51
|
Kremers HM, Lewallen EA, van Wijnen AJ, Lewallen DG. Clinical Factors, Disease Parameters, and Molecular Therapies Affecting Osseointegration of Orthopedic Implants. CURRENT MOLECULAR BIOLOGY REPORTS 2016; 2:123-132. [PMID: 28008373 PMCID: PMC5166702 DOI: 10.1007/s40610-016-0042-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Total hip and knee arthroplasty are effective interventions for management of end-stage arthritis. Indeed, about 7 million Americans are currently living with artificial hip and knee joints. The majority of these individuals, however, will outlive their implants and require revision surgeries, mostly due to poor implant osseointegration and aseptic loosening. Revisions are potentially avoidable with better management of patient-related risk factors that affect the osseointegration of orthopedic implants. In this review, we summarize the published clinical literature on the role of demographics, biologic factors, comorbidities, medications and aseptic loosening risk. We focus on several systemic and local factors that are particularly relevant to implant osseointegration. Examples include physiological and molecular processes that are linked to hyperglycemia, oxidative stress, metabolic syndrome and dyslipidemia. We discuss how orthopedic implant osseointegration can be affected by a number of molecular therapies that are antiresorptive or bone anabolic (i.e. calcium, vitamin D, bisphosphonates, calcitonin, strontium, hormone replacement therapy, selective estrogen-receptor modulators).
Collapse
Affiliation(s)
- Hilal Maradit Kremers
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW,
Rochester, MN 55905
- Department of Health Sciences Research, Mayo Clinic, 200 First St
SW, Rochester, MN 55905
| | - Eric A. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW,
Rochester, MN 55905
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW,
Rochester, MN 55905
| | - David G. Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW,
Rochester, MN 55905
| |
Collapse
|
52
|
Ishii Y, Noguchi H, Sato J, Takayama S, Toyabe SI. Preoperative Bone Mineral Density and Bone Turnover in Women Before Primary Knee Arthroplasty. Open Orthop J 2016; 10:382-388. [PMID: 28523079 PMCID: PMC5434765 DOI: 10.2174/1874325001610010382] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The preoperative prevalence of osteoporosis and/or osteopenia and overall bone quality in prospective total knee arthroplasty (TKA) patients may affect the postoperative outcome after prosthetic insertion into the bone. The purpose of this study is to determine the baseline bone mineral density (BMD) and bone turnover in preoperative, female, primary TKA patients. METHODS We prospectively measured the lumbar spine and hip BMDs using dual-energy X-ray absorptiometry (DEXA) scans in a cohort of 119 knees (107 patients) one day before surgery. We also assessed bone turnover using urinary levels of N-telopeptide (NTX), a type I collagen crosslinker, normalized to creatinine. RESULTS The prevalence of osteoporosis by DEXA scan (T-score ≤ -2.5) among the TKAs was 12% in the spine and 10% in the hip. Eighty-three knees (70%) had osteopenia or osteoporosis of either the spine or hip. The mean T-score of the spine was -0.7 (SD 1.6), which is within normal limits, and of the hip was -1.2 (SD 1.0), which is defined as osteopenia. The mean Z-scores of 0.9 (SD 1.4) in the spine and 0.6 (SD 0.9) in the hip were positive. The median urinary NTX/creatinine ratio was elevated at 58.1 (interquartile range: 13.7 to 188.4). CONCLUSION Based on Z-scores, the TKA patients had higher spine and hip BMDs than the age-matched general population. Elevated NTX levels may suggest a systemic or local abnormal bone turnover. Further study is needed to determine whether such turnover, as a type of patient-related medical systemic disorder, affects postoperative clinical outcomes.
Collapse
Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan
| | - Hideo Noguchi
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan
| | - Satoshi Takayama
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan
| | - Shin-Ichi Toyabe
- Division of Information Science and Biostatistics, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata 951-8520 Japan
| |
Collapse
|
53
|
Hopkins SJ, Toms AD, Brown M, Welsman JR, Ukoumunne OC, Knapp KM. A study investigating short- and medium-term effects on function, bone mineral density and lean tissue mass post-total knee replacement in a Caucasian female post-menopausal population: implications for hip fracture risk. Osteoporos Int 2016; 27:2567-76. [PMID: 26919995 DOI: 10.1007/s00198-016-3546-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 02/16/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED Significant increased hip fracture incidence has been reported in the year following total knee replacement. This study demonstrates that bone and muscle loss is a post-surgical consequence of total knee replacement, alongside poor outcomes in function and activity potentially contributing to reduced quality of life and increased hip fracture risk. INTRODUCTION A significant increase in hip fracture incidence in the year following total knee replacement (TKR) surgery has been reported. This study investigated function and activity following TKR and the effects of limited mobility on bone and muscle loss and their potential contribution to hip fracture risk. METHODS Changes in dual-energy X-ray absorptiometry (DXA) (GE Lunar Prodigy, Bedford MA), bone mineral density (BMD) at the neck of femur (NOF), total hip region (TH) and lumbar spine were measured alongside leg lean tissue mass (LLTM) in post-menopausal Caucasian females following TKR (N = 19) compared to controls (N = 43). Lumbar spine trabecular bone scores (TBSs) were calculated. Ipsilateral/contralateral weight bearing, lower limb function, 3-day pedometer readings, pain levels and falls were also recorded. Measurements were obtained at pre-surgery baseline and at 6 weeks, 6 months and 12 months post-surgery. RESULTS No statistically significant differences were demonstrated between groups at baseline bilaterally in LLTM or BMD at the NOF and TH. Losses in ipsilateral NOF and TH BMD and contralateral LLTM were significantly higher in the TKR group at 6 months. Impairment in function and weight bearing persisted in the TKR group 12 months post-operatively alongside deficits in bilateral muscle mass and ipsilateral NOF and TH BMD. Falls incidence was not significantly higher in the TKR group. CONCLUSIONS Bone loss at the hip with associated muscle loss is a consequence of TKR that, in addition to poor patient outcomes in function and activity, potentially contributes to increased hip fracture risk in the year following surgery.
Collapse
Affiliation(s)
- S J Hopkins
- University of Exeter Medical School, Room 1.29, South Cloisters, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - A D Toms
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - M Brown
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - J R Welsman
- University of Exeter Medical School, Room 1.29, South Cloisters, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - O C Ukoumunne
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - K M Knapp
- University of Exeter Medical School, Room 1.29, South Cloisters, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| |
Collapse
|
54
|
Elwakil WA, Mohasseb D, Elkaffash D, Elshereef S, Elshafey M. Serum leptin and osteoporosis in postmenopausal women with primary knee osteoarthritis. EGYPTIAN RHEUMATOLOGIST 2016. [DOI: 10.1016/j.ejr.2016.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
55
|
Terencio MC, Ferrándiz ML, Carceller MC, Ruhí R, Dalmau P, Vergés J, Montell E, Torrent A, Alcaraz MJ. Chondroprotective effects of the combination chondroitin sulfate-glucosamine in a model of osteoarthritis induced by anterior cruciate ligament transection in ovariectomised rats. Biomed Pharmacother 2016; 79:120-8. [PMID: 27044820 DOI: 10.1016/j.biopha.2016.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/08/2016] [Indexed: 01/15/2023] Open
Abstract
CONTEXT The efficacy of the combination chondroitin sulfate-glucosamine (CS-GlcN) in the treatment of knee osteoarthritis (OA) has been suggested in recent clinical studies. In vitro reports have also suggested anti-inflammatory and anti-resorptive effects of this combination. OBJECTIVE The aim of this study was to characterize the effects of CS-GlcN on joint degradation in vivo including the assessment of inflammation and bone metabolism in a model of OA. MATERIALS AND METHODS We have used the OA model induced by anterior cruciate ligament transection (ACLT) in ovariectomised rats. CS-GlcN was administered daily (oral gavage) from week 0 until week 12 after ovariectomy at the dose of 140 (CS)+175 (GlcN)(HCl) mg/kg. Histochemical analyses were performed, the levels of biomarkers and inflammatory mediators were measured by luminex or ELISA and bone microstructure was determined by μCT. RESULTS CS-GlcN protected against cartilage degradation and reduced the levels of inflammatory mediators such as interleukin-1β and tumor necrosis factor-α in the affected knee. In addition, serum biomarkers of inflammation and cartilage and bone degradation including matrix metalloproteinase-3, C-telopeptide of type II collagen and the ratio receptor activator of nuclear factor κB ligand/osteoprotegerin were significantly decreased by CS-GlcN. This treatment also tended to improve some bone microstructural parameters without reaching statistical significance. DISCUSSION AND CONCLUSIONS These results demonstrate the chondroprotective effects of CS-GlcN in vivo, in the experimental model of ACLT in ovariectomised rats, and suggest that this combination may be useful to control the joint catabolic effects of inflammatory stress. These findings could have clinical relevance related to the prevention of joint degradation by CS-GlcN and support the potential development of OA treatments based on this combination.
Collapse
Affiliation(s)
- María Carmen Terencio
- Department of Pharmacology and IDM, University of Valencia, Av. Vicent Andrés Estellé s/n, 46100 Burjasot, Valencia, Spain
| | - María Luisa Ferrándiz
- Department of Pharmacology and IDM, University of Valencia, Av. Vicent Andrés Estellé s/n, 46100 Burjasot, Valencia, Spain
| | - María Carmen Carceller
- Department of Pharmacology and IDM, University of Valencia, Av. Vicent Andrés Estellé s/n, 46100 Burjasot, Valencia, Spain
| | - Ramón Ruhí
- Technological Extraction Department, Bioiberica S.A., Pol. Ind. "Mas Puigvert" Crta. N-II, Km 680.6, 08389 Palafolls, Barcelona, Spain
| | - Pere Dalmau
- Technological Extraction Department, Bioiberica S.A., Pol. Ind. "Mas Puigvert" Crta. N-II, Km 680.6, 08389 Palafolls, Barcelona, Spain
| | - Josep Vergés
- Pre-Clinical R&D Department, PharmaScience Division, Bioiberica S.A., Francesc Macià 7, 08029 Barcelona, Spain
| | - Eulàlia Montell
- Pre-Clinical R&D Department, PharmaScience Division, Bioiberica S.A., Francesc Macià 7, 08029 Barcelona, Spain
| | - Anna Torrent
- Pre-Clinical R&D Department, PharmaScience Division, Bioiberica S.A., Francesc Macià 7, 08029 Barcelona, Spain
| | - María José Alcaraz
- Department of Pharmacology and IDM, University of Valencia, Av. Vicent Andrés Estellé s/n, 46100 Burjasot, Valencia, Spain.
| |
Collapse
|
56
|
Finnilä S, Moritz N, SvedströM E, Alm JJ, Aro HT. Increased migration of uncemented acetabular cups in female total hip arthroplasty patients with low systemic bone mineral density. A 2-year RSA and 8-year radiographic follow-up study of 34 patients. Acta Orthop 2016; 87:48-54. [PMID: 26569616 PMCID: PMC4940591 DOI: 10.3109/17453674.2015.1115312] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Low bone mineral density (BMD) may jeopardize the initial component stability and delay osseointegration of uncemented acetabular cups in total hip arthroplasty (THA). We measured the migration of uncemented cups in women with low or normal BMD. PATIENTS AND METHODS We used radiostereometric analysis (RSA) to measure the migration of hydroxyapatite-coated titanium alloy cups with alumina-on-alumina bearings in THA of 34 female patients with a median age of 64 (41-78) years. 10 patients had normal BMD and 24 patients had low systemic BMD (T-score ≤ -1) based on dual-energy X-ray absorptiometry (DXA). Cup migration was followed with RSA for 2 years. Radiographic follow-up was done at a median of 8 (2-10) years. RESULTS Patients with normal BMD did not show a statistically significant cup migration after the settling period of 3 months, while patients with low BMD had a continuous proximal migration between 3 and 12 months (p = 0.03). These differences in cup migration persisted at 24 months. Based on the perceived risk of cup revision, 14 of the 24 cases were "at risk" (proximal translation of 0.2 to 1.0 mm) in the low-BMD group and 2 of the 10 cases were "at risk" in the normal-BMD group (odds ratio (OR) = 8.0, 95% CI: 1.3-48). The radiographic follow-up showed no radiolucent lines or osteolysis. 2 cups have been revised for fractures of the ceramic bearings, but none for loosening. INTERPRETATION Low BMD contributed to cup migration beyond the settling period of 3 months, but the migrating cups appeared to osseointegrate eventually.
Collapse
Affiliation(s)
- Sami Finnilä
- Orthopaedic Research Unit, Turku University Hospital and University of Turku
| | - Niko Moritz
- Orthopaedic Research Unit, Turku University Hospital and University of Turku
| | - Erkki SvedströM
- Department of Diagnostic Radiology, Turku University Hospital, Turku, Finland.
| | - Jessica J Alm
- Orthopaedic Research Unit, Turku University Hospital and University of Turku
| | - Hannu T Aro
- Orthopaedic Research Unit, Turku University Hospital and University of Turku,Correspondence:
| |
Collapse
|
57
|
von Schewelov T, Magnusson H, Cöster M, Karlsson C, Rosengren BE. Osteoarthritis of the Distal Interphalangeal and First Carpometacarpal Joints is Associated with High Bone Mass in Women and Small Bone Size and Low Lean Mass in Men. Open Orthop J 2015; 9:399-404. [PMID: 26401163 PMCID: PMC4578130 DOI: 10.2174/1874325001509010399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 05/26/2015] [Accepted: 07/01/2015] [Indexed: 11/30/2022] Open
Abstract
Objective: To determine if primary hand osteoarthritis (OA) is associated with abnormal bone and anthropometric traits. Methods: We used DXA to measure total body bone mineral density (BMD), femoral neck width (bone size) and total body lean and fat mass in 39 subjects with hand OA (primary DIP and/or CMC I) and 164 controls. Data are presented as mean Z-scores or Odds Ratios (OR) with 95% confidence intervals. Results: Women with hand OA had (compared to controls) higher BMD (0.5(0.1,0.9)) but similar bone size (-0.3(-0.8,0.2)), lean mass (0.3(-0.3,0.9)), fat mass (-0.1(-0.6,0.5)) and BMI (0.0(-0.6,0.6)). Men with hand OA had (compared to controls) similar BMD (-0.1(-0.7,0.6)), smaller bone size (-0.5(-1.1,-0.01)), lower lean mass (-0.6(-1.1,-0.04)), and similar fat mass (-0.2(-0.7,0.4)) and BMI -0.1(-0.6,0.6). In women, each SD higher BMD was associated with an OR of 1.8 (1.03, 3.3) for having hand OA. In men each SD smaller bone size was associated with an OR of 1.8 (1.02, 3.1) and each SD lower proportion of lean body mass with an OR of 1.9 (1.1, 3.3) for having hand OA. Conclusion: Women with primary DIP finger joint and/or CMC I joint OA have a phenotype with higher BMD while men with the disease have a smaller bone size and lower lean body mass.
Collapse
Affiliation(s)
- Thord von Schewelov
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Håkan Magnusson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Maria Cöster
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Caroline Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| |
Collapse
|
58
|
Diachkova GV, Sazonova NV, Larionova TA, Diachkov KA. Density of bones forming hip and knee joints in patients aged over 60 years with coxarthrosis and gonarthrosis according to multislice computed tomography. ADVANCES IN GERONTOLOGY 2015. [DOI: 10.1134/s2079057015030066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
59
|
Lv H, Zhang L, Yang F, Zhao Z, Yao Q, Zhang L, Tang P. Comparison of microstructural and mechanical properties of trabeculae in femoral head from osteoporosis patients with and without cartilage lesions: a case-control study. BMC Musculoskelet Disord 2015; 16:72. [PMID: 25887431 PMCID: PMC4391480 DOI: 10.1186/s12891-015-0530-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/13/2015] [Indexed: 11/24/2022] Open
Abstract
Background Degeneration of cartilage will change load distribution, affecting bone remodeling progress and trabecular structure and strength. However, in human primary osteoporosis, whether cartilage lesions would also affect properties beneath trabecular bone remains unknown. In this study, we explored the differences in local trabecular properties between osteoporosis patients with and without cartilage lesions. Methods Eighteen pairs of femoral heads with and without cartilage lesions in a weight-bearing area were collected from senile femoral neck fracture patients. The Mankin score and glycosaminoglycan (GAG) content were used to evaluate the severity of the cartilage lesions. Micro-CT and compression tests were used to obtain structural and mechanical characteristics of each trabecular column. Multivariate linear regression was performed to evaluate the association between mechanical parameters and the degree of cartilage lesion. Results In osteoporosis patients with cartilage lesions, the bone volume fraction (BV/TV) and trabecular thickness (Tb.Th) of the trabecular column were significantly higher than that of osteoporotic control patients (all P < 0.05), while the Young’s modulus was lower (P = 0.024). Multivariable linear regression indicated that in both groups, bone mineral density (BMD) significantly correlated with Young’s modulus (all P < 0.05). While in patients with cartilage lesion, GAG content was also correlated with Young’s modulus (standardized coefficient 0.443, P < 0.01). Conclusions Osteoporosis patients with cartilage lesions exhibited a weaker mechanical property of trabeculae. The intimate association of cartilage lesions and impairment of trabecular mechanical properties indicate that cartilage and trabeculae belong to an interdependent functional unit. Previously proposed adaptive mechanisms in osteoarthritis might also be applicable to the progression of osteoporosis.
Collapse
Affiliation(s)
- Houchen Lv
- Department of Orthopedics, General Hospital of Chinese PLA, No.28 Fuxing Road, Beijing, China.
| | - Licheng Zhang
- Department of Orthopedics, General Hospital of Chinese PLA, No.28 Fuxing Road, Beijing, China.
| | - Fei Yang
- BNLMS State Key Laboratory of Polymer Physics & Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing, China.
| | - Zhe Zhao
- Department of Orthopedics, General Hospital of Chinese PLA, No.28 Fuxing Road, Beijing, China.
| | - Qi Yao
- Department of Orthopedics, Beijing Shijitan Hospital, Beijing, China.
| | - Lihai Zhang
- Department of Orthopedics, General Hospital of Chinese PLA, No.28 Fuxing Road, Beijing, China.
| | - Peifu Tang
- Department of Orthopedics, General Hospital of Chinese PLA, No.28 Fuxing Road, Beijing, China.
| |
Collapse
|
60
|
Virdi AS, Irish J, Sena K, Liu M, Ke HZ, McNulty MA, Sumner DR. Sclerostin antibody treatment improves implant fixation in a model of severe osteoporosis. J Bone Joint Surg Am 2015; 97:133-40. [PMID: 25609440 DOI: 10.2106/jbjs.n.00654] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The mechanical fixation of orthopaedic and dental implants is compromised by diminished bone volume, such as with osteoporosis. Systemic administration of sclerostin antibody (Scl-Ab) has been shown to enhance implant fixation in normal animals. In the present study, we tested whether Scl-Ab can improve implant fixation in established osteoporosis in a rat model. METHODS We used an ovariectomized (ovx) rat model, in which we found a 78% decrease in trabecular bone volume at the time of implant surgery; sham-ovx, age-matched rats were used as controls. After placement of a titanium implant in the medullary cavity of the distal aspect of the femur, the rats were maintained for four, eight, or twelve weeks and treated biweekly with Scl-Ab or with the delivery vehicle alone. Outcomes were measured with use of microcomputed tomography, mechanical testing, and static and dynamic histomorphometry. RESULTS Scl-Ab treatment doubled implant fixation strength in both the sham-ovx and ovx groups, although the enhancement was delayed in the ovx group. Scl-Ab treatment also enhanced bone-implant contact; increased peri-implant trabecular thickness and volume; and increased cortical thickness. These structural changes were associated with an approximately five to sevenfold increase in the bone-formation rate and a >50% depression in the eroded surface following Scl-Ab treatment. Trabecular bone thickness and bone-implant contact accounted for two-thirds of the variance in fixation strength. CONCLUSIONS In this model of severe osteoporosis, Scl-Ab treatment enhanced implant fixation by stimulating bone formation and suppressing bone resorption, leading to enhanced bone-implant contact and improved trabecular bone volume and architecture. CLINICAL RELEVANCE Systemic administration of anti-sclerostin antibodies might be a useful strategy in total joint replacement when bone mass is deficient.
Collapse
Affiliation(s)
- Amarjit S Virdi
- Department of Anatomy and Cell Biology, Rush University Medical Center, 600 South Paulina Street, Suite 507, Chicago, IL 60612. E-mail address for A.S. Virdi:
| | - John Irish
- Department of Anatomy and Cell Biology, Rush University Medical Center, 600 South Paulina Street, Suite 507, Chicago, IL 60612. E-mail address for A.S. Virdi:
| | - Kotaro Sena
- Department of Periodontology, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Min Liu
- Metabolic Disorders, Amgen, Inc., One Amgen Center Drive, 29-1-A, Thousand Oaks, CA 91320
| | - Hua Zhu Ke
- Metabolic Disorders, Amgen, Inc., One Amgen Center Drive, 29-1-A, Thousand Oaks, CA 91320
| | - Margaret A McNulty
- Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Skip Bertman Drive, Baton Rouge, LA 70803
| | - Dale R Sumner
- Department of Anatomy and Cell Biology, Rush University Medical Center, 600 South Paulina Street, Suite 507, Chicago, IL 60612. E-mail address for A.S. Virdi:
| |
Collapse
|
61
|
Domingues VR, Campos GCD, Plapler PG, Rezende MUD. Prevalence of osteoporosis in patients awaiting total hip arthroplasty. ACTA ORTOPEDICA BRASILEIRA 2015; 23:34-7. [PMID: 26327793 PMCID: PMC4544518 DOI: 10.1590/1413-78522015230100981] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022]
Abstract
Objective: To evaluate the prevalence of osteoporosis in patients awaiting total hip arthroplasty. Method: Twenty-nine patients diagnosed with hip osteoarthritis awaiting primary total arthroplasty of the hip answered WOMAC questionnaire, VAS and questions about habits, osteoporosis and related diseases. Bone mineral densitometry of the lumbar spine and hips and laboratory tests (complete blood count and examination of calcium metabolism) were performed. Weight and height were measured to calculate body mass index (BMI). The evaluated quantitative characteristics were compared between patients with and without osteoporosis using the Mann-Whitney tests. Results: Thirteen men and 16 women with a mean age of 61.5 years old, WOMAC 51.4; EVA 6.4 and BMI 27.6 were evaluated. The prevalence of osteoporosis was 20.7%, and 37.9% had osteopenia. Patients with osteoporosis were older than patients without osteoporosis (p=0.006). The mean bone mineral density of the femoral neck without hip osteoarthritis was lower than the affected side (p=0.007). Thirty-five percent of patients did not know what osteoporosis is. Of these, 30% had osteopenia or osteoporosis. Conclusion: osteoarthritis and osteoporosis may coexist and the population waiting for total hip arthroplasty should be considered at risk for the presence of osteoporosis. Level of Evidence III, Observational Study.
Collapse
|
62
|
Karlsson MK, Magnusson H, Cöster M, Karlsson C, Rosengren BE. Patients with knee osteoarthritis have a phenotype with higher bone mass, higher fat mass, and lower lean body mass. Clin Orthop Relat Res 2015; 473:258-64. [PMID: 25280553 PMCID: PMC4390976 DOI: 10.1007/s11999-014-3973-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 09/19/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although knee osteoarthritis (OA) is common, its etiology is poorly understood. Specifically, it is not known whether knee OA is associated with abnormal anthropometric and musculoskeletal characteristics known to be associated with OA in general. We recently studied this topic for patients with hip arthritis; however, it is important to evaluate it for knee OA separately, because there are reports indicating that patients with primary OA in different joints may have a different phenotype. QUESTIONS/PURPOSES Do patients with primary knee OA have a phenotype with higher bone mineral density (BMD), higher body mass index (BMI), larger skeletal size, lower lean body mass, and higher fat content? METHODS We included 38 women and 74 men (mean age, 61 years; range, 34-85 years) with primary knee OA and 122 women and 121 men as control subjects. We used dual-energy x-ray absorptiometry to measure total body BMD (g/cm2), femoral neck width (cm), fat and lean mass (%), and BMI (kg/m2). Z scores were calculated for each individual. Data are presented as means with 95% confidence intervals. RESULTS Women with knee OA had the following Z scores: total body BMD 0.8 (0.5-1.0); BMI 1.6 (1.1-2.0); femoral neck width 0.1 (-0.3 to 0.4); proportion of lean mass -1.0 (-1.5 to -0.6); and proportion of fat mass 1.0 (0.6-1.4). Men with knee OA had the following Z scores: total body BMD 0.5 (0.3-0.7); BMI 0.9 (0.6-1.1); femoral neck width 0.3 (0.1-0.7); proportion of lean mass -0.9 (-1.1 to -0.8); and proportion of fat mass 0.7 (0.5-0.9). CONCLUSIONS Women and men with idiopathic knee OA have a phenotype with higher BMD, higher BMI, proportionally higher fat mass, and proportionally lower lean body mass. Men also have a larger skeletal size. CLINICAL RELEVANCE A higher BMD may lead to stiffer bone, a higher BMI to a greater joint load, and a proportionally lower lean body (muscle) mass to lower joint-protective ability, and all trait deviations probably predispose for knee OA.
Collapse
Affiliation(s)
- Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Håkan Magnusson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Maria Cöster
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Caroline Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02 Malmö, Sweden
| |
Collapse
|
63
|
Karlsson MK, Karlsson C, Magnusson H, Cöster M, von Schewelov T, Nilsson JÅ, Brudin L, Rosengren BE. Individuals with primary osteoarthritis have different phenotypes depending on the affected joint - a case control study from southern sweden including 514 participants. Open Orthop J 2014; 8:450-6. [PMID: 25614774 PMCID: PMC4298037 DOI: 10.2174/1874325001408010450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/06/2014] [Accepted: 11/13/2014] [Indexed: 01/28/2023] Open
Abstract
Objective: The aim of this study was to evaluate whether primary osteoarthritis (OA), independent of affected joint, is associated with a phenotype that is different from the phenotype in a normative cohort.
Material and Methods: We included 274 patients with primary OA, 30 women and 32 men (mean age 66 years, range 42-84) with primary hip OA, 38 women and 74 men (mean age 61 years; range 34-85) with primary knee OA, 42 women and 19 men (men age 64 years, range 42-87) with primary ankle or foot OA and 20 women and 19 men (mean age 66 years, range 47-88) with primary hand or finger OA. Of all patients included with OA, 23% had hip OA, 41% knee OA, 22% ankle or foot OA and 14% hand or finger OA. Serving as references were 122 women and 118 men of the same ages who were population-based, included as a control cohort. We measured total body BMD (g/cm2) and proportion of fat and lean mass (%) with dual energy X-ray absorptiometry. Height, weight and BMI (kg/m2) were also assessed. We then calculated Z-scores (number of standard deviations difference from the mean value of the control cohort) in the OA patients and compared these between the groups.
Results: Individuals with hand OA and controls had similar phenotype. Individuals with lower extremity OA, irrespective of the affected joint, had similar weight, BMI and BMD, but higher than in individuals with hand OA and controls (all p<0.05). Individuals with lower extremity OA had higher fat and lower lean mass than individuals with hand OA and controls (all p<0.001).
Conclusion: Individuals with primary OA in the lower extremity have a phenotype with higher BMD, higher BMI, proportionally higher fat content and lower lean body mass content. The different skeletal phenotypes in our patients with OA in the lower extremity and patients with hand OA indicate that separate pathophysiologic pathways may be responsible for primary OA in different joints
Collapse
Affiliation(s)
- Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Caroline Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Håkan Magnusson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Maria Cöster
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Tord von Schewelov
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Jan Åke Nilsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Lars Brudin
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| |
Collapse
|
64
|
Karlsson MK, Magnusson H, von Schewelov T, Cöster M, Karlsson C, Rosengren BE. Patients with Osteoarthritis in all Three Knee Compartments and Patients with Medial Knee Osteoarthritis Have a Phenotype with High Bone Mass and High Fat Mass but Proportionally Low Lean Mass. Open Orthop J 2014; 8:390-6. [PMID: 25408779 PMCID: PMC4235065 DOI: 10.2174/1874325001408010390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/17/2014] [Accepted: 09/21/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Cross-sectional studies have shown that patients with primary hip osteoarthritis (OA) have higher bone mineral density (BMD), higher BMI, lower lean body mass, and higher fat content. But it is unknown if this phenotype is found also in patients with knee OA and if it precedes OA or manifests as a result of the disease. PATIENTS AND METHODS We included 21 women and 18 men (mean age, 71 years; range, 48-85 years) with primary OA in all three knee compartments, 17 women and 56 men (mean age, 55 years; range, 34-74 years) with primary medial knee OA and 122 women and 121 men without OA as controls. We measured total body BMD (g/cm(2)), fat and lean mass (%) by dual energy X-ray absorptiometry and also registered height and weight to calculate BMI (kg/m(2)). Z-scores were calculated for each individual. Data are presented as means with 95% confidence intervals within brackets. RESULTS Individuals with primary OA in all three knee compartments had the following Z-scores: total body BMD 0.4 (0.0, 0.9); BMI 1.2 (0.7, 1.6); proportion of lean mass -0.6 (-1.1, -0.1); proportion of fat mass 0.4 (0.0, 1.8). Individuals with medial knee OA had the following Z-scores: total body BMD 0.4 (0.3, 0.6); BMI 1.1 (0.8, 1.4); proportion of lean mass -0.8 (-1.3, -0.9); proportion of fat mass 0.9 (0.7, 1.1). INTERPRETATIONS A phenotype with higher BMD, higher BMI, higher fat mass, and proportionally lower lean body mass is evident in individuals with primary OA in all three knee compartments and in patients with only medial knee OA.
Collapse
Affiliation(s)
- Magnus K Karlsson
- Department of Orthopedics, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Håkan Magnusson
- Department of Orthopedics, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Thord von Schewelov
- Department of Orthopedics, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Maria Cöster
- Department of Orthopedics, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Caroline Karlsson
- Department of Orthopedics, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Björn E Rosengren
- Department of Orthopedics, Skåne University Hospital, SE-205 02 Malmö, Sweden
| |
Collapse
|
65
|
Bone mineral density and association of osteoarthritis with fracture risk. Osteoarthritis Cartilage 2014; 22:1251-8. [PMID: 25042553 DOI: 10.1016/j.joca.2014.07.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 06/23/2014] [Accepted: 07/10/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE High body mass index (BMI) is associated with increased risk of osteoarthritis (OA) and reduced risk of fragility fracture. However, the relationship between fragility fracture and OA remained unclear. This study sought to investigate the effect of bone mineral density (BMD) in the OA-fracture relationship. METHODS Data from 2412 women and 1452 men aged >45 years in the Dubbo Osteoporosis Epidemiology Study (DOES) were analyzed. Individuals have been followed for up to 22 years (median: 7.5 years; range: 0.1-22 years). Femoral neck BMD (FNBMD) and lumbar spine BMD (LSBMD) was measured by dual energy X-ray absorptiometry (DXA) (GE LUNAR, Madison, WI). The presence of OA was ascertained at baseline by self-reported diagnosis. The incidence of low-trauma fracture was ascertained from X-ray reports. RESULTS Overall, 29% of women and 26% of men had reported a diagnosis of OA. Fracture risk was significantly higher in women with OA than those without OA (Hazard ratio (HR) = 1.50; 95% confidence interval (CI), 1.28-1.76). However, the association was mainly observed in women with osteopenic BMD (HR = 1.74; 95% CI, 1.38-2.17) and normal-BMD (HR = 1.50; 95% CI, 1.06-2.13) and not in those with osteoporosis. Further analysis revealed that osteopenic women with OA had significant increase in risk of vertebral (HR = 1.85; 95% CI, 1.24-2.75) and limb fracture (HR = 2.49; 95% CI, 1.77-3.48), but not in hip fracture. In men, no comparable relationship was found before and after adjustment for covariates. CONCLUSION Women with OA have an increased risk of fragility fracture, and the risk was mainly observed in non-osteoporotic group.
Collapse
|
66
|
Patients with hip osteoarthritis have a phenotype with high bone mass and low lean body mass. Clin Orthop Relat Res 2014; 472:1224-9. [PMID: 24276858 PMCID: PMC3940750 DOI: 10.1007/s11999-013-3395-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 11/18/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although hip osteoarthritis (OA) is common, its etiology is poorly understood. Specifically, it is not known whether hip OA is associated with abnormal relationships among the anthropometric and musculoskeletal characteristics that are associated with OA in general. QUESTIONS We asked whether patients with primary hip OA have a phenotype with higher bone mineral density (BMD), higher BMI, larger skeletal size, lower lean body mass, and higher fat content. MATERIAL AND METHODS We included 30 women and 32 men (mean age, 66 years; range, 42-84 years) with primary hip OA and 96 women and 91 men as control subjects. Dual energy x-ray absorptiometry was used to measure total body BMD (g/cm(2)), femoral neck width (cm), fat and lean mass (%), and BMI (kg/m(2)). Z scores were calculated for each individual. Data are presented as means with 95% CI. RESULTS Women with hip OA had the following Z scores: total body BMD 0.6 (0.3, 1.0); BMI 0.6 (0.2, 1.0); femoral neck width 0.2 (-0.6, 1.0); percent total body lean mass -0.9 (-1.2, -0.5); and percent total body fat mass 0.6 (0.2, 0.9). Men with hip OA had the following mean Z scores: total body BMD 0.5 (0.0, 1.0); BMI 0.8 (0.3, 1.3); femoral neck width 0.4 (0.01, 0.9); percent total body lean mass -0.8 (-1.1, -0.5); and percent total body fat mass 0.5 (0.2, 0.8). CONCLUSIONS Women and men with idiopathic hip OA have a phenotype with higher BMD, higher BMI, proportionally higher fat mass, and proportionally lower lean body mass. Men also have a larger skeletal size. CLINICAL RELEVANCE A higher BMD may lead to a stiffer bone and a proportionally lower lean body mass to lower joint-protective ability, both traits probably predisposing for hip OA.
Collapse
|
67
|
Ross RD, Hamilton JL, Wilson BM, Sumner DR, Virdi AS. Pharmacologic augmentation of implant fixation in osteopenic bone. Curr Osteoporos Rep 2014; 12:55-64. [PMID: 24293098 DOI: 10.1007/s11914-013-0182-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Osteoporosis presents a challenge for successful implant fixation due to an impaired healing response. Preclinical studies have consistently reported reduced osseointegration capability in trabecular bone. Although clinical studies of implant success in dentistry have not found a negative effect due to osteoporosis, low bone mass is a significant risk factor for implant migration in orthopedics. Pharmacologic treatment options that limit bone resorption or upregulate formation have been studied preclinically. While, both treatment options improve implant fixation, direct comparisons to-date have found anti-catabolic more effective than anabolic treatments for establishing implant fixation, but combination approaches are better than either treatment alone. Clinically, anti-catabolic treatments, particularly bisphosphonates have been shown to increase the longevity of implants, while limited clinical evidence on the effects of anabolic treatment exists. Preclinical experiments are needed to determine the effects of osteoporosis and subsequent treatment on the long-term maintenance of fixation and recovery after bone loss.
Collapse
Affiliation(s)
- R D Ross
- Anatomy and Cell Biology, Rush University Medical Center, 600 S. Paulina Street, Suite # AcFc 507, Chicago, IL, 60612, USA
| | | | | | | | | |
Collapse
|
68
|
Im GI, Kim MK. The relationship between osteoarthritis and osteoporosis. J Bone Miner Metab 2014; 32:101-9. [PMID: 24196872 DOI: 10.1007/s00774-013-0531-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 10/06/2013] [Indexed: 02/04/2023]
Abstract
The relationship between osteoarthritis (OA) and osteoporosis (OP), the two most common skeletal disorders related to aging, is controversial. Previous studies suggest that OA is inversely related to OP when studied cross-sectionally and systematically. However, there are differences in the results depending on the parameter used to define OA. The purpose of this review is to analyze and summarize the literature, and derive possible answers to three key questions along with a brief introduction on underlying mechanisms: (1) Is OA correlated to a high bone mineral density (BMD)? (2) Does OA influence the progression of OP or osteoporotic fractures? (3) Does high BMD affect the incidence and progression of OA? A review of the literature suggests that OA is inversely related to OP in general when studied cross-sectionally and systematically. However, when analyzed in individual bones, the BMD of the appendicular skeleton in OA-affected joints may decrease, particularly in the upper extremities. On whether OA influences bone loss or osteoporotic fractures, differences are observed according to the affected joints. The risk for osteoporotic fracture does not seem to decrease despite a high BMD in patients with OA, probably due to postural instability and muscle strength. Low BMD at the lumbar spine is associated with a lower incidence of knee OA although it does not arrest the progression of knee OA.
Collapse
Affiliation(s)
- Gun-Il Im
- Department of Orthopaedics, Dongguk University Ilsan Hospital, Goyang, 410-773, Republic of Korea,
| | | |
Collapse
|
69
|
Hahn MH, Won YY. Bone mineral density changes after total knee replacement in women over the age of 65. J Bone Metab 2013; 20:105-9. [PMID: 24524066 PMCID: PMC3910310 DOI: 10.11005/jbm.2013.20.2.105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 10/29/2013] [Accepted: 10/30/2013] [Indexed: 11/30/2022] Open
Abstract
Background There are few reports on bone mineral density (BMD) changes of axial bones after total knee replacement (TKR) due to severe osteoarthritis (OA) of the knee joint and its results are controversial. The purpose of our study was to measure the BMD changes of hip and spine in patients receiving TKR due to severe OA and to identify clinical factors relating BMD changes. Methods Among 66 female patients above 65 years old who underwent TKR due to severe OA and checked preoperative BMD, 52 patients who checked 1 year follow up BMD were enrolled. We investigated the association of the BMD changes with bilaterality of operation, obesity, preoperative knee functional scores, bisphosphonate medication, and diagnosis of osteoporosis. Results We found no correlation between BMD changes and bilaterality of operation, obesity, preoperative knee functional scores and diagnosis of osteoporosis. Spine BMD increased in non-treatment and bisphosphonate treatment group but total hip BMD significantly increased in bisphosphonate treatment group. Conclusions Bisphosphonate treatment for 1 year prevents early reduction of hip BMD just after TKR regardless osteoporosis diagnosis. We considered that the bisphosphonate medication would be beneficial to prevention of later hip fracture in elderly patient receiving TKR due to severe OA of knee joints.
Collapse
Affiliation(s)
- Myung Hoon Hahn
- Department of Orthopedic Surgery, Cheil General Hospital & Women's Health Care Center, Seoul, Korea
| | - Ye Yeon Won
- Department of Orthopedic Surgery, Medical College of Ajou University, Suwon, Korea
| |
Collapse
|
70
|
Sadeghi-Naini M, Smith TO, Gholami J, Nedjat S, Hing CB, Abolghasemian M. Pharmacologic interventions for preventing and treating periprosthetic osteoporosis following total hip arthroplasty. Hippokratia 2013. [DOI: 10.1002/14651858.cd010812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mohsen Sadeghi-Naini
- Tehran University of Medical Sciences; Multidisciplinary Orthopedic and Rheumatologic research association (MORRA); Num 56 - Vesal street Enghelab Avenue Tehran Iran 1417755331
| | - Toby O Smith
- University of East Anglia; Faculty of Medicine and Health Sciences; Queen's Building Norwich Norfolk UK NR4 7TJ
| | - Jaleh Gholami
- Tehran University of Medical Sciences; Faculty of Public Health; Pour Sina Street Keshavarz Boulevard Tehran Iran
| | - Saharnaz Nedjat
- Tehran University of Medical Sciences (TUMS); School of Public Health; Keshavarz Bulvar Tehran Iran 0098
| | - Caroline B Hing
- St George's Hospital; Department of Trauma and Orthopaedic Surgery; London UK
| | - Mansour Abolghasemian
- Shafa Hospital, Tehran University of Medical Sciences; Department of Orthopaedics; Jaleh street, Baharestan Square Tehran Iran 1157637131
| |
Collapse
|
71
|
Russell LA. Osteoporosis and Orthopedic Surgery: Effect of Bone Health on Total Joint Arthroplasty Outcome. Curr Rheumatol Rep 2013; 15:371. [DOI: 10.1007/s11926-013-0371-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
72
|
Pagès-Castellà A, Prieto Alhambra D. Artrosis, osteoporosis y fracturas: controversias y evidencias. Med Clin (Barc) 2013; 141:217-20. [DOI: 10.1016/j.medcli.2013.01.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 01/23/2013] [Accepted: 01/24/2013] [Indexed: 01/07/2023]
|
73
|
Castaño-Betancourt MC, Rivadeneira F, Bierma-Zeinstra S, Kerkhof HJM, Hofman A, Uitterlinden AG, van Meurs JBJ. Bone parameters across different types of hip osteoarthritis and their relationship to osteoporotic fracture risk. ACTA ACUST UNITED AC 2013. [DOI: 10.1002/art.37792] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
74
|
Rubinacci A, Tresoldi D, Scalco E, Villa I, Adorni F, Moro GL, Fraschini GF, Rizzo G. Comparative high-resolution pQCT analysis of femoral neck indicates different bone mass distribution in osteoporosis and osteoarthritis. Osteoporos Int 2012; 23:1967-75. [PMID: 21947103 DOI: 10.1007/s00198-011-1795-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 09/01/2011] [Indexed: 01/19/2023]
Abstract
SUMMARY Osteoarthritis is linked to a reduced risk of femoral fracture despite osteoporosis. Different bone distribution in the femoral neck in osteoarthritis and fracture was revealed using a peripheral quantitative computed tomography (pQCT) comparative analysis. Our findings sustain the presence of an adaptive mechanism of bone structure providing fracture protection in osteoarthritis. INTRODUCTION Although osteoarthritis is associated with reduced femoral fracture risk, it does not protect from bone loss. We investigated whether adaptive mechanisms are present at the arthritic joint, leading to reduced fracture risk, despite the presence of low bone mass density. METHODS We performed pQCT comparative analyses of human femoral neck specimens derived from 32 postmenopausal women who received hip prostheses for osteoarthritis (n = 19) or femoral fracture (n = 13) by applying an in-house automated software to extract bone structure descriptors, characterize trabecular and cortical bone distribution, and evaluate their mutual relationships. RESULTS The cortical bone volume and trabecular thickness were significantly (p < 0.05) higher in the osteoarthritis group than in the fracture group. Trabecular bone volume was also significantly (p < 0.05) higher in the osteoarthritis group than the fracture group at the inferior and anterior quadrants. Significance was maintained after adjusting for age, cortical bone volume, and cortical porosity thickness. Multiple linear regression analysis showed that thickness, volume, and apparent density of the trabecular region significantly (p < 0.05) correlated with the same cortical descriptors in osteoarthritis, but no significant relationship was found in the fracture group. Age differentially affected the mutual relationships in the two groups, showing a significant correlation with trabecular thickness in both groups and with apparent trabecular density only in femoral fracture group. CONCLUSIONS Starting from these differences in the structural descriptors, our study sustains the presence of a compensatory mechanism in osteoarthritis to preserve the mechanical competence of bone structure, despite the loss of trabecular bone, underlying lower fracture risk.
Collapse
MESH Headings
- Age Factors
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement
- Bone Density/physiology
- Female
- Femoral Neck Fractures/complications
- Femoral Neck Fractures/diagnostic imaging
- Femoral Neck Fractures/physiopathology
- Femoral Neck Fractures/surgery
- Femur Neck/diagnostic imaging
- Femur Neck/physiopathology
- Humans
- Image Processing, Computer-Assisted/methods
- Osteoarthritis, Hip/complications
- Osteoarthritis, Hip/diagnostic imaging
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/surgery
- Osteoporosis, Postmenopausal/complications
- Osteoporosis, Postmenopausal/diagnostic imaging
- Osteoporosis, Postmenopausal/physiopathology
- Osteoporotic Fractures/complications
- Osteoporotic Fractures/diagnostic imaging
- Osteoporotic Fractures/physiopathology
- Osteoporotic Fractures/surgery
- Tomography, X-Ray Computed
- Weight-Bearing/physiology
Collapse
Affiliation(s)
- A Rubinacci
- Bone Metabolism Unit, Scientific Institute San Raffaele, via Olgettina 60, 20132, Milan, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
75
|
Setty N, Leboff MS, Thornhill TS, Rinaldi G, Glowacki J. Underestimated fracture probability in patients with unilateral hip osteoarthritis as calculated by FRAX. J Clin Densitom 2011; 14:447-52. [PMID: 21852168 PMCID: PMC3360478 DOI: 10.1016/j.jocd.2011.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 06/02/2011] [Accepted: 06/08/2011] [Indexed: 11/29/2022]
Abstract
Osteoporosis (OP) and osteoarthritis (OA) are age-related diseases often considered to be mutually exclusive. We previously found that 25% of women with advanced OA had occult OP and that femoral neck (FN) bone mineral density (BMD) T-scores were significantly higher for osteoarthritic vs contralateral hips. The FRAX calculator incorporates clinical risk factors and FN BMD T-score to estimate 10-yr total fracture probability and hip fracture probability. In 35 women and men aged 41 yr or older with unilateral hip OA scheduled for hip replacement, we tested whether FRAX fracture probability is underestimated when using data for the OA rather than the contralateral hip. There were between-hip differences for FN BMD T-score (p<0.0001), total fracture probability (p =0.0004), and hip fracture probability (p =0.0009). Use of FN BMD T-scores resulted in OP treatment recommendations for 0% and 11% of subjects compared with 11% and 17% for total fracture probability and hip fracture probability, respectively. In 6-11% of subjects in this series, the FRAX calculator underestimated fracture probability with data for the OA hip. With the increased use of FRAX in clinical use, these data suggest that measurement of BMD at the contralateral hip may yield higher calculated FRAX total and hip fracture probabilities.
Collapse
Affiliation(s)
- Nithya Setty
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | |
Collapse
|
76
|
Prieto-Alhambra D, Javaid MK, Judge A, Maskell J, Kiran A, de Vries F, Cooper C, Arden NK. Fracture risk before and after total hip replacement in patients with osteoarthritis: Potential benefits of bisphosphonate use. ACTA ACUST UNITED AC 2011; 63:992-1001. [DOI: 10.1002/art.30214] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
77
|
Watson WS, Periasamy K, Meek RMD, Alm J, Aro HT. Female patients with low systemic BMD. Acta Orthop 2010; 81:768; author reply 769. [PMID: 21110706 PMCID: PMC3216091 DOI: 10.3109/17453674.2010.537811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- WS Watson
- Nuclear medicine department, Dept of Orthopaedics& Trauma, Southern General Hospital, Glasgow, U.K.
| | - K Periasamy
- Nuclear medicine department, Dept of Orthopaedics& Trauma, Southern General Hospital, Glasgow, U.K.
| | - RMD Meek
- Nuclear medicine department, Dept of Orthopaedics& Trauma, Southern General Hospital, Glasgow, U.K.
| | | | | |
Collapse
|