adiponectin replacement therapy shows promising outcomes in various diseases, especially for bone-related disorders. Challenges in using the complete protein have led to alternative approaches, with AdipoRon and AdipoAI emerging as extensively researched drug candidates. Their influence on models of bone-related disorders has progressed considerably but there has been no review of their effectiveness in modulating bone metabolism and repair.

METHODS

This systematic review seeks to address this knowledge gap. Based on preclinical evidence from PubMed, EMBASE, and COCHRANE, ten studies were included following PRISMA guidelines. The JBI Checklist Critical Appraisal Tool assessed the quality of this systematic review. The studies encompassed various animal models, addressing bone defects, osseointegration, diabetes-associated periodontitis, fracture repair, growth retardation, and diabetes-associated peri-implantitis.

RESULTS

AdipoRon and AdipoAI demonstrated effectiveness in modulating bone metabolism and repair through diverse pathways, including the activation of AdipoR1/APPL1, inhibition of F-actin ring formation, suppression of IκB-α phosphorylation, p65 nuclear translocation and Wnt5a-Ror2 signaling pathway, reduction of CCL2 secretion and expression, regulation of autophagy via LC3A/B expression, modulation of SDF-1 production, activation of the ERK1/2 signaling pathway, modulation of bone integration-related markers and osteokines such as RANKL, BMP-2, OPG, OPN, and Runx2, inhibition of RANKL in osteoblasts, and inhibition of podosome formation via the activation of AMPK.

CONCLUSION

While preclinical studies show promise, human trials are crucial to confirm the clinical safety and effectiveness of AdipoRon and AdipoAI. Caution is necessary due to potential off-target effects, especially in bone therapy with multi-target approaches. Structural biology and computational methods can help predict and understand these effects.

Trabecular Bone Ontogeny of the Human Distal Tibia

OBJECTIVES

There is an increasing understanding of how trabecular bone adapts to biomechanical changes during ontogeny. However, limited research exists regarding the distal tibia, which is important in weight-bearing locomotion as part of the ankle joint. This study aims to document the ontogenetic trabecular patterns of the distal tibia, in addition to changes in its structural heterogeneity.

MATERIALS AND METHODS

Thirty-eight distal tibiae, ranging in age from 28 intrauterine weeks to 8 postnatal years, from the Scheuer juvenile skeletal collection were examined. Trabecular bone was analyzed using a quantitative volume of interest approach and qualitative whole bone mapping following microcomputed tomography.

RESULTS

Fetal and perinatal tibia lack mature organization and are associated with high bone volume fraction. During the first year of life, there is a decrease in bone volume fraction and an indication of early re-organization of trabecular struts in the distal tibia. After one year of age, the distal tibia exhibits increased trabecular structural heterogeneity.

DISCUSSION

The trabecular architecture of the fetal and perinatal distal tibia lacks mature organization and instead reflects ossification patterns. At these stages, there is a rapid accumulation of bone mass associated with gestational overproduction, hypothesized to be in preparation for subsequent postnatal changes. During the first year of life there is a decrease in volume fraction, associated with constructive regression. It is postulated this is related to changing biomechanical forces associated with the bipedal gait, in addition to growth demands. After one year of age, the distal tibia exhibits structural heterogeneity with trabecular adaption to accommodate specific bipedal stresses.

Restructuring of Femoral Cortical Bone During Growth and Locomotor Development of Wild Chimpanzees (Pan troglodytes verus)

OBJECTIVE

Chimpanzees are altricial in terms of their locomotor development and transition from being carried to engaging in suspensory and arboreal locomotor behaviors to eventually relying on terrestrial quadrupedalism as their main form of locomotion. Here, we consider the mechanical implications of femoral cortical bone restructuring during growth and locomotor development in wild chimpanzees.

MATERIALS AND METHODS

Cortical bone structure was examined in an ontogenetic sample of wild chimpanzees from a single subspecies (P. t. verus) spanning in age from 2 weeks to 12.6 years. Diaphyseal cross-sections were extracted from micro-CT scans of the femur at 35%, 50%, and 65% of total intermetaphyseal length and variation in cortical bone structure was assessed based on bending rigidity (Imax/Imin, Ix/Iy), relative medullary area, and cortical bone porosity.

RESULTS

Diaphyseal shape is relatively circular with a high amount of cortical bone porosity and a large relative medullary area during early infancy. Distinct shifts in cortical bone structure occurred for each studied parameter with the biggest changes occurring within the first 5 years. Values appear to stabilize as quadrupedal walking increases in frequency and is established as the main form of locomotion.

DISCUSSION

Collectively, the results suggest a degree of integration in which cortical bone restructures in response to rapid changes in locomotion in addition to nonmechanical influences such as hormonal, and growth factors, without compromising function and structural integrity. The extent of influence of each factor varies throughout growth and highlights the need for caution in functional interpretations of cortical bone geometry.

Quantitative ultrasound imaging reveals distinct fracture-associated differences in tibial intracortical pore morphology and viscoelastic properties in aged individuals with and without diabetes mellitus - an exploratory study

Introduction

Diabetes mellitus (DM) is a chronic metabolic disorder that increases fragility fracture risk. Conventional DXA-based areal bone mineral density (aBMD) assessments often underestimate this risk. Cortical Backscatter (CortBS) ultrasound, a radiation-free technique, non-invasively analyzes cortical bone's viscoelastic and microstructural properties. This study aimed to evaluate CortBS's discriminative performance in DM patients compared to DXA and characterize changes in cortical bone microstructure in Type 1 and Type 2 DM (T1DM, T2DM) patients.

Methods

This in-vivo study included 89 DM patients (T1DM = 39, T2DM = 48) and 76 age- and sex-matched controls. DXA measured aBMD, while CortBS measurements were taken at the anteromedial tibia using a medical ultrasound scanner with custom software. Multivariate analysis of variance assessed the impact of DM type on CortBS and DXA measurement results. Partial least squares discriminant analyses with cross-validation were used to compare the discrimination performance for vertebral, non-vertebral, and any fragility fractures, adjusting for gender, age, and anthropometric parameters (weight, height, BMI).

Results

Fractures occurred in 8/23 T1DM, 17/18 T2DM, and 16/55 controls. DXA parameters were reduced in fracture patients, with significant diabetes impact. T2DM was associated with altered CortBS parameters, reduced scatterer density, and larger pores. CortBS outperformed DXA in discriminating fracture risk (0.61 ≤ AUC(DXA) ≤ 0.63, 0.68 ≤ AUC(CortBS) ≤ 0.69).

Conclusions

Both T1DM and T2DM showed altered bone metabolism, with T2DM linked to impaired tissue formation. CortBS provides insights into pathophysiological changes in diabetic bone and provided superior fracture risk assessment in DM patients compared to DXA.

Oligomeric Proanthocyanidins Ameliorate Cadmium-Induced Senescence of Osteocytes Through Combating Oxidative Stress and Inflammation

Osteocyte senescence is associated with skeletal dysfunction, but how to prevent bone loss and find the effective therapeutic targets is a potential scientific concern. Cadmium (Cd) is a widespread environmental contaminant that causes substantial bone damage in both animals and humans. Oligomeric proanthocyanidins (OPC) are naturally polyphenolic substances found in various plants and demonstrate significant anti-senescence potential. Here, we investigated the protective effects of OPC against Cd-induced senescence of osteocytes and identify potential regulatory mechanisms. OPC alleviated Cd-induced senescence of osteocytes by attenuating cell cycle arrest, reducing ROS accumulation, and suppressing pro-inflammatory responses in vitro. Furthermore, OPC effectively prevented the Cd-induced breakdown of dendritic synapses in osteocytes in vitro. Correspondingly, OPC ameliorated Cd-induced damage of osteocytes through anti-senescence activity in vivo. Taken together, our results establish OPC as a promising therapeutic agent that ameliorates Cd-induced osteocyte senescence by mitigating oxidative stress and inflammatory responses.