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Schadow JE, Maxey D, Smith TO, Finnilä MAJ, Manske SL, Segal NA, Wong AKO, Davey RA, Turmezei T, Stok KS. Systematic review of computed tomography parameters used for the assessment of subchondral bone in osteoarthritis. Bone 2024; 178:116948. [PMID: 37926204 DOI: 10.1016/j.bone.2023.116948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To systematically review the published parameters for the assessment of subchondral bone in human osteoarthritis (OA) using computed tomography (CT) and gain an overview of current practices and standards. DESIGN A literature search of Medline, Embase and Cochrane Library databases was performed with search strategies tailored to each database (search from 2010 to January 2023). The search results were screened independently by two reviewers against pre-determined inclusion and exclusion criteria. Studies were deemed eligible if conducted in vivo/ex vivo in human adults (>18 years) using any type of CT to assess subchondral bone in OA. Extracted data from eligible studies were compiled in a qualitative summary and formal narrative synthesis. RESULTS This analysis included 202 studies. Four groups of CT modalities were identified to have been used for subchondral bone assessment in OA across nine anatomical locations. Subchondral bone parameters measuring similar features of OA were combined in six categories: (i) microstructure, (ii) bone adaptation, (iii) gross morphology (iv) mineralisation, (v) joint space, and (vi) mechanical properties. CONCLUSIONS Clinically meaningful parameter categories were identified as well as categories with the potential to become relevant in the clinical field. Furthermore, we stress the importance of quantification of parameters to improve their sensitivity and reliability for the evaluation of OA disease progression and the need for standardised measurement methods to improve their clinical value.
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Affiliation(s)
- Jemima E Schadow
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
| | - David Maxey
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom.
| | - Toby O Smith
- Warwick Medical School, University of Warwick, United Kingdom.
| | - Mikko A J Finnilä
- Research Unit of Health Science and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Sarah L Manske
- Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Neil A Segal
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, United States.
| | - Andy Kin On Wong
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada; Schroeder's Arthritis Institute, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
| | - Rachel A Davey
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia.
| | - Tom Turmezei
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
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Pienkowski D, Wood CL, Malluche HH. Trabecular bone microcrack accumulation in patients treated with bisphosphonates for durations up to 16 years. J Orthop Res 2023; 41:1033-1039. [PMID: 36163612 PMCID: PMC10039958 DOI: 10.1002/jor.25441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/21/2022] [Accepted: 09/12/2022] [Indexed: 02/04/2023]
Abstract
This study quantified the length, number, and density of microcracks in bone from patients treated with bisphosphonates as a function of duration. Anterior iliac crest bone samples from 51 osteoporotic Caucasian females continuously treated with oral bisphosphonates for 1-16 years were obtained by bone biopsy. Samples were histologically processed and analyzed for bone area, microcrack number, and microcrack length. The analyses used statistical modeling and considered patient age, bone mineral density, bone volume/total volume, trabecular thickness, and bone turnover as potential covariates. Microcrack density (number of microcracks/total examined bone area) was linearly related (p = 0.018) to bisphosphonate treatment duration. None of the analyzed covariates contributed significantly to the observed relationship between microcrack density and bisphosphonate treatment duration. Observed increases in microcrack density with increasing bisphosphonate treatment duration is important because increasing levels of microcracks may not only affect bone remodeling but also reduce elastic modulus and are suspected to adversely affect other mechanical properties that may influence fracture risk. The present findings add to our prior results showing changes in bone material properties and modulus with bisphosphonate treatment duration and thereby provide a more comprehensive assessment of the relationship between bisphosphonate treatment duration and bone quality. Statement of Clinical Significance: The present findings provide information guiding clinical use of oral bisphosphonates for post-menopausal osteoporosis therapy.
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Affiliation(s)
- David Pienkowski
- F. Joseph Halcomb III, MD Department of Biomedical Engineering, University of Kentucky, Lexington, KY
| | | | - Hartmut H. Malluche
- Division of Nephrology, Bone & Mineral Metabolism, Department of Medicine, University of Kentucky, Lexington, KY
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3
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Soldati E, Roseren F, Guenoun D, Mancini L, Catelli E, Prati S, Sciutto G, Vicente J, Iotti S, Bendahan D, Malucelli E, Pithioux M. Multiscale Femoral Neck Imaging and Multimodal Trabeculae Quality Characterization in an Osteoporotic Bone Sample. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8048. [PMID: 36431532 PMCID: PMC9694313 DOI: 10.3390/ma15228048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Although multiple structural, mechanical, and molecular factors are definitely involved in osteoporosis, the assessment of subregional bone mineral density remains the most commonly used diagnostic index. In this study, we characterized bone quality in the femoral neck of one osteoporotic patients as compared to an age-matched control subject, and so used a multiscale and multimodal approach including X-ray computed microtomography at different spatial resolutions (pixel size: 51.0, 4.95 and 0.9 µm), microindentation and Fourier transform infrared spectroscopy. Our results showed abnormalities in the osteocytes lacunae volume (358.08 ± 165.00 for the osteoporotic sample vs. 287.10 ± 160.00 for the control), whereas a statistical difference was found neither for shape nor for density. The osteoporotic femoral head and great trochanter reported reduced elastic modulus (Es) and hardness (H) compared to the control reference (−48% (p < 0.0001) and −34% (p < 0.0001), respectively for Es and H in the femoral head and −29% (p < 0.01) and −22% (p < 0.05), respectively for Es and H in the great trochanter), whereas the corresponding values in the femoral neck were in the same range. The spectral analysis could distinguish neither subregional differences in the osteoporotic sample nor between the osteoporotic and healthy samples. Although, infrared spectroscopic measurements were comparable among subregions, and so regardless of the bone osteoporotic status, the trabecular mechanical properties were comparable only in the femoral neck. These results illustrate that bone remodeling in osteoporosis is a non-uniform process with different rates in different bone anatomical regions, hence showing the interest of a clear analysis of the bone microarchitecture in the case of patients’ osteoporotic evaluation.
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Affiliation(s)
- Enrico Soldati
- Aix Marseille University, CNRS, IUSTI, 13453 Marseille, France
- Aix Marseille University, CNRS, CRMBM, 13385 Marseille, France
- Aix Marseille University, CNRS, ISM, 13288 Marseille, France
| | - Flavy Roseren
- Aix Marseille University, CNRS, ISM, 13288 Marseille, France
| | - Daphne Guenoun
- Aix Marseille University, CNRS, ISM, 13288 Marseille, France
- Aix Marseille University, APHM, CNRS, ISM, Sainte Marguerite Hospital, Institute for Locomotion, Department of Radiology, 13274 Marseille, France
| | - Lucia Mancini
- Elettra-Sincrotrone Trieste S.C.p.A, SS 14–km 1535 in Area Science Park, Basovizza, 34149 Trieste, Italy
- Slovenian National Building and Civil Engineering Institute, Dimičeva ulica 12, 1000 Ljubljana, Slovenia
| | - Emilio Catelli
- University of Bologna, Department of Chemistry “G. Ciamician”, Ravenna Campus, Via Guaccimanni, 42, 48121 Ravenna, Italy
| | - Silvia Prati
- University of Bologna, Department of Chemistry “G. Ciamician”, Ravenna Campus, Via Guaccimanni, 42, 48121 Ravenna, Italy
| | - Giorgia Sciutto
- University of Bologna, Department of Chemistry “G. Ciamician”, Ravenna Campus, Via Guaccimanni, 42, 48121 Ravenna, Italy
| | - Jerome Vicente
- Aix Marseille University, CNRS, IUSTI, 13453 Marseille, France
| | - Stefano Iotti
- Università di Bologna, Department of Pharmacy and Biotechnology (FaBit), Via Zamboni 33, 40126 Bologna, Italy
- National Institute of Biostructures and Biosystems, Viale delle Medaglie d’Oro 305, 00136 Roma, Italy
| | - David Bendahan
- Aix Marseille University, CNRS, CRMBM, 13385 Marseille, France
| | - Emil Malucelli
- Università di Bologna, Department of Pharmacy and Biotechnology (FaBit), Via Zamboni 33, 40126 Bologna, Italy
| | - Martine Pithioux
- Aix Marseille University, CNRS, ISM, 13288 Marseille, France
- Aix Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13274 Marseille, France
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Wang F, Zheng L, Theopold J, Schleifenbaum S, Heyde CE, Osterhoff G. Methods for bone quality assessment in human bone tissue: a systematic review. J Orthop Surg Res 2022; 17:174. [PMID: 35313901 PMCID: PMC8935787 DOI: 10.1186/s13018-022-03041-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/02/2022] [Indexed: 02/07/2023] Open
Abstract
Background For biomechanical investigations on bone or bone implants, bone quality represents an important potential bias. Several techniques for assessing bone quality have been described in the literature. This study aims to systematically summarize the methods currently available for assessing bone quality in human bone tissue, and to discuss the advantages and limitations of these techniques. Methods A systematic review of the literature was carried out by searching the PubMed and Web of Science databases from January 2000 to April 2021. References will be screened and evaluated for eligibility by two independent reviewers as per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies must apply to bone quality assessment with imaging techniques, mechanical testing modalities, and compositional characterization. The terms used for the systematic search were: “(bone quality”. Ti,ab.) AND “(human bone specimens)”. Results The systematic review identified 502 relevant articles in total. Sixty-eight articles met the inclusion criteria. Among them, forty-seven articles investigated several imaging modalities, including radiography, dual-energy X-ray absorptiometry (DEXA), CT-based techniques, and MRI-based methods. Nineteen articles dealt with mechanical testing approaches, including traditional testing modalities and novel indentation techniques. Nine articles reported the correlation between bone quality and compositional characterization, such as degree of bone mineralization (DBM) and organic composition. A total of 2898 human cadaveric bone specimens were included. Conclusions Advanced techniques are playing an increasingly important role due to their multiple advantages, focusing on the assessment of bone morphology and microarchitecture. Non-invasive imaging modalities and mechanical testing techniques, as well as the assessment of bone composition, need to complement each other to provide comprehensive and ideal information on the bone quality of human bone specimens. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03041-4.
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Affiliation(s)
- Fangxing Wang
- ZESBO - Center for Research On Musculoskeletal Systems, Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany. .,Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany.
| | - Leyu Zheng
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany
| | - Jan Theopold
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany
| | - Stefan Schleifenbaum
- ZESBO - Center for Research On Musculoskeletal Systems, Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany
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Li Y, Liem Y, Dall'Ara E, Sullivan N, Ahmed H, Blom A, Sharif M. Subchondral bone microarchitecture and mineral density in human osteoarthritis and osteoporosis: A regional and compartmental analysis. J Orthop Res 2021; 39:2568-2580. [PMID: 33751647 DOI: 10.1002/jor.25018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/01/2021] [Accepted: 03/02/2021] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) and osteoporosis (OP) are historically considered to be inversely correlated but there may be an overlap between the pathophysiology of the two diseases. This study aimed to investigate the subchondral bone microarchitecture and matrix mineralization, and the association between them in OA and OP in relation to the degree of cartilage degeneration. Fifty-six osteochondral plugs were collected from 16 OA femoral heads. They were graded on a regional basis according to the stages of cartilage degeneration, as evaluated by a new macroscopic and a modified microscopic grading system. Twenty-one plugs were collected from seven femoral heads with OP. Plugs were scanned by microcomputed tomography and the microarchitectural and mineral properties were obtained for both subchondral plate and trabecular bone. Microarchitecture and material and apparent densities of subchondral bone in OP were similar to regions with early cartilage degeneration but different from regions with advanced cartilage degradation in OA femoral heads. Subchondral trabecular bone was more mineralized than subchondral plate in both OP and OA, and this compartmental difference varied by severity of cartilage degradation. Furthermore, the relationship among trabecular bone volume fraction, tissue mineral density, and apparent bone density was similar in OP and different stages of OA. Subchondral bone microarchitecture and mineral properties in OP are different from OA in a regionalized manner in relation to stages of cartilage degeneration. Both regional and compartmental differences at structural, material, and cellular levels need to be studied to understand the transition of OA subchondral bone from being osteoporotic to sclerotic.
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Affiliation(s)
- Yunfei Li
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yulia Liem
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Enrico Dall'Ara
- Department of Oncology and Metabolism and Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Niall Sullivan
- Department of Trauma and Orthopaedics, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Haroon Ahmed
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Ashley Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Mohammed Sharif
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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6
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The Management between Comorbidities and Pain Level with Physical Activity in Individuals with Hip Osteoarthritis with Surgical Indication: A Cross-Sectional Study. ACTA ACUST UNITED AC 2021; 57:medicina57090890. [PMID: 34577813 PMCID: PMC8470884 DOI: 10.3390/medicina57090890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
Background and Objectives: The degenerative pathology of the hip joint appears in young age groups, related to fem-oroacetabular impingement, and in advanced age, due to other inflammatory causes, with greater potential for severity in the presence of comorbidities. Objectives: To evaluate the participation of the main causes of osteoarthritis in relation to physical activities, s Body Mass Index (BMI) and television time (TV). Materials and Methods: 54 patients with surgical indication treated at an orthopedic referral university hospital were stratified into groups (Impact: I, Osteonecrosis/rheumatic: II, Infectious/traumatic: III), and the influence of comorbidities on physical activity performance, relative to BMI and TV time. Results: It was observed that the impact group was the most frequent (51.8%), with 79.6% under the age of 60 years. This group followed the general mean (p < 0.05), using the variables of comorbidity and the level of physical activity. Pain intensity, TV time, BMI showed no correlation with physical activity. Conclusion: Morphostructural changes (group I) represented the most frequent etiological group, and severe pain was common in almost the entire sample. Unlike BMI, comorbidity showed a significant relationship with the level of physical activity.
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Ryan MK, Oliviero S, Costa MC, Wilkinson JM, Dall’Ara E. Heterogeneous Strain Distribution in the Subchondral Bone of Human Osteoarthritic Femoral Heads, Measured with Digital Volume Correlation. MATERIALS 2020; 13:ma13204619. [PMID: 33081288 PMCID: PMC7603047 DOI: 10.3390/ma13204619] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022]
Abstract
Osteoarthritis (OA) is a chronic disease, affecting approximately one third of people over the age of 45. Whilst the etiology and pathogenesis of the disease are still not well understood, mechanics play an important role in both the initiation and progression of osteoarthritis. In this study, we demonstrate the application of stepwise compression, combined with microCT imaging and digital volume correlation (DVC) to measure and evaluate full-field strain distributions within osteoarthritic femoral heads under uniaxial compression. A comprehensive analysis showed that the microstructural features inherent in OA bone did not affect the level of uncertainties associated with the applied methods. The results illustrate the localization of strains at the loading surface as well as in areas of low bone volume fraction and subchondral cysts. Trabecular thickness and connectivity density were identified as the only microstructural parameters with any association to the magnitude of local strain measured at apparent yield strain or the volume of bone exceeding yield strain. This work demonstrates a novel approach to evaluating the mechanical properties of the whole human femoral head in case of severe OA.
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Affiliation(s)
- Melissa K. Ryan
- Department of Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield S10 2TN, UK; (S.O.); (M.C.C.); (J.M.W.); (E.D.)
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield S10 2TN, UK
- Medical Device Research Institute, Flinders University, Adelaide 5042, Australia
- Correspondence: ; Tel.: +61-8-8201-3208
| | - Sara Oliviero
- Department of Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield S10 2TN, UK; (S.O.); (M.C.C.); (J.M.W.); (E.D.)
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield S10 2TN, UK
| | - Maria Cristiana Costa
- Department of Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield S10 2TN, UK; (S.O.); (M.C.C.); (J.M.W.); (E.D.)
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield S10 2TN, UK
| | - J. Mark Wilkinson
- Department of Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield S10 2TN, UK; (S.O.); (M.C.C.); (J.M.W.); (E.D.)
| | - Enrico Dall’Ara
- Department of Oncology and Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield S10 2TN, UK; (S.O.); (M.C.C.); (J.M.W.); (E.D.)
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield S10 2TN, UK
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8
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He Z, Chu L, Liu X, Han X, Zhang K, Yan M, Li X, Yu Z. Differences in subchondral trabecular bone microstructure and finite element analysis-based biomechanical properties between osteoporosis and osteoarthritis. J Orthop Translat 2020; 24:39-45. [PMID: 32642427 PMCID: PMC7320230 DOI: 10.1016/j.jot.2020.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 01/06/2023] Open
Abstract
Background/Objective The microstructure of the subchondral trabecular bone, including the composition and distribution of plates and rods, has an important influence on the disease progression and mechanical properties of osteoarthritis (OA) and osteoporosis (OP). We aimed to determine whether differences in plates and rods influence the variations in the quantities and qualities of the subchondral trabecular bone between OA and OP. Materials and methods Thirty-eight femoral head samples [OA, n = 13; OP, n = 17; normal control (NC), n = 8] were collected from male patients undergoing total hip arthroplasty. They were scanned using microcomputed tomography, and subchondral trabecular structures were analysed using individual trabecular segmentation. Micro-finite element analysis (μFEA) was applied to assess the mechanical property of the trabecular bone. Cartilage changes were evaluated by using histological assessment. Analysis of variance was used to compare intergroup differences in structural and mechanical properties and cartilage degradation. Pearson analysis was used to evaluate the relationship between the trabecula microstructure and biomechanical properties. Results Compared with the OP and NC group, there was serious cartilage damage in the OA group. With respect to the microstructure results, the OA group had the highest plate and rod trabecular microstructures including number and junction density among the three groups. For the mechanical properties detected via μFEA, the OA group had higher stiffness and failure load than did the OP group. Pearson analysis revealed that compared with OP, OA had a higher number of microstructure parameters (e.g., rod bone volume fraction and rod trabecular number) that were positively correlated with its mechanical property. Conclusions Compared with OP, the OA subchondral bone has both increased plate and rod microarchitecture and has more microstructures positively related with its mechanical property. These differences may help explain the variation in mechanical properties between these bone diseases. The translational potential of this article Our findings suggested that changes in the plates and rods of the subchondral trabecular bone play a critical role in OA and OP progression and that the improvement of the subchondral trabecular bone may be a promising treatment approach.
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Affiliation(s)
- Zihao He
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Linyang Chu
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200011, China
| | - Xuqiang Liu
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, The Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi, China
| | - Xuequan Han
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Kai Zhang
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Mengning Yan
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xiaofeng Li
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, The Artificial Joint Engineering and Technology Research Center of Jiangxi Province, Nanchang, Jiangxi, China
- Corresponding author.
| | - Zhifeng Yu
- Shanghai Key Laboratory of Orthopedic Implant, Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Corresponding author.
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9
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Xie W, Li F, Han Y, Qin Y, Wang Y, Chi X, Xiao J, Li Z. Neuropeptide Y1 receptor antagonist promotes osteoporosis and microdamage repair and enhances osteogenic differentiation of bone marrow stem cells via cAMP/PKA/CREB pathway. Aging (Albany NY) 2020; 12:8120-8136. [PMID: 32381754 PMCID: PMC7244071 DOI: 10.18632/aging.103129] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/30/2020] [Indexed: 12/15/2022]
Abstract
Osteoporosis is a common metabolic bone disorder in the elderly population. The accumulation of bone microdamage is a critical factor of osteoporotic fracture. Neuropeptide Y (NPY) has been reported to regulated bone metabolism through Y1 receptor (Y1R). In this study the effects and mechanisms of Y1R antagonist on prevention for osteoporosis were characterized. In the clinical experiment, compared with osteoarthritis (OA), osteoporosis (OP) showed significant osteoporotic bone microstructure and accumulation of bone microdamage. NPY and Y1R immunoreactivity in bone were stronger in OP group, and were both correlated with bone volume fraction (BV/TV). In vivo experiment, Y1R antagonist significantly improved osteoporotic microstructure in the ovariectomized (OVX) rats. And Y1R antagonist promoted RUNX2, OPG and inhibit RANKL, MMP9 in bone marrow. In vitro cell culture experiment, NPY inhibited osteogenesis, elevated RANKL/OPG ratio and downregulated the expression of cAMP, p-PKAs and p-CREB in BMSCs, treated with Y1R antagonist or 8-Bromo-cAMP could inhibit the effects of NPY. Together, Y1R antagonist improved the bone microstructure and reduced bone microdamage in OVX rats. NPY-Y1R could inhibit osteoblast differentiation of BMSCs via cAMP/PKA/CREB pathway. Our findings highlight the regulation of NPY-Y1R in bone metabolism as a potential therapy strategy for the prevention of osteoporosis and osteoporotic fracture.
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Affiliation(s)
- Weixin Xie
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.,Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Fan Li
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.,Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yi Han
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yi Qin
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yuan Wang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Xiaoying Chi
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Jie Xiao
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Zhanchun Li
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
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10
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Dai G, Xiao H, Liao J, Zhou N, Zhao C, Xu W, Xu W, Liang X, Huang W. Osteocyte TGFβ1‑Smad2/3 is positively associated with bone turnover parameters in subchondral bone of advanced osteoarthritis. Int J Mol Med 2020; 46:167-178. [PMID: 32319543 PMCID: PMC7255453 DOI: 10.3892/ijmm.2020.4576] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/02/2020] [Indexed: 12/22/2022] Open
Abstract
Subchondral sclerosis is considered the main characteristic of advanced osteoarthritis, in which bone remodeling mediated by transforming growth factor β (TGFβ) signaling plays an indispensable role in the metabolism. Osteocytes have been identified as pivotal regulators of bone metabolism, due to their mechanosensing and endocrine function. Therefore, the aim of the present study was to investigate the association between osteocyte TGFβ signal and subchondral sclerosis. Knee tibia plateau samples were collected from osteoarthritic patients and divided into three groups: The full cartilage, partial cartilage and full defect groups. Next, changes in osteocyte TGFβ signaling and subchondral bone structure underlying various types of cartilage erosion were detected. Bone mineral density (BMD) assay, histology [hematoxylin and eosin, Safranin‑O/Fast green, and tartrate resistant acid phosphatase (TRAP) staining], and reverse transcription‑quantitative PCR mainly detected structural alterations, osteogenic and osteoclastic activity in the cartilage and subchondral bone. The activation of the TGFβ signaling pathway in the subchondral bone was detected by immunohistochemistry and western blotting. The association between osteocyte TGFβ and the regulation of bone metabolism was analyzed by correlation analysis, and further proven in vitro. It was confirmed that the BMD of the subchondral bone increased and underwent sclerosis in the partial cartilage and full defect groups. Additional observation included the thinning of the area of calcified cartilage, in which a bone island formed locally, with subchondral bone plate thickening and increased trabecular bone volume. TRAP staining suggested an increase in bone resorption in subchondral underlying areas of the partial cartilage and full defect groups. Immunohistochemistry results confirmed the activation of osteocyte TGFβ in subchondral underlying areas with severe cartilage erosion. Moreover, osteocyte phosphorylated‑Smad2/3 was positively correlated with subchondral BMD, alkaline phosphatase and osteopontin mRNA expression, but it was negatively correlated with TRAP+ cells. Furthermore, it was confirmed in vitro that osteocyte TGFβ signaling could regulate the osteogenic and osteoclastic activity of the mesenchymal stem cells. This study illustrated that osteocyte TGFβ signaling is positively associated with the remodeling of subchondral bone in advanced osteoarthritis and provides a preliminary theoretical basis for further investigations of the role and mechanism of osteocyte TGFβ in subchondral of osteoarthritis.
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Affiliation(s)
- Guangming Dai
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Haozhuo Xiao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Junyi Liao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Nian Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Chen Zhao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Wei Xu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Wenjuan Xu
- Institute of Life and Science Research, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xi Liang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Wei Huang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
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11
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Arnold EL, Clement J, Rogers KD, Garcia-Castro F, Greenwood C. The use of μCT and fractal dimension for fracture prediction in osteoporotic individuals. J Mech Behav Biomed Mater 2020; 103:103585. [PMID: 32090913 DOI: 10.1016/j.jmbbm.2019.103585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 11/16/2022]
Abstract
Osteoporosis (OP) is a widespread condition with commonly associated fracture sites at the hip, vertebra and wrist. This study examines the effects of age and osteoporosis on bone quality by comparing the efficacy of using parameters which indicate bone quality (both traditional clinical parameters such as bone mineral density (BMD), as well as apparent Young's modulus determined by finite element analysis, among others) to predict fracture. Non-fracture samples were collected from the femoral heads of 83 donors (44 males, 39 females), and fracture samples were obtained from the femoral heads of 17 donors (female). Microarchitectural parameters (Bone Volume/Total Volume [BV/TV], Bone Surface/Bone Volume [BS/BV], Tissue Mineral Density [TMD, etc.]) were measured from μCT of each sample as well as 2D and 3D fractal dimension (D2D and D3D respectively). A cube was cropped from μCT images and an isotropic hexahedral element was assigned to each voxel. Finite element analysis was used to calculate the Young's modulus for each sample. Overall, values for microarchitectural characteristics, fractal dimension measurements and Young's Modulus were consistent with values within literature. Significant correlations are observed between age and BV/TV for non-fracture males and females, as well as between age and volumetric BMD (vBMD) for the same groups. Significant differences are present between age-matched non-fracture and fracture females for BV/TV, BS/BV, vBMD, TMD, D2D, D3D, (p < 0.01 for all). Properties which are not age dependent are significantly different between age-matched non-fracture and fracture specimens, indicating OP is a disease, and not just an accelerated aging process.
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Affiliation(s)
- Emily L Arnold
- Cranfield Forensic Institute, Cranfield University, Shrivenham, UK.
| | - John Clement
- Melbourne Dental School, University of Melbourne, Australia
| | - Keith D Rogers
- Cranfield Forensic Institute, Cranfield University, Shrivenham, UK
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12
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Subchondral bone deterioration in femoral heads in patients with osteoarthritis secondary to hip dysplasia: A case-control study. J Orthop Translat 2019; 24:190-197. [PMID: 33101970 PMCID: PMC7548347 DOI: 10.1016/j.jot.2019.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/20/2019] [Accepted: 10/28/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives Residual hip dysplasia is the most common underlying condition leading to secondary osteoarthritis (OA) of the hip. Subchondral bone alterations in OA secondary to hip dysplasia (HD-OA) are poorly investigated. The aim of the present study was to analyse the microarchitecture, bone remodelling and pathological alterations of subchondral bone in femoral heads from patients with HD-OA. Methods Subchondral bone specimens were extracted from both weight-bearing and non–weight-bearing regions of femoral heads from 20 patients with HD-OA and 20 patients with osteoporotic femoral neck fracture, during hip replacement surgery. Micro-CT and histological examination were performed to assess the microarchitecture and histopathological changes. Results The weight-bearing subchondral bone showed significantly more sclerotic microarchitecture and higher bone remodelling level in HD-OA as compared with osteoporosis. In the non–weight-bearing region, the two diseases shared similar microarchitectural characteristics, but higher bone remodelling level was detected in HD-OA. Distinct regional differences were observed in HD-OA, whereas the two regions exhibited similar characteristics in osteoporosis. In addition, HD-OA displayed more serious pathological alterations, including subchondral bone cyst, metaplastic cartilaginous tissue, bone marrow oedema and fibrous tissue, especially in the weight-bearing region. Conclusions Osteoarthritic deteriorations of subchondral bone induced by hip dysplasia spread throughout the whole joint, but exhibit region-dependent variations, with the weight-bearing region more seriously affected. Biomechanical stress might exert a pivotal impact on subchondral bone homeostasis in hip dysplasia. The translational potential of this article The histomorphometric findings in the project indicate an early intervention for the development of hip dysplasia in clinic.
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13
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Shimamura M, Iwata K, Mashiba T, Miki T, Yamamoto T. Accumulation of microdamage in subchondral bone at the femoral head in patients with end-stage osteoarthritis of the hip. J Bone Miner Metab 2019; 37:880-885. [PMID: 30701320 DOI: 10.1007/s00774-019-00988-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/10/2019] [Indexed: 01/13/2023]
Abstract
In end-stage osteoarthritis (OA) of the hip, the effect of bone metabolism with and without cartilage is unclear. In this study, we aimed to investigate histomorphology and microdamage in the subchondral bone of the femoral head in areas with and without articular cartilage in patients with end-stage OA. Nineteen femoral heads were evaluated in 10 women who underwent total hip arthroplasty for OA and in nine cadaveric controls (CNT). Chondral thickness and subchondral bone plate thickness (SBP.Th) were measured in 5-mm-wide areas where cartilage was lost (area A) or preserved (area B) in OA and in corresponding areas in the load-bearing portion of the femoral head in the CNT. Histomorphometry and microdamage in 5 × 5-mm areas of cancellous bone were assessed. SBP.Th and bone volume were significantly greater in area A than in area B or in the CNT. Osteoid volume was significantly greater in area A than in area B or in the CNT. There was no significant difference in eroded surface between area A and CNT. Microcrack density was significantly greater in area A than in area B or in the CNT. Although accumulation of microdamage was caused by concentration of stress on the subchondral bone in the cartilage loss area in end-stage OA, remodeling for microdamage repairing mechanism was not enhanced. It was considered that the subchondral cancellous bone volume was increased because of modeling, not remodeling, by stress concentration due to articular cartilage loss.
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Affiliation(s)
- Masashi Shimamura
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Ken Iwata
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Tasuku Mashiba
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Takanori Miki
- Department of Anatomy and Neurobiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Tetsuji Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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14
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Pienkowski D, Wood CL, Malluche HH. Young's modulus and hardness of human trabecular bone with bisphosphonate treatment durations up to 20 years. Osteoporos Int 2019; 30:277-285. [PMID: 30488274 DOI: 10.1007/s00198-018-4760-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
UNLABELLED Bone modulus from patients with osteoporosis treated with bisphosphonates for 1 to 20 years was analyzed. Modulus increases during the first 6 years of treatment and remains unchanged thereafter. INTRODUCTION Bisphosphonates are widely used for treating osteoporosis, but the relationship between treatment duration and bone quality is unclear. Since material properties partially determine bone quality, the present study quantified the relationship between human bone modulus and hardness with bisphosphonate treatment duration. METHODS Iliac crest bone samples from a consecutive case series of 86 osteoporotic Caucasian women continuously treated with oral bisphosphonates for 1.1-20 years were histologically evaluated to assess bone turnover and then tested using nanoindentation. Young's modulus and hardness were measured and related to bisphosphonate treatment duration by statistical modeling. RESULTS All bone samples had low bone turnover. Statistical models showed that with increasing bisphosphonate treatment duration, modulus and hardness increased, peaked, and plateaued. These models used quadratic terms to model modulus increases from 1 to 6 years of bisphosphonate treatment and linear terms to model modulus plateaus from 6 to 20 years of treatment. The treatment duration at which the quadratic-linear transition (join point) occurred also depended upon trabecular location. Hardness increased and peaked at 12.4 years of treatment; it remained constant for the next 7.6 years of treatment and was insensitive to trabecular location. CONCLUSIONS Bone modulus increases with bisphosphonate treatment durations up to 6 years, no additional modulus increases occurred after 6 years of treatment. Although hardness increased, peaked at 12.4 years and remained constant for the next 7.6 years of BP treatment, the clinical relevance of hardness remains unclear.
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Affiliation(s)
- D Pienkowski
- F. Joseph Halcomb III, MD Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
| | - C L Wood
- Department of Statistics, University of Kentucky, Lexington, KY, USA
| | - H H Malluche
- Division of Nephrology, Bone & Mineral Metabolism, Department of Medicine, University of Kentucky Chandler Medical Center, 800 Rose Street, MN-564, Lexington, KY, 40536-0298, USA.
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15
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Greenwood C, Clement J, Dicken A, Evans P, Lyburn I, Martin RM, Stone N, Zioupos P, Rogers K. Age-Related Changes in Femoral Head Trabecular Microarchitecture. Aging Dis 2018; 9:976-987. [PMID: 30574411 PMCID: PMC6284768 DOI: 10.14336/ad.2018.0124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/24/2018] [Indexed: 11/20/2022] Open
Abstract
Osteoporosis is a prevalent bone condition, characterised by low bone mineral density and increased fracture risk. Currently, the gold standard for identifying osteoporosis and increased fracture risk is through quantification of bone mineral density using dual energy X-ray absorption. However, many studies have shown that bone strength, and consequently the probability of fracture, is a combination of both bone mass and bone 'quality' (architecture and material chemistry). Although the microarchitecture of both non-fracture and osteoporotic bone has been previously investigated, many of the osteoporotic studies are constrained by factors such as limited sample number, use of ovariectomised animal models, and lack of male and female discrimination. This study reports significant differences in bone quality with respect to the microarchitecture between fractured and non-fractured human femur specimens. Micro-computed tomography was utilised to investigate the microarchitecture of femoral head trabecular bone from a relatively large cohort of non-fracture and fracture human donors. Various microarchitectural parameters have been determined for both groups, providing an understanding of the differences between fracture and non -fracture material. The microarchitecture of non-fracture and fracture bone tissue is shown to be significantly different for many parameters. Differences between sexes also exist, suggesting differences in remodelling between males and females in the fracture group. The results from this study will, in the future, be applied to develop a fracture model which encompasses bone density, architecture and material chemical properties for both female and male tissues.
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Affiliation(s)
| | - John Clement
- Melbourne Dental School, University of Melbourne, Melbourne, Australia.
| | - Anthony Dicken
- The Imaging Science Group, Nottingham Trent University, Nottingham, UK.
| | - Paul Evans
- The Imaging Science Group, Nottingham Trent University, Nottingham, UK.
| | | | | | - Nick Stone
- Physics and Astronomy, Exeter University, Exeter, UK.
| | - Peter Zioupos
- Cranfield Forensic Institute, Cranfield University, Shrivenham, UK.
| | - Keith Rogers
- Cranfield Forensic Institute, Cranfield University, Shrivenham, UK.
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16
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Zhao S, Arnold M, Ma S, Abel RL, Cobb JP, Hansen U, Boughton O. Standardizing compression testing for measuring the stiffness of human bone. Bone Joint Res 2018; 7:524-538. [PMID: 30258572 PMCID: PMC6138811 DOI: 10.1302/2046-3758.78.bjr-2018-0025.r1] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objectives The ability to determine human bone stiffness is of clinical relevance in many fields, including bone quality assessment and orthopaedic prosthesis design. Stiffness can be measured using compression testing, an experimental technique commonly used to test bone specimens in vitro. This systematic review aims to determine how best to perform compression testing of human bone. Methods A keyword search of all English language articles up until December 2017 of compression testing of bone was undertaken in Medline, Embase, PubMed, and Scopus databases. Studies using bulk tissue, animal tissue, whole bone, or testing techniques other than compression testing were excluded. Results A total of 4712 abstracts were retrieved, with 177 papers included in the analysis; 20 studies directly analyzed the compression testing technique to improve the accuracy of testing. Several influencing factors should be considered when testing bone samples in compression. These include the method of data analysis, specimen storage, specimen preparation, testing configuration, and loading protocol. Conclusion Compression testing is a widely used technique for measuring the stiffness of bone but there is a great deal of inter-study variation in experimental techniques across the literature. Based on best evidence from the literature, suggestions for bone compression testing are made in this review, although further studies are needed to establish standardized bone testing techniques in order to increase the comparability and reliability of bone stiffness studies. Cite this article: S. Zhao, M. Arnold, S. Ma, R. L. Abel, J. P. Cobb, U. Hansen, O. Boughton. Standardizing compression testing for measuring the stiffness of human bone. Bone Joint Res 2018;7:524–538. DOI: 10.1302/2046-3758.78.BJR-2018-0025.R1.
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Affiliation(s)
- S Zhao
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - M Arnold
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - S Ma
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK and Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - R L Abel
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - J P Cobb
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK
| | - U Hansen
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - O Boughton
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, UK and Department of Mechanical Engineering, Imperial College London, London, UK
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17
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Bencardino JT, Stone TJ, Roberts CC, Appel M, Baccei SJ, Cassidy RC, Chang EY, Fox MG, Greenspan BS, Gyftopoulos S, Hochman MG, Jacobson JA, Mintz DN, Mlady GW, Newman JS, Rosenberg ZS, Shah NA, Small KM, Weissman BN. ACR Appropriateness Criteria ® Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excluding Other Vertebrae. J Am Coll Radiol 2018; 14:S293-S306. [PMID: 28473086 DOI: 10.1016/j.jacr.2017.02.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022]
Abstract
Stress fractures, including both fatigue and insufficiency types, are frequently encountered in clinical practice as a source of pain in both athletes and patients with predisposing conditions. Radiography is the imaging modality of choice for baseline diagnosis. MRI has greatly improved our ability to diagnose radiographically occult stress fractures. Tc-99m bone scan and CT may also be useful as diagnostic tools. Although fatigue and insufficiency fractures can be self-limited and go onto healing even without diagnosis, there is usually value in initiating prompt therapeutic measures as incomplete stress fractures have the potential of progressing to completion and requiring more invasive treatment or delay in return to activity. This is particularly important in the setting of stress fractures of the femoral neck. Accuracy in the identification of these injuries is also relevant because the differential diagnosis includes entities that would otherwise be treated significantly different (ie, osteoid osteoma, osteomyelitis, and metastasis). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jenny T Bencardino
- Principal Author and Panel Vice-Chair, New York University School of Medicine, New York, New York.
| | - Taylor J Stone
- Research Author, Charlotte Radiology, Charlotte, North Carolina
| | | | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York; American Academy of Orthopaedic Surgeons
| | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | - Eric Y Chang
- VA San Diego Healthcare System, San Diego, California
| | - Michael G Fox
- University of Virginia Health System, Charlottesville, Virginia
| | | | | | - Mary G Hochman
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jon A Jacobson
- University of Michigan Medical Center, Ann Arbor, Michigan
| | | | - Gary W Mlady
- University of New Mexico, Albuquerque, New Mexico
| | | | | | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
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18
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Human type H vessels are a sensitive biomarker of bone mass. Cell Death Dis 2017; 8:e2760. [PMID: 28471445 PMCID: PMC5520742 DOI: 10.1038/cddis.2017.36] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/25/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023]
Abstract
Vascularization is fundamental for bone formation and bone tissue homeostasis. However, in human subjects, a direct molecular relationship has not been identified between angiogenesis and agents that promote bone disease or factors related to age. Osteopenia is a condition in which bone mineral density is lower than normal, and it represents a sign of normal aging. Here we tested whether the type H vessel, which was recently identified as strongly positive for CD31 and Endomucin (CD31hiEmcnhi) in mice, is an important indicator of aging and osteopenia in human subjects. We found that age-dependent losses of type H vessels in human bone sections conform to the observations in aged mice. The abundance of human type H vessels and osteoprogenitors may be relevant to changes in the skeletal microarchitecture and advanced osteopenia. Furthermore, ovariectomized mice, a widely used model for postmenopausal osteoporosis, exhibited significantly reduced type H vessels accompanied by reduced osteoprogenitors, which is consistent with impaired bone microarchitecture and osteoporosis, suggesting that this feature is an indicator of bone mass independent of aging. More importantly, administration of desferrioxamine led to significantly increased bone mass via enhanced angiogenesis and increased type H vessels in ovariectomized mice. Altogether, these data represent a novel finding that type H vessels are regulated in aged and osteopenia subjects. The abundance of human type H vessels is an early marker of bone loss and represents a potential target for improving bone quality via the induction of type H vessels.
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19
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Finnilä MAJ, Thevenot J, Aho O, Tiitu V, Rautiainen J, Kauppinen S, Nieminen MT, Pritzker K, Valkealahti M, Lehenkari P, Saarakkala S. Association between subchondral bone structure and osteoarthritis histopathological grade. J Orthop Res 2017; 35:785-792. [PMID: 27227565 PMCID: PMC5412847 DOI: 10.1002/jor.23312] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/19/2016] [Indexed: 02/04/2023]
Abstract
Despite increasing evidence that subchondral bone contributes to osteoarthritis (OA) pathogenesis, little is known about local changes in bone structure compared to cartilage degeneration. This study linked structural adaptation of subchondral bone with histological OA grade. Twenty-five osteochondral samples of macroscopically different degeneration were prepared from tibiae of 14 patients. Samples were scanned with micro-computed tomography (μCT) and both conventional structural parameters and novel 3D parameters based on local patterns were analyzed from the subchondral plate and trabecular bone. Subsequently, samples were processed for histology and evaluated for OARSI grade. Each bone parameter and OARSI grade was compared to assess structural adaptation of bone with OA severity. In addition, thicknesses of cartilage, calcified cartilage, and subchondral plate were analyzed from histological sections and compared with subchondral bone plate thickness from μCT. With increasing OARSI grade, the subchondral plate became thicker along with decreased specific bone surface, while there was no change in tissue mineral density. Histological analysis showed that subchondral plate thickness from μCT also includes calcified cartilage. Entropy of local patterns increased with OA severity, reflecting higher tissue heterogeneity. In the trabecular compartment, bone volume fraction and both trabecular thickness and number increased with OARSI grade while trabecular separation and structure model index decreased. Also, elevation of local patterns became longitudinal in the subchondral plate and axial transverse in trabecular bone with increasing OARSI grade. This study demonstrates the possibility of radiological assessment of OA severity by structural analysis of bone. © 2016 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. J Orthop Res 35:785-792, 2017.
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Affiliation(s)
- Mikko A. J. Finnilä
- Research Unit of Medical Imaging, Physics and TechnologyFaculty of Medicine, University of OuluOuluFinland,Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland,Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Jérôme Thevenot
- Research Unit of Medical Imaging, Physics and TechnologyFaculty of Medicine, University of OuluOuluFinland,Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Olli‐Matti Aho
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland,Cancer and Translational Medicine Research UnitFaculty of MedicineUniversity of OuluOuluFinland
| | - Virpi Tiitu
- Institute of Biomedicine, AnatomyUniversity of Eastern FinlandKuopioFinland
| | - Jari Rautiainen
- Research Unit of Medical Imaging, Physics and TechnologyFaculty of Medicine, University of OuluOuluFinland,Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland,Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Sami Kauppinen
- Research Unit of Medical Imaging, Physics and TechnologyFaculty of Medicine, University of OuluOuluFinland
| | - Miika T. Nieminen
- Research Unit of Medical Imaging, Physics and TechnologyFaculty of Medicine, University of OuluOuluFinland,Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland,Department of Diagnostic RadiologyOulu University HospitalOuluFinland
| | - Kenneth Pritzker
- Department of Laboratory Medicine and PathobiologyUniversity of Toronto and Mount Sinai HospitalTorontoOntarioCanada
| | | | - Petri Lehenkari
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland,Cancer and Translational Medicine Research UnitFaculty of MedicineUniversity of OuluOuluFinland,Department of SurgeryOulu University HospitalOuluFinland
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and TechnologyFaculty of Medicine, University of OuluOuluFinland,Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland,Department of Diagnostic RadiologyOulu University HospitalOuluFinland
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21
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Lowitz T, Museyko O, Bousson V, Chappard C, Laouisset L, Laredo JD, Engelke K. Advanced Knee Structure Analysis (AKSA): a comparison of bone mineral density and trabecular texture measurements using computed tomography and high-resolution peripheral quantitative computed tomography of human knee cadavers. Arthritis Res Ther 2017; 19:1. [PMID: 28073368 PMCID: PMC5223490 DOI: 10.1186/s13075-016-1210-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/13/2016] [Indexed: 12/21/2022] Open
Abstract
Background A change of loading conditions in the knee causes changes in the subchondral bone and may be a cause of osteoarthritis (OA). However, quantification of trabecular architecture in vivo is difficult due to the limiting spatial resolution of the imaging equipment; one approach is the use of texture parameters. In previous studies, we have used digital models to simulate changes of subchondral bone architecture under OA progression. One major result was that, using computed tomography (CT) images, subchondral bone mineral density (BMD) in combination with anisotropy and global homogeneity could characterize this progression. The primary goal of this study was a comparison of BMD, entropy, anisotropy, variogram slope, and local and global inhomogeneity measurements between high-resolution peripheral quantitative CT (HR-pQCT) and CT using human cadaveric knees. The secondary goal was the verification of the spatial resolution dependence of texture parameters observed in the earlier simulations, two important prerequisites for the interpretation of in vivo measurements in OA patients. Method The applicability of texture analysis to characterize bone architecture in clinical CT examinations was investigated and compared to results obtained from HR-pQCT. Fifty-seven human knee cadavers (OA status unknown) were examined with both imaging modalities. Three-dimensional (3D) segmentation and registration processes, together with automatic positioning of 3D analysis volumes of interest (VOIs), ensured the measurement of BMD and texture parameters at the same anatomical locations in CT and HR-pQCT datasets. Results According to the calculation of dice ratios (>0.978), the accuracy of VOI locations between methods was excellent. Entropy, anisotropy, and global inhomogeneity showed significant and high linear correlation between both methods (0.68 < R2 < 1.00). The resolution dependence of these parameters simulated earlier was confirmed by the in vitro measurements. Conclusion The high correlation of HR-pQCT- and CT-based measurements of entropy, global inhomogeneity, and anisotropy suggests interchangeability between devices regarding the quantification of texture. The agreement of the experimentally determined resolution dependence of global inhomogeneity and anisotropy with earlier simulations is an important milestone towards their use to quantify subchondral bone structure. However, an in vivo study is still required to establish their clinical relevance.
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Affiliation(s)
- Torsten Lowitz
- Institute of Medical Physics, University of Erlangen-Nürnberg, Henkestr. 91, 91052, Erlangen, Germany
| | - Oleg Museyko
- Institute of Medical Physics, University of Erlangen-Nürnberg, Henkestr. 91, 91052, Erlangen, Germany
| | - Valérie Bousson
- AP-HP, Hôpital Lariboisière, Service de Radiologie Ostéo-Articulaire, 2, rue Ambroise-Paré, F-75475, Paris, Cedex 10, France.,Univ. Paris Diderot, Sorbonne Paris Cité, Laboratoire B2OA, CNRS UMR 7052, 75010, Paris, France
| | - Christine Chappard
- AP-HP, Hôpital Lariboisière, Service de Radiologie Ostéo-Articulaire, 2, rue Ambroise-Paré, F-75475, Paris, Cedex 10, France.,Univ. Paris Diderot, Sorbonne Paris Cité, Laboratoire B2OA, CNRS UMR 7052, 75010, Paris, France
| | - Liess Laouisset
- AP-HP, Hôpital Lariboisière, Service de Radiologie Ostéo-Articulaire, 2, rue Ambroise-Paré, F-75475, Paris, Cedex 10, France.,Univ. Paris Diderot, Sorbonne Paris Cité, Laboratoire B2OA, CNRS UMR 7052, 75010, Paris, France
| | - Jean-Denis Laredo
- AP-HP, Hôpital Lariboisière, Service de Radiologie Ostéo-Articulaire, 2, rue Ambroise-Paré, F-75475, Paris, Cedex 10, France.,Univ. Paris Diderot, Sorbonne Paris Cité, Laboratoire B2OA, CNRS UMR 7052, 75010, Paris, France
| | - Klaus Engelke
- Institute of Medical Physics, University of Erlangen-Nürnberg, Henkestr. 91, 91052, Erlangen, Germany.
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Osteoarthritis of the hip joint in elderly patients is most commonly atrophic, with low parameters of acetabular dysplasia and possible involvement of osteoporosis. Arch Osteoporos 2017; 12:30. [PMID: 28332125 PMCID: PMC5362671 DOI: 10.1007/s11657-017-0325-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/08/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED As elderly patients with hip osteoarthritis aged, acetabular dysplasia parameters decreased (Sharp's angle, acetabular roof obliquity angle, and acetabular head index) and the incidence of the atrophic type increased. Vertebral body fracture was more frequent in the atrophic type, suggesting the involvement of osteoporosis at the onset of hip osteoarthritis. INTRODUCTION Osteoarthritis (OA) is associated with increased bone formation at a local site. However, excessive bone resorption has also been found to occur in the early stages of OA. Osteoporosis may be involved in the onset of OA in elderly patients. We conducted a cross-sectional radiographic study of patients with hip OA and examined the association between age and factors of acetabular dysplasia (Sharp's angle, acetabular roof obliquity angle, and acetabular head index) as well as the osteoblastic response to determine the potential involvement of osteoporosis. METHODS This study included 366 patients (58 men, 308 women) who had undergone total hip arthroplasty for the diagnosis of hip OA. We measured the parameters of acetabular dysplasia using preoperative frontal X-ray images and evaluated each patient according to Bombelli classification of OA (hypertrophic, normotrophic, or atrophic type). RESULTS As the patients aged, the parameters of acetabular dysplasia decreased. The incidence of the atrophic type of OA was significantly higher in older patients. Vertebral body fractures were more frequent in the atrophic type than in the other types. Additionally, the index of acetabular dysplasia was lower in the atrophic type. By contrast, the hypertrophic type was present in relatively younger patients and was associated with an increased index of acetabular dysplasia. CONCLUSION In elderly patients with hip OA, the parameters of acetabular dysplasia decreased and the incidence of the atrophic type increased as the patients aged. The frequency of vertebral body fracture was high in patients with the atrophic type, suggesting the involvement of osteoporosis in the onset of hip OA.
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Estublier C, Chapurlat R, Szulc P. Older men with severe disc degeneration have more incident vertebral fractures-the prospective MINOS cohort study. Rheumatology (Oxford) 2016; 56:37-45. [PMID: 27703044 DOI: 10.1093/rheumatology/kew327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/29/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Data on the relationship between disc degeneration (DD) and fragility fractures in men are limited. The aim of this study was to prospectively analyse the risk of vertebral and non-vertebral fractures in men with thoracolumbar DD according to the severity of its radiological signs: disc space narrowing (DSN), osteophytes and endplate sclerosis. METHODS Men >50 years of age (n = 765) had lateral spine radiographs and DXA and were monitored prospectively. We analysed the risk of incident vertebral (7.5 years) and non-vertebral fractures (10 years) in men according to the severity of DD. RESULTS After adjustment for age and weight, BMD increased with increasing total DSN score, endplate sclerosis and osteophytosis. Over 7.5 years, 28 incident vertebral fractures occurred in 27 men. After adjustment for age, BMI, spine BMD, prior fractures and abdominal aortic calcifications, the vertebral fracture risk was 3-fold higher in the upper DSN quartile vs men without DSN. After adjustment for the same confounders, vertebral fracture risk was also nearly 3-fold higher in the upper DSN quartile vs the three lower quartiles combined. Over 10 years, 61 men sustained non-vertebral fragility fractures. After adjustment for age, BMI, hip BMD, abdominal aortic calcifications and prior falls and fractures, the non-vertebral fracture risk decreased with increasing DSN score. The risk of non-vertebral fracture was half as high in men above the median total DSN score vs men below the median. CONCLUSION In older men, severe DD is associated with higher BMD. Multilevel severe DSN is associated with higher vertebral fracture risk and lower non-vertebral fracture risk.
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Affiliation(s)
- Charline Estublier
- Department of Rheumatology, Hôpital Edouard Herriot, INSERM UMR 1033, University of Lyon, Lyon, France
| | - Roland Chapurlat
- Department of Rheumatology, Hôpital Edouard Herriot, INSERM UMR 1033, University of Lyon, Lyon, France
| | - Pawel Szulc
- Department of Rheumatology, Hôpital Edouard Herriot, INSERM UMR 1033, University of Lyon, Lyon, France
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Pan Q, O'Connor MI, Coutts RD, Hyzy SL, Olivares-Navarrete R, Schwartz Z, Boyan BD. Characterization of osteoarthritic human knees indicates potential sex differences. Biol Sex Differ 2016; 7:27. [PMID: 27257472 PMCID: PMC4890516 DOI: 10.1186/s13293-016-0080-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/12/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The prevalence of osteoarthritis is higher in women than in men in every age group, and overall prevalence increases with advancing age. Sex-specific differences in the properties of osteoarthritic joint tissues may permit the development of sex-specific therapies. Sex hormones regulate cartilage and bone development and homeostasis in a sex-dependent manner. Recent in vitro studies show that the vitamin D3 metabolite 1α,25-dihydroxyvitamin D3 [1α,25(OH)2D3] also has sex-specific effects on musculoskeletal cells, suggesting that vitamin D3 metabolites may play a role in osteoarthritis-related sex-specific differences. The purpose of this study was to determine if sex-specific differences exist in synovial fluid and knee tissues isolated from male and female patients with severe knee osteoarthritis. We determined the presence of vitamin D3 metabolites, inflammatory cytokines, growth factors, and matrix metalloproteinases (MMPs) in synovial fluid and assessed responses of articular chondrocytes and subchondral osteoblasts to 17β-estradiol, dihydrotestosterone, and 1α,25(OH)2D3. METHODS Samples from knee joints of 10 Caucasian male and 10 Caucasian female patients with advanced osteoarthritis aged 65 to 75 years were obtained from total knee arthroplasty. Vitamin D metabolites, cytokines, MMPs, and growth factors in the synovial fluid were measured. Primary cultures of chondrocytes were isolated from fibrillated articular cartilage adjacent to osteoarthritis lesions and minimally affected cartilage distal to the lesion. Osteoblasts were isolated from the subchondral bone. Expression of receptors for 17β-estradiol and 1α,25(OH)2D3 was assessed by real-time PCR. Chondrocytes and osteoblasts were treated with 10(-8) M 17β-estradiol, dihydrotestosterone, or 1α,25(OH)2D3 and effects on gene expression and protein synthesis determined. RESULTS Histology of the articular cartilage confirmed advanced osteoarthritis. Sex differences were found in synovial fluid levels of vitamin D metabolites, cytokines, and metalloproteinases as well as in the cellular expression of receptors for 17β-estradiol and 1α,25(OH)2D3. Male cells were more responsive to 1α,25(OH)2D3 and dihydrotestosterone, whereas 17β-estradiol-affected female cells. CONCLUSIONS These results demonstrate that there are underlying sex differences in knee tissues affected by osteoarthritis. Our findings do not address osteoarthritis etiology but have implications for different prevention methods and treatments for men and women. Further research is needed to better understand these sex-based differences.
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Affiliation(s)
- Qingfen Pan
- Department of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA USA
| | - Mary I O'Connor
- Center for Musculoskeletal Care, Yale University School of Medicine, New Haven, CT USA
| | - Richard D Coutts
- Department of Orthopaedics, University of California at San Diego, San Diego, CA USA
| | - Sharon L Hyzy
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA USA
| | | | - Zvi Schwartz
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA USA ; Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, TX USA
| | - Barbara D Boyan
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA USA ; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA USA ; School of Engineering, Virginia Commonwealth University, 601 West Main Street, Suite 331, Richmond, VA 23284 USA
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Horecka A, Hordyjewska A, Blicharski T, Kocot J, Żelazowska R, Lewandowska A, Kurzepa J. Simvastatin Effect on Calcium and Silicon Plasma Levels in Postmenopausal Women with Osteoarthritis. Biol Trace Elem Res 2016; 171:1-5. [PMID: 26858096 PMCID: PMC4831989 DOI: 10.1007/s12011-016-0635-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
Abstract
Postmenopausal women more often suffered from knee osteoarthritis and its pathogenesis still remains unclear. Calcium and silicon are significant elements involved in bone and joint metabolism, especially in older people. Cardiovascular diseases are common worldwide and simvastatin is the most prescribed drug in such population of patients. The purpose of this study was to evaluate the effect of simvastatin administration on calcium and silicon concentration in the plasma of postmenopausal women with osteoarthritis. Sixty postmenopausal mild hypercholesterolemic women (mean age 61.4 years, range 54-68) were enrolled. Thirty patients received simvastatin (20 or 40 mg/day) for at least 1 year before being enrolled (simvastatin "+" group). Control group consists of remaining 30 women (simvastatin "-"group). Silicon and calcium concentrations were measured spectrophotometrically. Plasma simvastatin level was determined 3 h after the drug administration using HPLC-UV-Vis. Calcium but not silicon level was significantly lower in patients receiving simvastatin in comparison with non-statin group (1.91 ± 0.32 vs. 2.33 ± 0.19 mmol/l, p < 0.05). A weak but significant positive correlation between plasma silicon and simvastatin levels (r = 0.3, p < 0.05) was observed; this may be due to the fact that simvastatin contains silicon dioxide as an inactive ingredient. The mean simvastatin concentration was 9.02 ng/ml. All hypotheses were verified at the significance level of p < 0.05. A statistically significant decrease in the plasma calcium concentration of postmenopausal women, treated with simvastatin suggests that simvastatin may play a role in calcium metabolism in postmenopausal women with osteoarthritis. Positive correlation of simvastatin concentration with silicon level in the plasma suggests that both might prompt the positive effect of osteoarthritis treatment.
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Affiliation(s)
- Anna Horecka
- Chair and Department of Medical Chemistry, Medical University of Lublin, Chodźki 4A, PL 20-093, Lublin, Poland.
| | - Anna Hordyjewska
- Chair and Department of Medical Chemistry, Medical University of Lublin, Chodźki 4A, PL 20-093, Lublin, Poland
| | - Tomasz Blicharski
- Chair of Orthopedics and Rehabilitation, Medical University of Lublin, Jaczewskiego 8, PL 20-954, Lublin, Poland
| | - Joanna Kocot
- Chair and Department of Medical Chemistry, Medical University of Lublin, Chodźki 4A, PL 20-093, Lublin, Poland
| | - Renata Żelazowska
- Chair and Department of Medical Chemistry, Medical University of Lublin, Chodźki 4A, PL 20-093, Lublin, Poland
| | - Anna Lewandowska
- Chair and Department of Medical Chemistry, Medical University of Lublin, Chodźki 4A, PL 20-093, Lublin, Poland
| | - Jacek Kurzepa
- Chair and Department of Medical Chemistry, Medical University of Lublin, Chodźki 4A, PL 20-093, Lublin, Poland
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Xiao J, Yu W, Wang X, Wang B, Chen J, Liu Y, Li Z. Correlation between neuropeptide distribution, cancellous bone microstructure and joint pain in postmenopausal women with osteoarthritis and osteoporosis. Neuropeptides 2016; 56:97-104. [PMID: 26706183 DOI: 10.1016/j.npep.2015.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/11/2015] [Accepted: 12/07/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To explore the relationship between the distribution of neuropeptides, cancellous bone microstructure and joint pain in postmenopausal women with osteoarthritis (OA) and osteoporosis (OP). METHODS Cancellous bone of the femoral head was obtained at the time of hip arthroplasty from 20 postmenopausal women, 10 with OA and 10 with OP. Pain intensity was evaluated using the visual analog scale (VAS) before the operation. The microstructural parameters were measured with micro-CT and the neuropeptides of the cancellous bone were stained by an immunohistochemical method. RESULTS We observed that BV/TV, Tb.Th and Th.N values in the OP were significantly decreased compared to those in the OA. Immunohistochemical analysis revealed that the mean optical density (MOD) values for SP, CGRP, and VIP in the OA group were significantly higher than those in the OP, and the MOD value for NPY in the OA was significantly lower than that in the OP. We also observed that the MOD values for SP were positively correlated with AD, BV/TV, Tb.Th, Tb.N and Conn.D and negatively with MD, Tb.Sp and SMI in all patients. The MOD values for CGRP were positively correlated with AD, BV/TV and Tb.Th. MOD values for VIP were positively correlated with BV/TV and Tb.Th and negatively with SMI. The VAS score was correlated positively with the MOD values for SP, CGRP, VIP and negatively with NPY in all patients. CONCLUSIONS Neuropeptides play an important role in the pathogenesis of OA and OP, which may cause pain and influence the bone microstructure.
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Affiliation(s)
- Jie Xiao
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Weifeng Yu
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Xiangrui Wang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Bo Wang
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Jianwei Chen
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Yue Liu
- Department of Human Anatomy, Histology and Embryology, Shanghai Key Laboratory for Reproductive Medicine, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, China
| | - Zhanchun Li
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
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Kobayashi N, Inaba Y, Yukizawa Y, Takagawa S, Ike H, Kubota S, Naka T, Saito T. Bone mineral density distribution in the proximal femur and its relationship to morphologic factors in progressed unilateral hip osteoarthritis. J Bone Miner Metab 2015; 33:455-61. [PMID: 25449973 DOI: 10.1007/s00774-014-0610-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/02/2014] [Indexed: 11/26/2022]
Abstract
Although an adverse relationship between osteoporosis and osteoarthritis (OA) has been reported, it remains controversial. In most previous reports of OA, bone mineral density (BMD) changes in the subtrochanteric region have not been clarified, whilst BMD of the femoral neck and trochanteric region has been well investigated. In our current study, we investigated the BMD ratio compared to the contralateral side in the whole proximal femurs of hip OA patients. We aimed to clarify the morphologic factor that may influence these BMD ratios. We performed dual energy X-ray absorptiometry (DEXA) analysis of 69 hip joints from unilateral progressed OA cases. The minimum joint space, center edge angle, Sharp angle, acetabular head index, neck-shaft angle, and leg length discrepancy were also measured as radiographic factors. The correlation between BMD ratio and radiographic morphologic factors was then evaluated by logistic regression. The BMD ratio was higher in the femoral neck than in the distal region. In terms of radiographic factors, the neck-shaft angle was revealed to influence the decreased BMD ratio in the distal subtrochanteric part, whilst the leg length discrepancy and Sharp angle showed a relationship with the increased BMD ratio in the proximal neck region. The discrepancy in the BMD ratio between the femoral neck and the distal subtrochanteric region in the proximal femur is influenced by several morphologic factors.
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Affiliation(s)
- Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University, School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan,
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Lv H, Zhang L, Yang F, Li M, Yin P, Su X, Yin P, Zhang L, Tang P. A novel 3D-printed device for localization and extraction of trabeculae from human femoral heads: a comparison with traditional visual extraction. Osteoporos Int 2015; 26:1791-9. [PMID: 25708796 DOI: 10.1007/s00198-015-3058-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/28/2015] [Indexed: 01/09/2023]
Abstract
UNLABELLED In this study, we propose a novel method for accurate trabeculae extraction from human femoral heads using 3D-printing techniques and compare spatial deviation errors between this novel method and the conventional method. We found that spatial deviation errors, which indicate inaccuracy and unreliability, were significantly higher with the conventional method. INTRODUCTION Assessment of structural and mechanical properties of local bone is important in the study of pathological changes associated with musculoskeletal degenerative diseases. However, the widely used visual extraction method (VIS) for trabecular columns showed large deviations from veridicality, referred to as spatial deviation errors (SDE). Here, we propose a novel method for accurately locating and trephining trabeculae using a 3D-printed (3DP) positioning device and also evaluate the SDE of the VIS. METHODS Twenty femoral heads were obtained from osteoporotic patients, and the trabecular columns were extracted from the principal compressive trabeculae by VIS (n = 10) or the 3DP (n = 10) method. Morphological, structural, and mechanical properties were compared between both groups along with the recorded errors in spatial deviation. RESULTS Compared with the 3DP group, the average angle of central axis deflection in the VIS group was significantly greater; SDE in the VIS group was 26.1, 8.8, 4.1, 9.8, 7.2, 8.1, and 10.1 % greater for bone mineral density, bone volume/tissue volume ratio, trabecular thickness, trabecular number, Young's modulus, yield strength, and ultimate strength. CONCLUSION In this study, a high degree of SDE was demonstrated in the VIS, which indicates that the conventional technique is unreliable. Additionally, accurate sample fabrication and credible quantitative analysis of local trabeculae among individuals can be achieved with the aid of computed tomography and the 3DP device, thus providing a more objective method for researching musculoskeletal degenerative diseases and possibly a better clinical understanding of these disorders.
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Affiliation(s)
- H Lv
- Department of Orthopedics, General Hospital of Chinese PLA, No. 28 Fuxing Road, Beijing, 100853, China
| | - L Zhang
- Department of Orthopedics, General Hospital of Chinese PLA, No. 28 Fuxing Road, Beijing, 100853, China
| | - F Yang
- BNLMS State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100190, China
| | - M Li
- Department of Orthopedics, General Hospital of Chinese PLA, No. 28 Fuxing Road, Beijing, 100853, China
| | - P Yin
- Department of Orthopedics, General Hospital of Chinese PLA, No. 28 Fuxing Road, Beijing, 100853, China
| | - X Su
- Department of Orthopedics, General Hospital of Chinese PLA, No. 28 Fuxing Road, Beijing, 100853, China
| | - P Yin
- Department of Orthopedics, General Hospital of Chinese PLA, No. 28 Fuxing Road, Beijing, 100853, China
| | - L Zhang
- Department of Orthopedics, General Hospital of Chinese PLA, No. 28 Fuxing Road, Beijing, 100853, China.
| | - P Tang
- Department of Orthopedics, General Hospital of Chinese PLA, No. 28 Fuxing Road, Beijing, 100853, China.
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Osteoarthritis and bone mineral density: are strong bones bad for joints? BONEKEY REPORTS 2015; 4:624. [PMID: 25628884 PMCID: PMC4303262 DOI: 10.1038/bonekey.2014.119] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/19/2014] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is a common and disabling joint disorder affecting millions of people worldwide. In OA, pathological changes are seen in all of the joint tissues including bone. Although both cross-sectional and longitudinal epidemiological studies have consistently demonstrated an association between higher bone mineral density (BMD) and OA, suggesting that increased BMD is a risk factor for OA, the mechanisms underlying this observation remain unclear. Recently, novel approaches to examining the BMD-OA relationship have included studying the disease in individuals with extreme high bone mass, and analyses searching for genetic variants associated with both BMD variation and OA, suggesting possible pleiotropic effects on bone mass and OA risk. These studies have yielded valuable insights into potentially relevant pathways that might one day be exploited therapeutically. Although animal models have suggested that drugs reducing bone turnover (antiresorptives) may retard OA progression, it remains to be seen whether this approach will prove to be useful in human OA. Identifying individuals with a phenotype of OA predominantly driven by increased bone formation could help improve the overall response to these treatments. This review aims to summarise current knowledge regarding the complex relationship between BMD and OA.
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Gao J, Gong H, Zhang R, Zhu D. Age-related regional deterioration patterns and changes in nanoscale characterizations of trabeculae in the femoral head. Exp Gerontol 2015; 62:63-72. [PMID: 25582596 DOI: 10.1016/j.exger.2015.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/03/2014] [Accepted: 01/08/2015] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the mechanical properties and features of bone materials at the nanoscale level in different regions of the femoral head in elderly patients with femoral neck fracture. Ten femoral heads from female patients with femoral neck fractures were extracted during surgery (five for the Aged group, aged 65-66 years; five for the Advanced aged group, aged 85-95 years). The femoral head was divided into three equal layers (anterior, central, and posterior) in the coronal view, and each layer was segmented into five regions (superior, central, inferior, medial, and lateral). Nanoindentation testing and atomic force microscopy imaging were used to study the mechanical properties and surface morphology of the specimens. No statistical differences in grain size were found between age groups, which suggested that the nanostructure of trabeculae in the femoral heads of postmenopausal women cannot be used to predict age-related bone loss and fracture risk. Mechanical properties in the longitudinal direction deteriorated more quickly than those in the transverse direction for the whole femoral head. Comparisons between layers showed a higher deterioration rate with aging in the anterior layer than in other layers. In different regions, mechanical properties of the medial and lateral regions deteriorated more quickly than those in the three other regions, and deterioration in the longitudinal direction was more serious than that in the transverse direction. The regional deterioration patterns and material properties with aging observed in this study contribute to an understanding of the age-related fracture mechanism and provide a basis for predicting age-related fracture risk and decreasing early fixation failure in the proximal femur.
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Affiliation(s)
- Jiazi Gao
- Department of Engineering Mechanics, Jilin University, Changchun 130022, People's Republic of China
| | - He Gong
- Department of Engineering Mechanics, Jilin University, Changchun 130022, People's Republic of China.
| | - Rui Zhang
- Department of Engineering Mechanics, Jilin University, Changchun 130022, People's Republic of China
| | - Dong Zhu
- Traumatic Orthopedics, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
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Lowitz T, Museyko O, Bousson V, Kalender WA, Laredo JD, Engelke K. Characterization of knee osteoarthritis-related changes in trabecular bone using texture parameters at various levels of spatial resolution-a simulation study. BONEKEY REPORTS 2014; 3:615. [PMID: 25512855 DOI: 10.1038/bonekey.2014.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/24/2014] [Indexed: 12/21/2022]
Abstract
Articular cartilage and subchondral bone are the key tissues in osteoarthritis (OA). The role of the cancellous bone increasingly attracts attention in OA research. Because of its fast adaptation to changes in the loading distribution across joints, its quantification is expected to improve the diagnosis and monitoring of OA. In this study, we simulated OA progression-related changes of trabecular structure in a series of digital bone models and then characterized the potential of texture parameters and bone mineral density (BMD) as surrogate measures to quantify trabecular bone structure. Five texture parameters were studied: entropy, global and local inhomogeneity, anisotropy and variogram slope. Their dependence on OA relevant structural changes was investigated for three spatial resolutions typically used in micro computed tomography (CT; 10 μm), high-resolution peripheral quantitative CT (HR-pQCT) (90 μm) and clinical whole-body CT equipment (250 μm). At all resolutions, OA-related changes in trabecular bone architecture can be quantified using a specific (resolution dependent) combination of three texture parameters. BMD alone is inadequate for this purpose but if available reduces the required texture parameter combination to anisotropy and global inhomogeneity. The results are summarized in a comprehensive analysis guide for the detection of structural changes in OA knees. In conclusion, texture parameters can be used to characterize trabecular bone architecture even at spatial resolutions below the dimensions of a single trabecula and are essential for a detailed classification of relevant OA changes that cannot be achieved with a measurement of BMD alone.
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Affiliation(s)
- Torsten Lowitz
- Institute of Medical Physics, University of Erlangen-Nürnberg , Erlangen, Germany
| | - Oleg Museyko
- Institute of Medical Physics, University of Erlangen-Nürnberg , Erlangen, Germany
| | - Valerie Bousson
- Service de Radiologie Ostéo-Articulaire - Assistance Publique-Hopitaux de Paris, Hôpital Lariboisière , Paris, France ; Univ Paris Diderot, Sorbonne Paris Cité, CNRS UMR 7052 , Paris, France
| | - Willi A Kalender
- Institute of Medical Physics, University of Erlangen-Nürnberg , Erlangen, Germany
| | - Jean Denis Laredo
- Service de Radiologie Ostéo-Articulaire - Assistance Publique-Hopitaux de Paris, Hôpital Lariboisière , Paris, France ; Univ Paris Diderot, Sorbonne Paris Cité, CNRS UMR 7052 , Paris, France
| | - Klaus Engelke
- Institute of Medical Physics, University of Erlangen-Nürnberg , Erlangen, Germany
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Montoya MJ, Giner M, Miranda C, Vázquez MA, Caeiro JR, Guede D, Pérez-Cano R. Microstructural trabecular bone from patients with osteoporotic hip fracture or osteoarthritis: its relationship with bone mineral density and bone remodelling markers. Maturitas 2014; 79:299-305. [PMID: 25124531 DOI: 10.1016/j.maturitas.2014.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/02/2014] [Accepted: 07/08/2014] [Indexed: 01/28/2023]
Abstract
Osteoporosis (OP) and osteoarthritis (OA) are the most prevalent musculoskeletal disorders in the elderly but the relationship between them is unclear. The purposes of this study are to analyze the bone turnover markers (BTM), bone mineral density (BMD) and the structural and mechanical properties of trabecular bone in patients with OP and OA, and to explore the relationship between these two diseases. We studied 12 OP patients and 13 OA patients. We analyzed BTM (β-CrossLaps and PINP), BMD and microstructural and biomechanical parameters (micro-CT). Our results were: OP group has higher levels of β-CrossLaps and lower BMD at the femoral neck. Also, OP patients have a decreased volume of trabecular bone and less trabecular number, with architecture showing prevalence of rod-like trabeculae and worse connectivity than OA patients. The biomechanical parameters were worse in OP patients. BMD was correlated with almost all the structural and biomechanical parameters. Moreover, β-CrossLaps was negatively correlated with hip BMD and with bone surface density and positively with trabecular separation. BTM, BMD and bone microstructural changes in osteoporosis are opposite to those of OA. These findings justify a less resistant bone with higher risk of fragility fractures in OP patients. These histomorphometric and biomechanical changes may be suspected by measuring of BMD and β-CrossLaps levels.
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Affiliation(s)
- M José Montoya
- Medicine Department, University of Seville, Avda. Dr. Fedriani s/n, 41009 Sevilla, Spain.
| | - Mercè Giner
- Medicine Department, University of Seville, Avda. Dr. Fedriani s/n, 41009 Sevilla, Spain; Bone Metabolism Unit, Department of Internal Medicine, "Virgen Macarena" University Hospital, Seville, Spain.
| | - Cristina Miranda
- Bone Metabolism Unit, Department of Internal Medicine, "Virgen Macarena" University Hospital, Seville, Spain
| | - M Angeles Vázquez
- Medicine Department, University of Seville, Avda. Dr. Fedriani s/n, 41009 Sevilla, Spain
| | - José R Caeiro
- Department of Orthopaedic Surgery, Complexo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain; Trabeculae(®), Parque Tecnolóxico de Galicia, 32900 San Cibrao das Viñas, Ourense, Spain
| | - David Guede
- Trabeculae(®), Parque Tecnolóxico de Galicia, 32900 San Cibrao das Viñas, Ourense, Spain
| | - Ramón Pérez-Cano
- Medicine Department, University of Seville, Avda. Dr. Fedriani s/n, 41009 Sevilla, Spain; Bone Metabolism Unit, Department of Internal Medicine, "Virgen Macarena" University Hospital, Seville, Spain
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Föger-Samwald U, Patsch JM, Schamall D, Alaghebandan A, Deutschmann J, Salem S, Mousavi M, Pietschmann P. Molecular evidence of osteoblast dysfunction in elderly men with osteoporotic hip fractures. Exp Gerontol 2014; 57:114-21. [PMID: 24862290 DOI: 10.1016/j.exger.2014.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/28/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
Osteoporosis is extremely frequent in post-menopausal women; nevertheless, osteoporosis in men is also a severe and frequently occurring but often underestimated disease. Increasing evidence links bone loss in male idiopathic osteoporosis and age related osteoporosis to osteoblast dysfunction rather than increased osteoclast activity as seen in postmenopausal osteoporosis. The aim of this study was to investigate gene expression of osteoblast related genes and of bone architecture in bone samples derived from elderly osteoporotic men with hip fractures (OP) in comparison to bone samples from age matched men with osteoarthritis of the hip (OA). Femoral heads and adjacent neck tissue were collected from 12 men with low-trauma hip fractures and consecutive surgical hip replacement. Bone samples of age matched patients undergoing hip replacement due to osteoarthritis served as controls. One half of the bone samples was subjected to RNA extraction, reverse transcription, and real-time polymerase chain reactions. The second half of the bone samples was analyzed by static histomorphometry. From each half samples from four different regions, the central and subcortical region of the femoral head and neck, were analyzed. OP patients displayed a significantly decreased RUNX2, Osterix and SOST expression compared to OA patients. Major microstructural changes in OP bone were seen in the subcortical region of the neck and were characterized by a significant decrease of bone volume, and a significant increase of trabecular separation. In conclusion, decreased local gene expression of RUNX2 and Osterix in men with hip fractures strongly supports the concept of osteoblast dysfunction in male osteoporosis. Major microstructural changes in the trabecular structure associated with osteoporotic hip fractures in men are localized in the subcortical region of the femoral neck.
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Affiliation(s)
- Ursula Föger-Samwald
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Janina M Patsch
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria; Department of Radiodiagnostics, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Doris Schamall
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Afarin Alaghebandan
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Julia Deutschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Sylvia Salem
- Department of Orthopaedics, St. Vincent Hospital Vienna, Stumpergasse 13, A-1060 Vienna, Austria.
| | - Mehdi Mousavi
- Department of Trauma Surgery, Danube Hospital, Langobardenstrasse 122, A-1220 Vienna, Austria.
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Abstract
There is now general agreement that osteoarthritis (OA) involves all structures in the affected joint, culminating in the degradation of the articular cartilage. It is appropriate to focus particularly on the subchondral bone because characteristic changes occur in this tissue with disease progression, either in parallel, or contributing to, the loss of cartilage volume and quality. Changes in both the articular cartilage and the subchondral bone are mediated by the cells in these two compartments, chondrocytes and cells of the osteoblast lineage, respectively, whose primary roles are to maintain the integrity and function of these tissues. In addition, altered rates of bone remodeling across the disease process are due to increased or decreased osteoclastic bone resorption. In the altered mechanical and biochemical environment of a progressively diseased joint, the cells function differently and show a different profile of gene expression, suggesting direct effects of these external influences. There is also ex vivo and in vitro evidence of chemical crosstalk between the cells in cartilage and subchondral bone, suggesting an interdependence of events in the two compartments and therefore indirect effects of, for example, altered loading of the joint. It is ultimately these cellular changes that explain the altered morphology of the cartilage and subchondral bone. With respect to crosstalk between the cells in cartilage and bone, there is evidence that small molecules can transit between these tissues. For larger molecules, such as inflammatory mediators, this is an intriguing possibility but remains to be demonstrated. The cellular changes during the progression of OA almost certainly need to be considered in a temporal and spatial manner, since it is important when and where observations are made in either human disease or animal models of OA. Until recently, comparisons have been made with the assumption, for example, that the subchondral bone is behaviorally uniform, but this is not the case in OA, where regional differences of the bone are evident using magnetic resonance imaging (MRI). Nevertheless, an appreciation of the altered cell function during the progression of OA will identify new disease modifying targets. If, indeed, the cartilage and subchondral bone behave as an interconnected functional unit, normalization of cell behavior in one compartment may have benefits in both tissues.
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Affiliation(s)
- David M Findlay
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Royal Adelaide Hospital, Level 4 Bice Building, Adelaide, South Australia, 5000, Australia,
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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.
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Affiliation(s)
- Gun-Il Im
- Department of Orthopaedics, Dongguk University Ilsan Hospital, Goyang, 410-773, Republic of Korea,
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Thevenot J, Hirvasniemi J, Finnilä M, Pulkkinen P, Kuhn V, Link T, Eckstein F, Jämsä T, Saarakkala S. Trabecular homogeneity index derived from plain radiograph to evaluate bone quality. J Bone Miner Res 2013; 28:2584-91. [PMID: 23677814 DOI: 10.1002/jbmr.1987] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/02/2013] [Accepted: 05/06/2013] [Indexed: 11/06/2022]
Abstract
Radiographic texture analysis has been developed lately to improve the assessment of bone architecture as a determinant of bone quality. We validate here an algorithm for the evaluation of trabecular homogeneity index (HI) in the proximal femur from hip radiographs, with a focus on the impact of the principal compressive system of the trabecular bone, and evaluate its correlation with femoral strength, bone mineral density (BMD), and volumetric trabecular structure parameters. A semiautomatic custom-made algorithm was applied to calculate the HI in the femoral neck and trochanteric areas from radiographs of 178 femoral bone specimens (mean age 79.3 ± 10.4 years). Corresponding neck region was selected in CT scans to calculate volumetric parameters of trabecular structure. The site-specific BMDs were assessed from dual-energy X-ray absorptiometry (DXA), and the femoral strength was experimentally tested in side-impact configuration. Regression analysis was performed between the HI and biomechanical femoral strength, BMD, and volumetric parameters. The correlation between HI and failure load was R(2) = 0.50; this result was improved to R(2) = 0.58 for cervical fractures alone. The discrimination of bones with high risk of fractures (load <3000 N) was similar for HI and BMD (AUC = 0.87). Regression analysis between the HIs versus site-specific BMDs yielded R(2) = 0.66 in neck area, R(2) = 0.60 in trochanteric area, and an overall of R(2) = 0.66 for the total hip. Neck HI and BMD correlated significantly with volumetric structure parameters. We present here a method to assess HI that can explain 50% of an experimental failure load and determines bones with high fracture risk with similar accuracy as BMD. The HI also had good correlation with DXA and computed tomography-derived data.
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Affiliation(s)
- Jérôme Thevenot
- Department of Medical Technology, University of Oulu, Oulu, Finland
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Whitton RC, Mirams M, Mackie EJ, Anderson GA, Seeman E. Exercise-induced inhibition of remodelling is focally offset with fatigue fracture in racehorses. Osteoporos Int 2013; 24:2043-8. [PMID: 23371360 DOI: 10.1007/s00198-013-2291-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 12/14/2012] [Indexed: 11/26/2022]
Abstract
UNLABELLED Bone remodelling is inhibited by high repetitive loading. However, in subchondral bone of racehorses in training, eroded surface doubled in association with fatigue fracture and there was greater surrounding trabecular bone volume suggesting trabecular modelling unloads the bone focally, allowing damage repair by remodelling. INTRODUCTION Remodelling replaces damaged bone with new bone but is suppressed during high magnitude repetitive loading when damage is most likely. However, in cortical bone of racehorses, at sites of fatigue fracture, focal porosity, consistent with remodelling, is observed in proportion to the extent of surrounding callus. Focal areas of porosity are also observed at sites of fatigue damage in subchondral bone. We hypothesised that fatigued subchondral bone, like damaged cortical bone, is remodelled focally in proportion to the modelling of surrounding trabecular bone. METHODS Eroded and mineralizing surfaces and bone area were measured using backscattered scanning electron microscopy of post-mortem specimens of the distal third metacarpal bone in 11 racehorses with condylar fractures (cases) and eight racehorses in training without fractures (controls). RESULTS Cases had a two-fold greater eroded surface per unit area at the fracture site than controls (0.81 ± 0.10 vs. 0.40 ± 0.12 mm(-1), P = 0.021) but not at an adjacent site (0.22 ± 0.09 vs. 0.30 ± 0.11 mm(-1), P = 0.59). Area fraction of surrounding trabecular bone was higher in cases than controls (81 ± 2 vs. 72 ± 2 %, P = 0.0020) and the eroded surface at the fracture site correlated with the surrounding trabecular area (adjusted R (2) = 0.63, P = 0.0010). CONCLUSION In conclusion, exercise-induced inhibition of remodelling is offset at sites of fatigue fracture. Modelling of trabecular bone may contribute to unloading these regions, allowing repair by remodelling.
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Affiliation(s)
- R C Whitton
- Faculty of Veterinary Science, Equine Centre, University of Melbourne, 250 Princes Hwy, Werribee, Victoria 3030, Australia.
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