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Jaarah N, Lam CFJ, Lodhia N, Dulnoan D, Moore AE, Hampson G. Differential effects of teriparatide, denosumab and zoledronate on hip structural and mechanical parameters in osteoporosis; a real-life study. J Endocrinol Invest 2024; 47:1667-1677. [PMID: 38191946 PMCID: PMC11196340 DOI: 10.1007/s40618-023-02280-4] [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: 09/15/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE The aim of this study was to evaluate changes in hip geometry parameters following treatment with teriparatide (TPD), denosumab (Dmab) and zoledronate (ZOL) in real-life setting. METHODS We studied 249 patients with osteoporosis (OP) with mean [SD] age of 71.5 [11.1] years divided into 3 treatment groups; Group A received TPD; n = 55, Group B (Dmab); n = 116 and Group C (ZOL); n = 78 attending a routine metabolic bone clinic. Bone mineral density (BMD) was measured by DXA at the lumbar spine (LS), total hip (TH) and femoral neck (FN) prior to treatment and after 2 years (Group A), after a mean treatment duration of 3.3 [1.3] years (Group B) and after 1, 2 and 3 doses of ZOL (Group C) to assess treatment response. Hip structural analysis (HSA) was carried out retrospectively from DXA-acquired femur images at the narrow neck (NN), the intertrochanter (IT) and femoral shaft (FS). RESULTS Changes in parameters of hip geometry and mechanical strength were seen in the following treatment. Percentage change in cross-sectional area (CSA): 3.56[1.6] % p = 0.01 and cross-sectional moment of inertia (CSMI): 4.1[1.8] % p = 0.029 increased at the NN only in Group A. Improvement in HSA parameters at the IT were seen in group B: CSA: 3.3[0.67]% p < 0.001, cortical thickness (Co Th): 2.8[0.78]% p = 0.001, CSMI: 5.9[1.3]% p < 0.001, section modulus (Z):6.2[1.1]% p < 0.001 and buckling ratio (BR): - 3.0[0.86]% p = 0.001 with small changes at the FS: CSA: 1.2[0.4]% p = 0.005, Z:1.6 [0.76]%, p = 0.04. Changes at the IT were also seen in Group C (after 2 doses): CSA: 2.5[0.77]% p = 0.017, Co Th: 2.4[0.84]% p = 0.012, CSMI: 3.9[1.3]% p = 0.017, Z:5.2[1.16]% p < 0.001 and BR: - 3.1[0.88]% p = 0.001 and at the NN (following 3 doses): outer diameter (OD): 4.0[1.4]% p = 0.0005, endocortical diameter(ED): 4.3[1.67% p = 0.009, CSA:5.2[1.8]% p = 0.003, CSMI: 9.3[3.8]% p = 0.019. CONCLUSIONS Analysis of the effect of OP therapies on hip geometry is useful in understanding the mechanisms of their anti-fracture effect and may provide additional information on their efficacy.
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Affiliation(s)
- N Jaarah
- Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, 5Th Floor, North Wing, Lambeth Palace Road, London, UK
- Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK
| | - C F J Lam
- Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, 5Th Floor, North Wing, Lambeth Palace Road, London, UK
- Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK
| | - N Lodhia
- Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, 5Th Floor, North Wing, Lambeth Palace Road, London, UK
- Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK
| | - D Dulnoan
- Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK
| | - A E Moore
- Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK
| | - G Hampson
- Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, 5Th Floor, North Wing, Lambeth Palace Road, London, UK.
- Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK.
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Kim S, Jang S, Lee O. Simultaneous visualization of micro-damage in cortical bone, trabecular bone, and intracortical vasculature for diagnosing osteoporosis: An animal model synchrotron imaging. Microsc Res Tech 2024; 87:695-704. [PMID: 37983745 DOI: 10.1002/jemt.24457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023]
Abstract
Osteoporosis (OP) is difficult to diagnose through the three-dimensional visualization of micro-damage. In this study, aimed to make an objective diagnosis by visualizing micro-damage caused by OP using synchrotron radiation-based μCT (SR-μCT). Female mice (n = 12) were randomly divided into an ovariectomized group (OVX, n = 6) in which both ovaries were excised and OP occurred, and a sham-operated group (SHAM, n = 6). After six weeks, all femurs (left and right) were excised from both groups (n = 12 per group). Thereafter, femurs were randomly divided into SR-μCT (OVX group, n = 6; SHAM group, n = 6) and μCT (OVX group, n = 6; SHAM group, n = 6) groups. In the SR-μCT group, micro-damage was visualized by manually segmenting the cortical bone, trabecular bone, and intracortical vasculature using a water-shedding algorithm. In addition, trabecular bone was obtained by automatic segmentation using μCT. Cortical bone volume/total volume was greater (p = .015), and cortical thickness was greater in the SHAM group than in the OVX group (p = .007). Among the trabecular bone parameters, the bone volume/total volume (TV) in OVX was significantly lower than that in the SHAM group (p = .012). The canal volume was greater (p = .021) and lacuna volume was greater (p < .001) in the SHAM group than in the OVX group. We expect that it will be possible to analyze damage and recovery mechanisms in the field of rehabilitation. SR-μCT has been proposed as an objective method for OP diagnosis as it allows the visualization of microstructures. RESEARCH HIGHLIGHTS: Damage mechanism for diagnosis and evaluation in an osteoporosis model. Synchrotron radiation can objectively diagnose osteoporosis. Visualization is possible by segmenting microdamage caused by osteoporosis.
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Affiliation(s)
- Subok Kim
- Department of Software Convergence, Graduate School, Soonchunhyang University, Asan, Republic of Korea
| | - Sanghun Jang
- Department of Physical Therapy, College of Health and Life Sciences, Korea National University of Transportation, Jeungpyeong-gun, Republic of Korea
| | - Onseok Lee
- Department of Software Convergence, Graduate School, Soonchunhyang University, Asan, Republic of Korea
- Department of Medical IT Engineering, College of Medical Sciences, Soonchunhyang University, Asan, Republic of Korea
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Nakura N, Hirakawa K, Takayanagi S, Mihara M. Denosumab prevented periprosthetic bone resorption better than risedronate after total hip arthroplasty. J Bone Miner Metab 2023; 41:239-247. [PMID: 36745212 DOI: 10.1007/s00774-023-01405-2] [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: 11/11/2022] [Accepted: 01/17/2023] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Periprosthetic fracture caused by periprosthetic bone loss is an important concern in total hip arthroplasty (THA). Denosumab has been approved for postmenopausal women with osteoporosis who are at high risk of fracture. In this randomized controlled trial, we compared the effects of denosumab and risedronate on periprosthetic bone mineral density (BMD) after THA. MATERIALS AND METHODS The current study analyzed 108 patients who were scheduled to have THA. For 2 years, the patients were randomly assigned to the following two treatment groups: denosumab (60 mg subcutaneously every 6 months) or risedronate (17.5 mg oral weekly). The BMD changes in all Gruen zones and bone turnover markers were measured at the 5th postoperative day (baseline) and 6, 12, 18, and 24 months postoperatively. RESULTS The mean BMD in zones 1, 2, 6, and 7 was significantly higher with denosumab all administration at all postoperative time points compared to the risedronate group. The mean percentage changes in the BMD in these zones from baseline to 24 months postoperatively were + 11.9, + 2.9, + 8.1, and + 5.9% with denosumab group and - 9.6% -3.6, - 2.3, and - 19.2% with risedronate, respectively. The osteoclastic marker, tartrate-resistant acid phosphatase-5b (TRACP-5b), was significantly lower in the denosumab group compared to the risedronate group by 2 months. CONCLUSION Denosumab is more effective in preventing periprosthetic bone resorption than risedronate in the proximal femur. It also increased BMD around the stem implant following THA.
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Affiliation(s)
- Nariaki Nakura
- Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa, 247-0061, Japan.
- Kitakyushu General Hospital, Fukuoka, Japan.
| | - Kazuo Hirakawa
- Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa, 247-0061, Japan
| | - Satoshi Takayanagi
- Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa, 247-0061, Japan
| | - Masahiko Mihara
- Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa, 247-0061, Japan
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Wang Y, Li J, Men Y, Wei W. Intrinsic Cortical Property Analysis of the Medial Column of Proximal Humerus. Orthop Surg 2023; 15:793-800. [PMID: 36716195 PMCID: PMC9977591 DOI: 10.1111/os.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Adequate mechanical support of the medial column is paramount to maintain fracture reduction in locking plating of proximal humerus fractures. However, intrinsic cortical properties of the medial column are rarely discussed. The purpose of the study is to describe regional variation of cortex in the medial column. METHODS A total of 147 healthy participants were eligible for enrollment between December 2016 and December 2018. Subjects were divided into three groups: group A (20-39 years), group B (40-59 years), and group C (>60 years). For each individual, a color 3D thickness map for proximal humerus was created by cortical bone mapping (CBM) technique after bilateral shoulders were imaged by computed tomography. Measurement Indices including the cortical thickness (CTh), cortical mass surface density (CM) and the endocortical trabecular density (ECTD) were determined, after six regions of interest (ROI) were defined in metaphyseal region. Regional parameter variations were analyzed by one-way ANOVA. RESULTS The CTh, CM and ECTD values were approximately equivalent between genders in the proximal part of the medial column across all ages (P > 0.05).The greatest difference between sexes was found in CTh and CM values of middle and distal part (P < 0.05). The CTh and CM within medial column were negatively associated with age (P < 0.05). The proximal cortical bone of the medial column was thicker and more dense, compared to the lateral column (P < 0.05). Significant regional variation was found in all measured parameters in group A, but not in groups B and C. CONCLUSION Our finding proved that regional differences in the distribution of cortical bone in the medial column The attenuation of cortical bone heterogeneity in the medial column was found after the age of 40 years.
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Affiliation(s)
- Yeming Wang
- Department of OrthopaedicsTianjin Hospital, Tianjin UniversityTianjinChina
| | - Jian Li
- Department of RadiologyTianjin Hospital, Tianjin UniversityTianjinChina
| | - Yutao Men
- Tianjin Key Laboratory of the Design and Intelligent Control of the Advanced Mechanical SystemTianjin University of TechnologyTianjinChina,National Demonstration Center for Experimental Mechanical and Electrical Engineering EducationTianjin University of TechnologyTianjinChina
| | - Wanfu Wei
- Department of OrthopaedicsTianjin Hospital, Tianjin UniversityTianjinChina
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Iolascon G, Paoletta M, Liguori S, Gimigliano F, Moretti A. Bone fragility: conceptual framework, therapeutic implications, and COVID-19-related issues. Ther Adv Musculoskelet Dis 2022; 14:1759720X221133429. [PMID: 36317067 PMCID: PMC9614590 DOI: 10.1177/1759720x221133429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022] Open
Abstract
Bone fragility is the susceptibility to fracture even for common loads because of structural, architectural, or material alterations of bone tissue that result in poor bone strength. In osteoporosis, quantitative and qualitative changes in density, geometry, and micro-architecture modify the internal stress state predisposing to fragility fractures. Bone fragility substantially depends on the structural behavior related to the size and shape of the bone characterized by different responses in the load–deformation curve and on the material behavior that reflects the intrinsic material properties of the bone itself, such as yield and fatigue. From a clinical perspective, the measurement of bone density by DXA remains the gold standard for defining the risk of fragility fracture in all population groups. However, non-quantitative parameters, such as macro-architecture, geometry, tissue material properties, and microcracks accumulation can modify the bone’s mechanical strength. This review provides an overview of the role of different contributors to bone fragility and how these factors might be influenced by the use of anti-osteoporotic drugs and by the COVID-19 pandemic.
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Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | | | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
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Guo J, Zhou Y, Shang M, Chen W, Hou Z, Zhang Y, Dong W. Morphological characteristics of the surgical neck region in the proximal humerus at different ages. Eur J Med Res 2022; 27:102. [PMID: 35773745 PMCID: PMC9245283 DOI: 10.1186/s40001-022-00724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the study was to demonstrate the cortical thickness character in the humeral surgical neck region using 3D cortical bone mapping technique and try to illustrate its morphological changes with age. MATERIAL AND METHODS Normal individuals, including 11 volunteers younger than 18 years, 87 adult men and 46 adult women, were enrolled. The cortical thickness and height of the surgical neck region was measured with Mimic and 3 Matic software. The height of the region was compared and measured. People with an age of 18-30 years was identified as Group I, people in 31-40 years as Group II, people in 41-50 years as Group III, people in 51-60 years as Group IV, and Group V including people ≥ 61 years. RESULTS Compared with the baseline Group I, cortical thickness was significantly decreased by 0.52 mm (P = 0.006) in Group III, by 0.76 mm (P < 0.001) in Group IV, and by 0.77 mm (P < 0.001) in Group V. Age moderately predicted cortical thickness with r = -0.5481. The height of the cortical change region was significantly decreased by 2.25 mm (P = 0.007) in Group II, by 2.98 mm (P < 0.001) in Group III, and by 2.07 mm (P = 0.02) in Group IV. However, no significant decrease was illustrated in Group V (0.57 mm) (P = 0.891). The relation between age and the height of the cortical thickness change region was nonlinear. CONCLUSIONS This study identified an obvious decrease in cortical thickness with aging, and the height was curve fitted with aging in surgical neck region.
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Affiliation(s)
- Jialiang Guo
- The School of Medicine, Nankai University, Tianjin, People's Republic of China.,Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yali Zhou
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Meishuang Shang
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Wei Chen
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China. .,Chinese Academy of Engineering, Beijing, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People's Republic of China.
| | - Weichong Dong
- Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
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7
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Poole KE, Treece GM, Pearson RA, Gee AH, Bolognese MA, Brown JP, Goemaere S, Grauer A, Hanley DA, Mautalen C, Recknor C, Yang YC, Rojeski M, Libanati C, Whitmarsh T. Romosozumab Enhances Vertebral Bone Structure in Women With Low Bone Density. J Bone Miner Res 2022; 37:256-264. [PMID: 34738660 PMCID: PMC9299688 DOI: 10.1002/jbmr.4465] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022]
Abstract
Romosozumab monoclonal antibody treatment works by binding sclerostin and causing rapid stimulation of bone formation while decreasing bone resorption. The location and local magnitude of vertebral bone accrual by romosozumab and how it compares to teriparatide remains to be investigated. Here we analyzed the data from a study collecting lumbar computed tomography (CT) spine scans at enrollment and 12 months post-treatment with romosozumab (210 mg sc monthly, n = 17), open-label daily teriparatide (20 μg sc, n = 19), or placebo (sc monthly, n = 20). For each of the 56 women, cortical thickness (Ct.Th), endocortical thickness (Ec.Th), cortical bone mineral density (Ct.bone mineral density (BMD)), cancellous BMD (Cn.BMD), and cortical mass surface density (CMSD) were measured across the first lumbar vertebral surface. In addition, color maps of the changes in the lumbar vertebrae structure were statistically analyzed and then visualized on the bone surface. At 12 months, romosozumab improved all parameters significantly over placebo and resulted in a mean vertebral Ct.Th increase of 10.3% versus 4.3% for teriparatide, an Ec.Th increase of 137.6% versus 47.5% for teriparatide, a Ct.BMD increase of 2.1% versus a -0.1% decrease for teriparatide, and a CMSD increase of 12.4% versus 3.8% for teriparatide. For all these measurements, the differences between romosozumab and teriparatide were statistically significant (p < 0.05). There was no significant difference between the romosozumab-associated Cn.BMD gains of 22.2% versus 18.1% for teriparatide, but both were significantly greater compared with the change in the placebo group (-4.6%, p < 0.05). Cortical maps showed the topographical locations of the increase in bone in fracture-prone areas of the vertebral shell, walls, and endplates. This study confirms widespread vertebral bone accrual with romosozumab or teriparatide treatment and provides new insights into how the rapid prevention of vertebral fractures is achieved in women with osteoporosis using these anabolic agents. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Kenneth Es Poole
- Department of Medicine, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Graham M Treece
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Rose A Pearson
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Andrew H Gee
- Department of Engineering, University of Cambridge, Cambridge, UK
| | | | - Jacques P Brown
- CHU de Québec Research Centre and Laval University, Quebec City, Canada
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Deng Y, Wei W, Tang P. Applications of Calcium-Based Nanomaterials in Osteoporosis Treatment. ACS Biomater Sci Eng 2022; 8:424-443. [PMID: 35080365 DOI: 10.1021/acsbiomaterials.1c01306] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
With rapidly aging populations worldwide, osteoporosis has become a serious global public health problem. Caused by disordered systemic bone remodeling, osteoporosis manifests as progressive loss of bone mass and microarchitectural deterioration of bone tissue, increasing the risk of fractures and eventually leading to osteoporotic fragility fractures. As fracture risk increases, antiosteoporosis treatments transition from nonpharmacological management to pharmacological intervention, and finally to the treatment of fragility fractures. Calcium-based nanomaterials (CBNMs) have unique advantages in osteoporosis treatment because of several characteristics including similarity to natural bone, excellent biocompatibility, easy preparation and functionalization, low pH-responsive disaggregation, and inherent pro-osteogenic properties. By combining additional ingredients, CBNMs can play multiple roles to construct antiosteoporotic biomaterials with different forms. This review covers recent advances in CBNMs for osteoporosis treatment. For ease of understanding, CBNMs for antiosteoporosis treatment can be classified as locally applied CBNMs, such as implant coatings and filling materials for osteoporotic bone regeneration, and systemically administered CBNMs for antiosteoporosis treatment. Locally applied CBNMs for osteoporotic bone regeneration develop faster than the systemically administered CBNMs, an important consideration given the serious outcomes of fragility fractures. Nevertheless, many innovations in construction strategies and preparation methods have been applied to build systemically administered CBNMs. Furthermore, with increasing interest in delaying osteoporosis progression and avoiding fragility fracture occurrence, research into systemic administration of CBNMs for antiosteoporosis treatment will have more development prospects. Deep understanding of the CBNM preparation process and optimizing CBNM properties will allow for increased application of CBNMs in osteoporosis treatments in the future.
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Affiliation(s)
- Yuan Deng
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing 100000, China
| | - Wei Wei
- State Key Laboratory of Biochemical Engineering Institute of Process Engineering Chinese Academy of Sciences No. 1 Bei-Er-Tiao, Beijing 100190, P. R. China
| | - Peifu Tang
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing 100000, China
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9
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Grassi L, Väänänen SP, Isaksson H. Statistical Shape and Appearance Models: Development Towards Improved Osteoporosis Care. Curr Osteoporos Rep 2021; 19:676-687. [PMID: 34773211 PMCID: PMC8716351 DOI: 10.1007/s11914-021-00711-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Statistical models of shape and appearance have increased their popularity since the 1990s and are today highly prevalent in the field of medical image analysis. In this article, we review the recent literature about how statistical models have been applied in the context of osteoporosis and fracture risk estimation. RECENT FINDINGS Recent developments have increased their ability to accurately segment bones, as well as to perform 3D reconstruction and classify bone anatomies, all features of high interest in the field of osteoporosis and fragility fractures diagnosis, prevention, and treatment. An increasing number of studies used statistical models to estimate fracture risk in retrospective case-control cohorts, which is a promising step towards future clinical application. All the reviewed application areas made considerable steps forward in the past 5-6 years. Heterogeneities in validation hinder a thorough comparison between the different methods and represent one of the future challenges to be addressed to reach clinical implementation.
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Affiliation(s)
- Lorenzo Grassi
- Department of Biomedical Engineering, Lund University, Box 118, 221 00, Lund, Sweden.
| | - Sami P Väänänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Box 118, 221 00, Lund, Sweden
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Barkaoui A, Ait Oumghar I, Ben Kahla R. Review on the use of medical imaging in orthopedic biomechanics: finite element studies. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2021. [DOI: 10.1080/21681163.2021.1888317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Abdelwahed Barkaoui
- Laboratoire des Énergies Renouvelables et Matériaux Avancés, Université Internationale de Rabat, Sala Al Jadida Morocco
| | - Imane Ait Oumghar
- Laboratoire des Énergies Renouvelables et Matériaux Avancés, Université Internationale de Rabat, Sala Al Jadida Morocco
- Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France
| | - Rabeb Ben Kahla
- Laboratoire de Systémes et de Mécanique Appliquée, Ecole Polytechnique de Tunis, Université de Carthage, Tunis, Tunisia
- Ecole Nationale d’Ingénieurs de Tunis, Université de Tunis el Manar, Campus Universitaire, Tunis, Tunisia
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11
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Schileo E, Pitocchi J, Falcinelli C, Taddei F. Cortical bone mapping improves finite element strain prediction accuracy at the proximal femur. Bone 2020; 136:115348. [PMID: 32240847 DOI: 10.1016/j.bone.2020.115348] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
Despite evidence of the biomechanical role of cortical bone, current state of the art finite element models of the proximal femur built from clinical CT data lack a subject-specific representation of the bone cortex. Our main research hypothesis is that the subject-specific modelling of cortical bone layer from CT images, through a deconvolution procedure known as Cortical Bone Mapping (CBM, validated for cortical thickness and density estimates) can improve the accuracy of CT-based FE models of the proximal femur, currently limited by partial volume artefacts. Our secondary hypothesis is that a careful choice of cortical-specific density-elasticity relationship may improve model accuracy. We therefore: (i) implemented a procedure to include subject-specific CBM estimates of both cortical thickness and density in CT-based FE models. (ii) defined alternative models that included CBM estimates and featured a cortical-specific or an independently optimised density-elasticity relationship. (iii) tested our hypotheses in terms of elastic strain estimates and failure load and location prediction, by comparing with a published cohort of 14 femurs, where strain and strength in stance and fall loading configuration were experimentally measured, and estimated through reference FE models that did not explicitly model the cortical compartment. Our findings support the main hypothesis: an explicit modelling of the proximal femur cortical bone layer including CBM estimates of cortical bone thickness and density increased the FE strains prediction, mostly by reducing peak errors (average error reduced by 30%, maximum error and 95th percentile of error distribution halved) and especially when focusing on the femoral neck locations (all error metrics at least halved). We instead rejected the secondary hypothesis: changes in cortical density-elasticity relationship could not improve validation performances. From these improved baseline strain estimates, further work is needed to achieve accurate strength predictions, as models incorporating cortical thickness and density produced worse estimates of failure load and equivalent estimates of failure location when compared to reference models. In summary, we recommend including local estimates of cortical thickness and density in FE models to estimate bone strains in physiological conditions, and especially when designing exercise studies to promote bone strength.
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Affiliation(s)
- Enrico Schileo
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Jonathan Pitocchi
- Materialise N.V., Heverlee, Belgium; Multiscale in Mechanical and Biological Engineering (M2BE), University of Zaragoza, Zaragoza, Spain; Biomechanics Section, KU Leuven, Leuven, Belgium
| | | | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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12
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Warden SJ, Carballido-Gamio J, Weatherholt AM, Keyak JH, Yan C, Kersh ME, Lang TF, Fuchs RK. Heterogeneous Spatial and Strength Adaptation of the Proximal Femur to Physical Activity: A Within-Subject Controlled Cross-Sectional Study. J Bone Miner Res 2020; 35:681-690. [PMID: 31826314 PMCID: PMC7145739 DOI: 10.1002/jbmr.3939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/06/2019] [Accepted: 12/03/2019] [Indexed: 11/10/2022]
Abstract
Physical activity (PA) enhances proximal femur bone mass, as assessed using projectional imaging techniques. However, these techniques average data over large volumes, obscuring spatially heterogeneous adaptations. The current study used quantitative computed tomography, statistical parameter mapping, and subject-specific finite element (FE) modeling to explore spatial adaptation of the proximal femur to PA. In particular, we were interested in adaptation occurring at the superior femoral neck and improving strength under loading from a fall onto the greater trochanter. High/long jump athletes (n = 16) and baseball pitchers (n = 16) were utilized as within-subject controlled models as they preferentially load their take-off leg and leg contralateral to their throwing arm, respectively. Controls (n = 15) were included but did not show any dominant-to-nondominant (D-to-ND) leg differences. Jumping athletes showed some D-to-ND leg differences but less than pitchers. Pitchers had 5.8% (95% confidence interval [CI] 3.9%-7.6%) D-to-ND leg differences in total hip volumetric bone mineral density (vBMD), with increased vBMD in the cortical compartment of the femoral neck and trochanteric cortical and trabecular compartments. Voxel-based morphometry analyses and cortical bone mapping showed pitchers had D-to-ND leg differences within the regions of the primary compressive trabeculae, inferior femoral neck, and greater trochanter but not the superior femoral neck. FE modeling revealed pitchers had 4.1% (95% CI 1.4%-6.7%) D-to-ND leg differences in ultimate strength under single-leg stance loading but no differences in ultimate strength to a fall onto the greater trochanter. These data indicate the asymmetrical loading associated with baseball pitching induces proximal femur adaptation in regions associated with weight bearing and muscle contractile forces and increases strength under single-leg stance loading. However, there were no benefits evident at the superior femoral neck and no measurable improvement in ultimate strength to common injurious loading during aging (ie, fall onto the greater trochanter), raising questions as to how to better target these variables with PA. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Stuart J. Warden
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Julio Carballido-Gamio
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Alyssa M. Weatherholt
- Department of Kinesiology and Sport, Pott College of Science, Engineering, and Education, University of Southern Indiana, Evansville, IN
| | - Joyce H. Keyak
- Departments of Radiological Sciences, Mechanical and Aerospace Engineering, and Biomedical Engineering, University of California Irvine, Irvine CA
| | - Chenxi Yan
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL
| | - Mariana E. Kersh
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL
| | - Thomas F. Lang
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Robyn K. Fuchs
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN
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13
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Abstract
Numerous safe and efficient drug therapies are currently available to decrease risk of low trauma fractures in patients with osteoporosis including postmenopausal, male, and secondary osteoporosis. In this chapter, we give first an overview of the most important outcomes regarding fracture risk reduction, change in bone mineral density (BMD by DXA) and/or bone markers of the phase III clinical studies of well-established therapies (such as Bisphosphonates, Denosumab or Teriparatide) and also novel therapies (such as Romosozumab or Abaloparatide) and highlight their mechanisms of action at bone tissue/material level. The latter understanding is not only essential for the choice of drug, duration and discontinuation of treatment but also for the interpretation of the clinical outcomes (in particular of eventual changes in BMD) after drug administration. In the second part of this chapter, we focus on the management of different forms of osteoporosis and give a review of the respective current guidelines for treatment. Adverse effects of treatment such as atypical femoral fractures, osteonecrosis of the jaw or influence of fracture healing are considered also in this context.
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14
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Kaneko T, Okamura K, Yonemoto Y, Okura C, Suto T, Tachibana M, Sakane H, Inoue M, Chikuda H. Effects of denosumab on bone mineral density and bone turnover markers in rheumatoid arthritis patients switching from bisphosphonates. J Exp Orthop 2019; 6:41. [PMID: 31664591 PMCID: PMC6820644 DOI: 10.1186/s40634-019-0211-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/17/2019] [Indexed: 11/11/2022] Open
Abstract
Background To compare the efficacy of 12-month denosumab treatment on bone mineral density (BMD) and bone turnover markers (BTMs) between treatment-naïve osteoporosis patients with rheumatoid arthritis (RA) and those with previous bisphosphonate (BP) therapy. Methods A total of 36 RA patients with osteoporosis completed 12-month follow-up. Twenty-five patients were osteoporotic treatment-naïve (naïve group), and 11 patients were previously treated with BPs (switch group) (average 7.9 years). BMD and BTMs were measured before and 6 and 12 months after treatment. Results BTM levels were higher in the naïve group at baseline. However, the same level of suppression was achieved at 6 months in both groups. Spine BMD increased significantly in both groups. There was no significant difference in the mean percent changes of BMD of the spine (naïve group: 6.8 ± 0.8, switch group: 5.1 ± 1.5), femoral neck (2.9 ± 1.4, 2.9 ± 1.3), and total hip (1.7 ± 0.9, 1.4 ± 1.1) between these two groups at 12 months. Conclusions The effects of denosumab on BMD and BTMs of the switch group after long-term BP treatment are comparable to those of the naïve group in RA patients. Thus, switching BPs to denosumab is one of the useful options to treat osteoporosis with RA.
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Affiliation(s)
- Tetsuya Kaneko
- Department of Orthopaedic Surgery, Japan Redcross Society Fukaya Red Cross Hospital, Fukaya, Saitama, Japan.,Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma, Japan.,Department of Orthopaedic Surgery and Rheumatology, Inoue Hospital, Takasaki, Gunma, Japan.,Department of Orthopaedic Surgery, Fukaya Seikeigeka Clinic, Fukaya, Saitama, Japan
| | - Koichi Okamura
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma, Japan.
| | - Yukio Yonemoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma, Japan.,Department of Orthopaedic Surgery and Rheumatology, Inoue Hospital, Takasaki, Gunma, Japan
| | - Chisa Okura
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma, Japan
| | - Takahito Suto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma, Japan
| | - Masahiro Tachibana
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma, Japan
| | - Hideo Sakane
- Department of Orthopaedic Surgery, Japan Redcross Society Fukaya Red Cross Hospital, Fukaya, Saitama, Japan.,Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma, Japan
| | - Makoto Inoue
- Department of Orthopaedic Surgery and Rheumatology, Inoue Hospital, Takasaki, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showamachi, Maebashi, Gunma, Japan
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15
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Wang Y, Li J, Yang J, Dong J. Regional characteristics of cortical bone quality in the proximal humerus of postmenopausal women: a preliminary study. J Shoulder Elbow Surg 2019; 28:685-691. [PMID: 30527884 DOI: 10.1016/j.jse.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal humeral fractures represent the third most common fragility fracture treated in osteoporotic populations, after hip and distal radial fractures. The purpose of this study was to characterize the spatial variability in cortical geometry in the proximal humerus in postmenopausal women. METHODS The proximal humeri in 43 healthy postmenopausal women were imaged by computed tomography. Cortical bone mapping was applied to create color 3-dimensional thickness maps for each proximal humerus. Cortical parameters, including the cortical thickness (CTh), cortical mass surface density (CM), and endocortical trabecular density, were measured over the humeral head and metaphyseal region after 15 regions of interest (ROIs) were defined. RESULTS In the humeral head region, significant differences in CTh and CM values were detected between the anterior, lateral, and posterior walls (P < .05). The highest CTh and CM were found in the anterior wall in each plane (P < .05). Regarding the endocortical trabecular density, no significant findings were noted in the 3 planes (P > .05). In the metaphyseal region, the cortical structure in the medial column had higher CTh and CM values in ROI 10 compared with the lateral column (P < .05). The highest CTh and CM values of compact bone were seen in ROI 10 of the medial column (ROIs 10-12) (P < .05). CONCLUSION Our results showed significant regional variation of cortical bone in the humeral head region in postmenopausal women. Similar conditions were seen in the medial column in the metaphyseal region. This finding provides discriminatory information for stronger fixation of implants.
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Affiliation(s)
- Yeming Wang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China.
| | - Jian Li
- Department of Radiology, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jianhua Yang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jingming Dong
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
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16
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Abstract
Fractures resulting from osteoporosis become increasingly common in women after age 55 years and men after age 65 years, resulting in substantial bone-associated morbidities, and increased mortality and health-care costs. Research advances have led to a more accurate assessment of fracture risk and have increased the range of therapeutic options available to prevent fractures. Fracture risk algorithms that combine clinical risk factors and bone mineral density are now widely used in clinical practice to target high-risk individuals for treatment. The discovery of key pathways regulating bone resorption and formation has identified new approaches to treatment with distinctive mechanisms of action. Osteoporosis is a chronic condition and long-term, sometimes lifelong, management is required. In individuals at high risk of fracture, the benefit versus risk profile is likely to be favourable for up to 10 years of treatment with bisphosphonates or denosumab. In people at a very high or imminent risk of fracture, therapy with teriparatide or abaloparatide should be considered; however, since treatment duration with these drugs is restricted to 18-24 months, treatment should be continued with an antiresorptive drug. Individuals at high risk of fractures do not receive adequate treatment and strategies to address this treatment gap-eg, widespread implementation of Fracture Liaison Services and improvement of adherence to therapy-are important challenges for the future.
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Affiliation(s)
| | - Michael R McClung
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA; Mary MacKillop Institute for Health, Australian Catholic University, Melbourne, VIC, Australia
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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17
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Winzenrieth R, Humbert L, Di Gregorio S, Bonel E, García M, Del Rio L. Effects of osteoporosis drug treatments on cortical and trabecular bone in the femur using DXA-based 3D modeling. Osteoporos Int 2018; 29:2323-2333. [PMID: 29974136 DOI: 10.1007/s00198-018-4624-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/27/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED Effects of osteoporosis drugs on proximal femur cortical and trabecular bone were studied using dual-energy x-ray absorptiometry (DXA)-based 3D modeling method. Changes observed in this head-to-head study were consistent with those obtained using computed tomography in the literature. INTRODUCTION The aim of the present study was to assess the effects of osteoporosis drugs on cortical and trabecular bone at the proximal femur using DXA-based 3D modeling. METHODS We retrospectively analyzed 155 patients stratified by treatments: naive of treatment (NAIVE), alendronate (AL), denosumab (DMAB), and teriparatide (TPTD). DXA scans were performed at baseline and after treatment, and areal bone mineral density at spine and femur were measured. A software algorithm (3D-SHAPER) was used to derive 3D models from hip DXA scans and compute: trabecular and cortical volumetric BMD (vBMD), cortical thickness (Cth), and cortical surface BMD (cortical sBMD). Changes from baseline were normalized at 24 months and evaluated in terms or percentage. RESULTS After 24 months, a non-significant decrease was observed for trabecular vBMD, Cortical sBMD, Cth, and cortical vBMD (- 2.3, - 0.8, - 0.3, and - 0.5%) in the NAIVE group. Under AL and DMAB, significant increases were observed in trabecular vBMD (3.8 and 7.3%), cortical vBMD (1.4 and 2.0%), and cortical sBMD (1.5 and 3.6%). An increase in Cth was observed in patients under DMAB (1.8%). Under TPTD, a significant increase in Trabecular vBMD was observed (5.9%) associated with a non-significant increase of Cth (+ 1%) concomitant with a decrease in cortical vBMD (- 1.1%). CONCLUSION Results obtained in this head-to-head study are consistent with those obtained using computed tomography in the literature. DXA-based modeling techniques could complement standard DXA examination to monitor treatment effects on trabecular and cortical compartments.
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Affiliation(s)
- R Winzenrieth
- Musculoskeletal Unit, Galgo Medical, Carrer del Comte d'Urgell, 143, 08036, Barcelona, Spain.
- Department of Urology, Hospital Universitario de Bellvitge, l'Hospitalet, Spain.
| | - L Humbert
- Musculoskeletal Unit, Galgo Medical, Carrer del Comte d'Urgell, 143, 08036, Barcelona, Spain
- Department of Urology, Hospital Universitario de Bellvitge, l'Hospitalet, Spain
| | - S Di Gregorio
- Department of Urology, Hospital Universitario de Bellvitge, l'Hospitalet, Spain
- Cetir Grup Mèdic, Barcelona, Spain
| | - E Bonel
- Department of Urology, Hospital Universitario de Bellvitge, l'Hospitalet, Spain
- Cetir Grup Mèdic, Barcelona, Spain
| | - M García
- Department of Urology, Hospital Universitario de Bellvitge, l'Hospitalet, Spain
- Cetir Grup Mèdic, Barcelona, Spain
| | - L Del Rio
- Department of Urology, Hospital Universitario de Bellvitge, l'Hospitalet, Spain
- Cetir Grup Mèdic, Barcelona, Spain
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18
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Abstract
PURPOSE OF REVIEW Cortical bone mapping (CBM) is a technique for measuring localised skeletal changes from computed tomography (CT) images. It can provide measurements with accuracy surpassing the underlying imaging resolution. CBM can detect changes in several properties of the cortex, with no prior assumptions about the likely location of said changes. This paper summarises the theory behind CBM, discusses its strengths and limitations, and reviews some studies in which it has been applied. RECENT FINDINGS CBM has revealed associations between fracture risk and cortical properties in specific regions of the proximal femur which present feasible therapeutic targets. Analyses of several pharmaceutical and exercise interventions quantify effects that are distinct both in location and in the nature of the micro-architectural changes. CBM has illuminated age-related changes in the proximal femur and has recently been applied to other bones, as well as to the assessment of cartilage. The CBM processing pipeline is designed primarily for large cohort studies. Its main impact thus far has not been in the realm of clinical practice, but rather to improve our fundamental understanding of localised bone structure and changes.
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Affiliation(s)
- Graham Treece
- Department of Engineering, University of Cambridge, Cambridge, CB2 1PZ, UK.
| | - Andrew Gee
- Department of Engineering, University of Cambridge, Cambridge, CB2 1PZ, UK
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19
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Marques EA, Carballido-Gamio J, Gudnason V, Sigurdsson G, Sigurdsson S, Aspelund T, Siggeirsdottir K, Launer L, Eiriksdottir G, Lang T, Harris TB. Sex differences in the spatial distribution of bone in relation to incident hip fracture: Findings from the AGES-Reykjavik study. Bone 2018; 114:72-80. [PMID: 29777918 PMCID: PMC6137723 DOI: 10.1016/j.bone.2018.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/11/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
Abstract
In this case-cohort study, we used data-driven computational anatomy approaches to assess within and between sex spatial differences in proximal femoral bone characteristics in relation to incident hip fracture. One hundred male and 234 female incident hip fracture cases, and 1047 randomly selected noncase subcohort participants (562 female) were chosen from the population-based AGES-Reykjavik study (mean age of 77 years). The baseline -i.e. before hip fracture- hip quantitative computed tomography scans of these subjects were analyzed using voxel-based morphometry, tensor-based morphometry, and surface-based statistical parametric mapping to assess the spatial distribution of volumetric bone mineral density (vBMD), internal structure, and cortical bone properties (thickness, vBMD and trabecular vBMD adjacent to the endosteal surface) of the proximal femur, respectively, in relation to incident hip fracture. Results showed that in both men and women: 1) the superior aspect of the femoral neck and the trochanteric region (except for cortical bone thickness) were consistently identified as being associated with incident hip fracture, and 2) differences in bone properties between noncases and incident hip fracture cases followed similar trends, were located at compatible regions, and manifested heterogeneity in the spatial distribution of their magnitude with focal regions showing larger differences. With respect to sex differences, most of the regions with a significant interaction between fracture group and sex showed: 1) differences of greater magnitude in men between noncases and incident hip fracture cases with different spatial distributions for all bone properties with the exception of cortical bone thickness, and 2) that while most of these regions showed better bone quality in male cases than in female cases, female cases showed higher vBMD in the principal compressive group and higher endotrabecular vBMD at several regions including the anterior, posterior, and lateral aspects of the proximal femur. These findings indicate the value of these image analysis techniques by providing unique information about the specific patterns of bone deterioration associated with incident hip fracture and their sex differences, highlighting the importance of looking to men and women separately in the assessment of hip fracture risk.
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Affiliation(s)
- Elisa A Marques
- National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA.
| | - Julio Carballido-Gamio
- Department of Radiology, School of Medicine, University of Colorado Denver, Denver, CO, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association Research Institute, Kópavogur, Iceland; University of Iceland, Reykjavik, Iceland
| | - Gunnar Sigurdsson
- Icelandic Heart Association Research Institute, Kópavogur, Iceland; University of Iceland, Reykjavik, Iceland; Landspitalinn University Hospital, Reykjavik, Iceland
| | | | - Thor Aspelund
- Icelandic Heart Association Research Institute, Kópavogur, Iceland; Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Kristin Siggeirsdottir
- Department of Radiology, School of Medicine, University of Colorado Denver, Denver, CO, USA
| | - Lenore Launer
- National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA
| | | | - Thomas Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Tamara B Harris
- National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA
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20
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Abstract
Denosumab (Prolia®; Pralia®) is a human monoclonal antibody targeting the key bone resorption mediator RANKL. The drug is administered via subcutaneous injection once every 6 months and is approved for various indications, including the treatment of postmenopausal (PM) women with osteoporosis at increased/high risk of fracture or failure/intolerance of other osteoporosis therapies (indications featured in this review). Denosumab showed benefit in several phase 3 or 4 studies in PM women with osteoporosis or low bone mineral density (BMD), including the pivotal 3-year double-blind FREEDOM trial and its 7-year open-label extension. Denosumab reduced the risk of vertebral, nonvertebral and hip fractures and increased BMD across skeletal sites versus placebo in FREEDOM, with these benefits maintained over up to 10 years' therapy in the extension. The drug was also more effective in improving BMD than bisphosphonates, including in women switched from a bisphosphonate regimen, in 1-year trials; however, whether these differences translate into differences in anti-fracture efficacy is unclear. Denosumab was generally well tolerated over up to 10 years' treatment, although an increased risk of multiple vertebral fractures was observed after discontinuation of the drug. Thus, denosumab is a key treatment option for PM women with osteoporosis who have an increased/high risk of fracture or failure/intolerance of other osteoporosis therapies, although the potential for multiple vertebral fractures to occur after discontinuation of the drug requires consideration of subsequent management options.
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Affiliation(s)
- Emma D Deeks
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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21
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Li K, Zhang Y, Wang L, Duanmu YY, Tian W, Chen H, Yin L, Bo J, Wang Y, Li W, He L, Zhao WH, Xu SQ, Zhao LF, Zhou J, Wang FZ, Liu Y, Zhu L, Chen YZ, Zhang XL, Hao XG, Shi ZW, Wang JY, Shao JM, Chen ZJ, Lei RS, Ning G, Zhao Q, Jiang YH, Zhi YH, Li BQ, Chen X, Xiang QY, Wang L, Ma YZ, Liu SW, Cheng XG. The protocol for the Prospective Urban Rural Epidemiology China Action on Spine and Hip status study. Quant Imaging Med Surg 2018; 8:667-672. [PMID: 30211034 DOI: 10.21037/qims.2018.08.07] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Prospective Urban Rural Epidemiology (PURE) China Action on Spine and Hip status (CASH) study focused on the prevalence of osteoporosis and spinal fracture in China. The aim of the PURE CASH study is to determine the prevalence of osteoporosis and spinal fracture, and explore the potential relationship between spinal fracture and bone mineral density (BMD). This study is a prospective large-scale population study with a community-based sampling and recruitment strategy. The aim is to determine the prevalence of osteoporosis and vertebral fracture in this population, to evaluate the association between vertebral fractures and BMD values, and to assess the prediction power of BMD for incident fractures. Participants in the PURE CASH study are all from the PURE study in China, recruited from 12 centers in 7 Chinese provinces. The inclusion criteria are that participants should be aged more than 40 years and able to give informed consent. Exclusion criteria are pregnant women, individuals with metal implants in the lumbar spine, use of medications or the existence of any disease or condition known to have a major influence on BMD, and inability to give informed consent. A total of 3,457 participants undergo a quantitative computed tomography (QCT) scan of the upper abdomen. The scanning parameters are as follows: 120 kVp at all centers, mAs between 75 and 200, FOV 40 cm×40 cm. The BMD values of L1 to L3 are measured, and the average BMD calculated. The American College of Radiology QCT criteria for the diagnosis of osteoporosis is applied to determine the presence of osteoporosis. The scout view images of T4-L4 vertebrae are reviewed by two experienced radiologists for semi-quantification of vertebral fractures according to Genant's method.
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Affiliation(s)
- Kai Li
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yong Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yang-Yang Duanmu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Hui Chen
- Medical Research & Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Lu Yin
- Medical Research & Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Jian Bo
- Medical Research & Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Yang Wang
- Medical Research & Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Wei Li
- Medical Research & Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Li He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Wen-Hua Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Shao-Qi Xu
- Department of Radiology, Nanjing University of Chinese Medicine Affiliated Wujin Hospital of Traditional Chinese Medicine, Changzhou 213161, China
| | - Lin-Fen Zhao
- Department of Radiology, Nanjing University of Chinese Medicine Affiliated Wujin Hospital of Traditional Chinese Medicine, Changzhou 213161, China
| | - Jun Zhou
- Department of Radiology, the 4th People's Hospital of Shenyang, Shenyang 110031, China
| | - Feng-Zhe Wang
- Department of Radiology, the 4th People's Hospital of Shenyang, Shenyang 110031, China
| | - Yu Liu
- Department of Prevention and Healthcare, Shenyang No. 242 Hospital, Shenyang 110034, China
| | - Lei Zhu
- Department of Radiology, the People's Hospital of Dayi County, Chengdu 611330, China
| | - Yi-Zhong Chen
- Department of Radiology, the People's Hospital of Dayi County, Chengdu 611330, China
| | - Xiao-Lin Zhang
- Department of Prevention and Healthcare, Dayi County Public Health Hospital, Chengdu 611330, China
| | - Xiao-Guang Hao
- Department of Radiology, Taiyuan Central Hospital, Taiyuan 030009, China
| | - Zhi-Wei Shi
- Department of Radiology, Taiyuan Central Hospital, Taiyuan 030009, China
| | - Jun-Ying Wang
- Balingqiao Community Health Service Center, Taiyuan 030013, China
| | - Ji-Man Shao
- Department of Radiology, the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, China
| | - Zhi-Jian Chen
- Department of Radiology, the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, China
| | - Ren-Sheng Lei
- Nanchang County Center for Disease Control & Prevention, Nanchang 330200, China
| | - Gang Ning
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu 610041, China
| | - Qian Zhao
- General Practice Department, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yong-Hong Jiang
- Department of Radiology, Xi'an Honghui Hospital, Xi'an 710054, China
| | - Ya-Hong Zhi
- Department of Prevention and Healthcare, Hospital of Xidian University, Xi'an 710071, China
| | - Bao-Qing Li
- Department of Radiology, Beijing Shijingshan Hospital, Beijing 100043, China
| | - Xiao Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Quan-Yong Xiang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210019, China
| | - Liang Wang
- Center of Orthopedics, the 309th Hospital of People's Liberation Army, Beijing 100091, China
| | - Yuan-Zheng Ma
- Center of Orthopedics, the 309th Hospital of People's Liberation Army, Beijing 100091, China
| | - Shi-Wei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiao-Guang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
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Johannesdottir F, Allaire B, Bouxsein ML. Fracture Prediction by Computed Tomography and Finite Element Analysis: Current and Future Perspectives. Curr Osteoporos Rep 2018; 16:411-422. [PMID: 29846870 DOI: 10.1007/s11914-018-0450-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This review critiques the ability of CT-based methods to predict incident hip and vertebral fractures. RECENT FINDINGS CT-based techniques with concurrent calibration all show strong associations with incident hip and vertebral fracture, predicting hip and vertebral fractures as well as, and sometimes better than, dual-energy X-ray absorptiometry areal biomass density (DXA aBMD). There is growing evidence for use of routine CT scans for bone health assessment. CT-based techniques provide a robust approach for osteoporosis diagnosis and fracture prediction. It remains to be seen if further technical advances will improve fracture prediction compared to DXA aBMD. Future work should include more standardization in CT analyses, establishment of treatment intervention thresholds, and more studies to determine whether routine CT scans can be efficiently used to expand the number of individuals who undergo evaluation for fracture risk.
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Affiliation(s)
- Fjola Johannesdottir
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA.
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA.
| | - Brett Allaire
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
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23
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Wang Y, Li J, Yang J, Dong J. Regional variations of cortical bone in the humeral head region: A preliminary study. Bone 2018; 110:194-198. [PMID: 29458122 DOI: 10.1016/j.bone.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Incidence of proximal humeral fractures dramatically increased over the last decade due to demographic changes. The goal of this study was to analyze regional characteristics of cortical bone in the humeral head region using cortical bone mapping (CBM) technique. METHODS The proximal humerus of 103 healthy volunteers was imaged by clinical computed tomography (CT) scans. Three groups of volunteers were identified according to age: group A (20-39years), group B (40-59years), and group C (>60years). CBM was applied to create color 3D thickness maps for each proximal humerus. Cortical parameters, including the cortical thickness (CTh), cortical mass surface density (CM), and the endocortical trabecular density (ECTD) were measured over humeral head region after nine regions of interest (ROI) were defined. RESULTS Cortical bone structure of the humeral head region varied dramatically in cross-section independent of age, with significant cortical thinning at the posterior wall. Particularly, notable cortical thinning was also found in the distal end of lateral wall at 60years of age or older. The degree of regional variability of cortical properties within lateral wall tended to diminish with age. CONCLUSION Substantial regional variations in cortical bone structure at humeral head region were observed quantitatively in this study. These morphologic data provided useful information on clinical medicine such as surgical fixation.
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Affiliation(s)
- Yeming Wang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China.
| | - Jian Li
- Department of Radiology, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jianhua Yang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jingming Dong
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
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24
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Gee AH, Treece GM, Poole KES. How does the femoral cortex depend on bone shape? A methodology for the joint analysis of surface texture and shape. Med Image Anal 2018; 45:55-67. [PMID: 29414436 PMCID: PMC5842044 DOI: 10.1016/j.media.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/24/2017] [Accepted: 01/12/2018] [Indexed: 11/19/2022]
Abstract
In humans, there is clear evidence of an association between hip fracture risk and femoral neck bone mineral density, and some evidence of an association between fracture risk and the shape of the proximal femur. Here, we investigate whether the femoral cortex plays a role in these associations: do particular morphologies predispose to weaker cortices? To answer this question, we used cortical bone mapping to measure the distribution of cortical mass surface density (CMSD, mg/cm2) in a cohort of 125 females. Principal component analysis of the femoral surfaces identified three modes of shape variation accounting for 65% of the population variance. We then used statistical parametric mapping (SPM) to locate regions of the cortex where CMSD depends on shape, allowing for age. Our principal findings were increased CMSD with increased gracility over much of the proximal femur; and decreased CMSD at the superior femoral neck, coupled with increased CMSD at the calcar femorale, with increasing neck-shaft angle. In obtaining these results, we studied the role of spatial normalization in SPM, identifying systematic misregistration as a major impediment to the joint analysis of CMSD and shape. Through a series of experiments on synthetic data, we evaluated a number of registration methods for spatial normalization, concluding that only those predicated on an explicit set of homologous landmarks are suitable for this kind of analysis. The emergent methodology amounts to an extension of Geometric Morphometric Image Analysis to the domain of textured surfaces, alongside a protocol for labelling homologous landmarks in clinical CT scans of the human proximal femur.
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Affiliation(s)
- A H Gee
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK.
| | - G M Treece
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK.
| | - K E S Poole
- Department of Medicine, University of Cambridge, Level 5, Addenbrooke's Hospital, Box 157, Hills Road, Cambridge CB2 2QQ, UK.
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25
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Gosch M, Wicklein S. [Antibodies as treatment option in older adults]. Z Gerontol Geriatr 2017; 51:152-156. [PMID: 29264687 DOI: 10.1007/s00391-017-1352-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 10/30/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
Abstract
Monoclonal antibodies are already used for many different clinical indications. Besides oncology and rheumatology, denosumab is the only antibody that is currently prescribed in older adults with osteoporosis; however, apart from osteoporosis there might be more possible indications for the use of antibodies in chronic diseases and geriatric syndromes. Particularly, with respect to sarcopenia the transition to "doping for older adults" seems to be fluent. The present review provides an overview on the newest developments and prospective options.
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Affiliation(s)
- M Gosch
- Medizinische Klinik 2 - Schwerpunkt Geriatrie, Universitätsklinik für Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Campus Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland.
| | - S Wicklein
- Medizinische Klinik 2 - Schwerpunkt Geriatrie, Universitätsklinik für Geriatrie, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Campus Nürnberg, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Deutschland
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26
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Sone T, Kon N, Gaither KW, Okubo N, Osakabe T, Nakayama Y, Fukunaga M, Ito M, Nakamura T. Effects of 3-year denosumab treatment on hip structure in Japanese postmenopausal women and men with osteoporosis. Bone Rep 2017; 7:164-171. [PMID: 29188222 PMCID: PMC5701790 DOI: 10.1016/j.bonr.2017.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 12/31/2022] Open
Abstract
Denosumab, a human monoclonal antibody against RANK ligand, is shown to have strong anti-fracture effects in Japanese osteoporosis patients. However, there have been no data showing actions on Japanese bone architecture. Here we show that denosumab continuously improves several geometrical parameters calculated by hip structural analysis for 3 years. Compared to placebo, denosumab significantly increased bone mineral density, cortical thickness and cross sectional area in all of the three analyzed areas: the narrow neck, intertrochanter and femoral shaft. The subsequent derived mechanical parameters, cross-sectional moment of inertia, section modulus and buckling ratio, were also improved by denosumab. In addition, the improvement of these parameters was also observed in the patients that had switched from placebo to denosumab treatment. The present study suggests the structural evidence explaining the strong anti-fracture efficacy of denosumab and its significant effects on cortical bone in Japanese.
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Key Words
- BMD, bone mineral density
- BR, buckling ratio
- Bone quality
- CSA, cross sectional area
- CSMI, cross sectional moment of inertia
- CoTh, cortical thickness
- DIRECT, Denosumab fracture Intervention Randomized placebo Controlled Trial
- DMAb/DMAb, denosumab/denosumab
- DXA, dual-energy X-ray absorptiometry
- Denosumab
- ED, endocortical diameter
- FREEDOM, Fracture Reduction Evaluation of Denosumab in Osteoporosis every 6 Months
- HSA, hip structural analysis
- Hip structural analysis
- Japanese
- OD, outer diameter
- Osteoporosis
- PBO/DMAb, placebo/denosumab
- RANK ligand
- RANK, receptor activator of nuclear factor kappa-B
- SM, section modulus
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Affiliation(s)
- Teruki Sone
- Department of Nuclear Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Naohiro Kon
- Medical Science Department, Daiichi Sankyo Co. Ltd., Tokyo, Japan
| | - Kenneth W. Gaither
- Bioclinica, Inc., 11731 Northeast Glenn Widing Drive Portland, Oregon 97220, United States
| | - Naoki Okubo
- Biostatistics and Data Management Department, Daiichi Sankyo Co. Ltd., Tokyo, Japan
| | - Taisuke Osakabe
- Clinical Development Department, Daiichi Sankyo Co. Ltd., Tokyo, Japan
| | - Yutaka Nakayama
- Post-Marketing Regulatory Affairs Department, Daiichi Sankyo Co. Ltd., Tokyo, Japan
| | - Masao Fukunaga
- Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Masako Ito
- Center for Diversity and Inclusion, Nagasaki University, 1-14 Bunkyo-machi, Nagasaki 852-8521, Japan
| | - Toshitaka Nakamura
- Touto Sangenjaya Rehabilitation Hospital, 1-24-3 Sangenjaya, Setagaya-ku, Tokyo 154-0024, Japan
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27
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Measurement of the bone endocortical region using clinical CT. Med Image Anal 2017; 44:28-40. [PMID: 29179157 DOI: 10.1016/j.media.2017.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/07/2017] [Accepted: 11/15/2017] [Indexed: 12/13/2022]
Abstract
The extent of the endocortical region and cortical bone mineral density (cBMD) throughout the proximal femur are of interest as both have been linked to fracture risk and osteoporosis treatment response. Non-invasive in-vivo clinical CT-based techniques capable of measuring the cortical bone attributes of thickness, density and mass over a bone surface have already been proposed. Several studies have robustly shown these methods to be capable of producing cortical thickness measurements to a sub-millimetre accuracy. Unfortunately, these methods are unable to provide high quality cBMD estimates, and are not designed to measure any attributes over the endocortical region of cortical bone. In this paper, we develop a cortical bone mapping based technique capable of providing an improved cBMD estimate and a measure of the endocortical width, while maintaining similar quality cortical thickness and trabecular bone mineral density (tBMD) estimates. The performance of the technique was assessed using a paired dataset of ex-vivo QCT and HR-pQCT scans across 72 proximal femurs. The HR-pQCT scans were analysed using a new method developed for this study: high resolution tissue classification (HRTC). In HRTC the cortical, endocortical and sub-surface trabecular bone features are extracted from the partially resolvable microarchitectural details in the HR-pQCT scan. We demonstrate that measurement of the endocortical extent from QCT is possible with an accuracy of -0.15±0.71mm, and that local cBMD can be measured down to densities of 300 mg/cm3.
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28
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Valentinitsch A, Trebeschi S, Alarcón E, Baum T, Kaesmacher J, Zimmer C, Lorenz C, Kirschke JS. Regional analysis of age-related local bone loss in the spine of a healthy population using 3D voxel-based modeling. Bone 2017; 103:233-240. [PMID: 28716553 DOI: 10.1016/j.bone.2017.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/15/2017] [Accepted: 06/19/2017] [Indexed: 12/28/2022]
Abstract
Local variations in bone loss may be of great importance to individually predict osteoporotic fractures but are neglected by current densitometry techniques. The purpose of this study was to evaluate regional variations of normal bone loss at the spine among different age groups using voxel-based morphometry. Non-contrast MDCT scans of 16 patients under the age of 40 (mean age 26years) without spinal pathology were identified as a reference cohort, where each thoracolumbar vertebra was assessed individually. For comparison, 38 patients >40years were grouped by decades in 4 cohorts of 10 patients each, except the youngest, including 8 patients only. All spines were automatically detected, segmented and non-rigidly registered for spatially normalized vertebral bodies. Afterwards, statistical and T-score mapping was performed to highlight local density differences in comparison to the reference cohort. The calculated statistical maps of significantly affected density regions (ADR) started to highlight small local changes of volumetric bone mineral density (vBMD) distribution within the vertebra of L5 (ADR: 7.9%) in the fifties cohort. Regions near the endplates were most affected. The effect dramatically increased in the sixties cohort, where bone loss was most prominent from T12 to L2. In the seventies cohort, around 50% of voxels in T10 to L5 showed significantly decreased vBMD. In conclusion, ADR and local T-score maps of the spine showed age-related local variations in a healthy population, corresponding to known areas of fracture origination and increased fracture incidence. It thus might provide a powerful tool in diagnosis of osteoporosis.
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Affiliation(s)
- Alexander Valentinitsch
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
| | - Stefano Trebeschi
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
| | - Eva Alarcón
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
| | - Thomas Baum
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | | | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
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29
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Ren H, Shen G, Tang J, Qiu T, Zhang Z, Zhao W, Yu X, Huang J, Liang D, Yao Z, Yang Z, Jiang X. Promotion effect of extracts from plastrum testudinis on alendronate against glucocorticoid-induced osteoporosis in rat spine. Sci Rep 2017; 7:10617. [PMID: 28878388 PMCID: PMC5587701 DOI: 10.1038/s41598-017-10614-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 08/11/2017] [Indexed: 12/21/2022] Open
Abstract
Alendronate (ALN) is a key therapeutic used to treat glucocorticoid-induced osteoporosis (GIOP), but may induce severe side effects. We showed earlier that plastrum testudinis extracts (PTE) prevented and treated GIOP in vivo. However, clinically, PTE is seldom used alone. Herein, we reveal the synergistic effect of ALN and PTE can treat GIOP of the rat spine and define the mechanism. Sprague-Dawley rats were randomly assigned to four groups: a vehicle group, a GIOP group, an ALN group, and an ALN+PTE group. Each group was further divided into two experimental phases, including dexamethasone (DXM) intervention and withdrawal. Bone mass, microarchitecture, biomechanics, bone-turnover markers, and histomorphology were evaluated. The mRNA and protein expression levels of CTSK and Runx2 were detemined. We found that ALN+PTE improved bone quantity and quality, bone strength, bone turnover; and mitigated histological damage during glucocorticoid intervention and withdrawal. The therapeutic effect was better than that afforded by ALN alone. ALN+PTE reduced CTSK protein expression, promoted Runx2 mRNA and protein expression to varying extents, and more strongly inhibited bone resorption than did ALN alone. Overall, the synergistic effect mediated by ALN+PTE reversed GIOP during DXM intervention and withdrawal via affecting CTSK and Runx2 expression at mRNA and protein levels.
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Affiliation(s)
- Hui Ren
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou, Guangzhou, 510405, China
| | - Gengyang Shen
- Guangzhou University of Chinese Medicine Guangzhou , Guangzhou, 510405, China
| | - Jingjing Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou, Guangzhou, 510405, China
| | - Ting Qiu
- Guangzhou University of Chinese Medicine Guangzhou , Guangzhou, 510405, China
| | - Zhida Zhang
- Guangzhou University of Chinese Medicine Guangzhou , Guangzhou, 510405, China
| | - Wenhua Zhao
- Guangzhou University of Chinese Medicine Guangzhou , Guangzhou, 510405, China
| | - Xiang Yu
- Guangzhou University of Chinese Medicine Guangzhou , Guangzhou, 510405, China
| | - Jinjing Huang
- Guangzhou University of Chinese Medicine Guangzhou , Guangzhou, 510405, China
| | - De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou, Guangzhou, 510405, China
| | - Zhensong Yao
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou, Guangzhou, 510405, China
| | - Zhidong Yang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou, Guangzhou, 510405, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine Guangzhou, Guangzhou, 510405, China. .,Laboratory Affiliated to National Key Discipline of Orthopaedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China.
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30
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Abstract
This review focuses on new developments and current controversies in the field of quantitative computed tomography. Recent positions of the International Society for Clinical Densitometry acknowledged the clinical value of quantitative computed tomography of the spine and the hip using clinical whole-body computed tomography (CT) scanners. Opportunistic screening summarizes a number of new approaches describing the dual use of clinical CT scans. For example, CT scans may have been taken for tumor diagnosis but may also be used for the prediction of high or low fracture risks as an additional benefit for the patient. The assessment of the cortical parameters is another topic of current research. In CT images of the spine and the hip, a number of techniques have been developed to determine the thickness, mass, and bone density of the cortex. In higher-spatial resolution peripheral CT images of the radius and tibia obtained from special purpose scanners, 1 focus is the measurement of cortical porosity. Two different approaches, one based on the direct segmentation of the pores and one based on cortical density, will be reviewed.
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Affiliation(s)
- Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany; Bioclinica, Inc, Hamburg, Germany.
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31
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McClung MR. Denosumab for the treatment of osteoporosis. Osteoporos Sarcopenia 2017; 3:8-17. [PMID: 30775498 PMCID: PMC6372782 DOI: 10.1016/j.afos.2017.01.002] [Citation(s) in RCA: 16] [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: 01/14/2017] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 12/13/2022] Open
Abstract
Denosumab, a specific inhibitor of RANK ligand, is a novel therapy for postmenopausal osteoporosis and related disorders. An extensive clinical development program has evaluated the clinical efficacy and safety of denosumab with several thousand patients being followed for up to 10 years. Combined with more than six years of postmarketing experience, these studies provide substantial confidence that denosumab is a convenient and appropriate treatment for patients, including Asians, at high risk for fracture. This review will summarize the clinical development of denosumab and lessons learned since its approval for clinical use in 2010.
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Affiliation(s)
- Michael R. McClung
- Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia
- Oregon Osteoporosis Center, 2881 NW Cumberland Road, Portland, OR 97210, USA
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32
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Poole KES, Skingle L, Gee AH, Turmezei TD, Johannesdottir F, Blesic K, Rose C, Vindlacheruvu M, Donell S, Vaculik J, Dungl P, Horak M, Stepan JJ, Reeve J, Treece GM. Focal osteoporosis defects play a key role in hip fracture. Bone 2017; 94:124-134. [PMID: 27777119 PMCID: PMC5135225 DOI: 10.1016/j.bone.2016.10.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 10/05/2016] [Accepted: 10/20/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip fractures are mainly caused by accidental falls and trips, which magnify forces in well-defined areas of the proximal femur. Unfortunately, the same areas are at risk of rapid bone loss with ageing, since they are relatively stress-shielded during walking and sitting. Focal osteoporosis in those areas may contribute to fracture, and targeted 3D measurements might enhance hip fracture prediction. In the FEMCO case-control clinical study, Cortical Bone Mapping (CBM) was applied to clinical computed tomography (CT) scans to define 3D cortical and trabecular bone defects in patients with acute hip fracture compared to controls. Direct measurements of trabecular bone volume were then made in biopsies of target regions removed at operation. METHODS The sample consisted of CT scans from 313 female and 40 male volunteers (158 with proximal femoral fracture, 145 age-matched controls and 50 fallers without hip fracture). Detailed Cortical Bone Maps (c.5580 measurement points on the unfractured hip) were created before registering each hip to an average femur shape to facilitate statistical parametric mapping (SPM). Areas where cortical and trabecular bone differed from controls were visualised in 3D for location, magnitude and statistical significance. Measures from the novel regions created by the SPM process were then tested for their ability to classify fracture versus control by comparison with traditional CT measures of areal Bone Mineral Density (aBMD). In women we used the surgical classification of fracture location ('femoral neck' or 'trochanteric') to discover whether focal osteoporosis was specific to fracture type. To explore whether the focal areas were osteoporotic by histological criteria, we used micro CT to measure trabecular bone parameters in targeted biopsies taken from the femoral heads of 14 cases. RESULTS Hip fracture patients had distinct patterns of focal osteoporosis that determined fracture type, and CBM measures classified fracture type better than aBMD parameters. CBM measures however improved only minimally on aBMD for predicting any hip fracture and depended on the inclusion of trabecular bone measures alongside cortical regions. Focal osteoporosis was confirmed on biopsy as reduced sub-cortical trabecular bone volume. CONCLUSION Using 3D imaging methods and targeted bone biopsy, we discovered focal osteoporosis affecting trabecular and cortical bone of the proximal femur, among men and women with hip fracture.
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Affiliation(s)
- Kenneth E S Poole
- Department of Medicine, University of Cambridge and Addenbrooke's Hospital, Hills Road, Cambridge, UK.
| | - Linda Skingle
- Department of Medicine, University of Cambridge and Addenbrooke's Hospital, Hills Road, Cambridge, UK
| | - Andrew H Gee
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Thomas D Turmezei
- Department of Medicine, University of Cambridge and Addenbrooke's Hospital, Hills Road, Cambridge, UK
| | - Fjola Johannesdottir
- Department of Medicine, University of Cambridge and Addenbrooke's Hospital, Hills Road, Cambridge, UK
| | - Karen Blesic
- Department of Medicine, University of Cambridge and Addenbrooke's Hospital, Hills Road, Cambridge, UK
| | - Collette Rose
- Department of Medicine, University of Cambridge and Addenbrooke's Hospital, Hills Road, Cambridge, UK
| | | | - Simon Donell
- Department of Orthopaedics, Norfolk & Norwich University Hospital, Norwich, UK
| | - Jan Vaculik
- Department of Orthopaedics, Faculty of Medicine, Charles University and Bulovka Hospital, Prague, Czech Republic
| | - Pavel Dungl
- Department of Orthopaedics, Faculty of Medicine, Charles University and Bulovka Hospital, Prague, Czech Republic
| | - Martin Horak
- Department of Radiology, Homolka Hospital, Prague, Czech Republic
| | - Jan J Stepan
- Faculty of Medicine 1, Charles University and Institute of Rheumatology, Prague, Czech Republic
| | - Jonathan Reeve
- BOTNAR Research Institute, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, UK
| | - Graham M Treece
- Department of Engineering, University of Cambridge, Cambridge, UK
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33
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Carballido-Gamio J, Bonaretti S, Kazakia GJ, Khosla S, Majumdar S, Lang TF, Burghardt AJ. Statistical Parametric Mapping of HR-pQCT Images: A Tool for Population-Based Local Comparisons of Micro-Scale Bone Features. Ann Biomed Eng 2016; 45:949-962. [PMID: 27830488 DOI: 10.1007/s10439-016-1754-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/26/2016] [Indexed: 12/26/2022]
Abstract
HR-pQCT enables in vivo multi-parametric assessments of bone microstructure in the distal radius and distal tibia. Conventional HR-pQCT image analysis approaches summarize bone parameters into global scalars, discarding relevant spatial information. In this work, we demonstrate the feasibility and reliability of statistical parametric mapping (SPM) techniques for HR-pQCT studies, which enable population-based local comparisons of bone properties. We present voxel-based morphometry (VBM) to assess trabecular and cortical bone voxel-based features, and a surface-based framework to assess cortical bone features both in cross-sectional and longitudinal studies. In addition, we present tensor-based morphometry (TBM) to assess trabecular and cortical bone structural changes. The SPM techniques were evaluated based on scan-rescan HR-pQCT acquisitions with repositioning of the distal radius and distal tibia of 30 subjects. For VBM and surface-based SPM purposes, all scans were spatially normalized to common radial and tibial templates, while for TBM purposes, rescans (follow-up) were spatially normalized to their corresponding scans (baseline). VBM was evaluated based on maps of local bone volume fraction (BV/TV), homogenized volumetric bone mineral density (vBMD), and homogenized strain energy density (SED) derived from micro-finite element analysis; while the cortical bone framework was evaluated based on surface maps of cortical bone thickness, vBMD, and SED. Voxel-wise and vertex-wise comparisons of bone features were done between the groups of baseline and follow-up scans. TBM was evaluated based on mean square errors of determinants of Jacobians at baseline bone voxels. In both anatomical sites, voxel- and vertex-wise uni- and multi-parametric comparisons yielded non-significant differences, and TBM showed no artefactual bone loss or apposition. The presented SPM techniques demonstrated robust specificity thus warranting their application in future clinical HR-pQCT studies.
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Affiliation(s)
| | - Serena Bonaretti
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Galateia J Kazakia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas F Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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Shuai B, Zhu R, Yang YP, Shen L, Xu XJ, Ma C, Lu L. Positive Effects of Qing'e Pill () on Trabecular Microarchitecture and its Mechanical Properties in Osteopenic Ovariectomised Mice. Chin J Integr Med 2016; 25:270-277. [PMID: 27778261 DOI: 10.1007/s11655-016-2604-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the impact of Qing'e Pill (, QEP) on the cancellous bone microstructure and its effect on the level of β-catenin in a mouse model of postmenopausal osteoporosis. METHODS Ninety-six 8-week-old specific pathogen free C57BL/6 mice were randomly divided into 4 groups (24/group): sham, ovariectomised osteoporosis model, oestradiol-treated, and QEP-treated groups. Three months after surgery, the third lumbar vertebra and left femur of the animals were dissected and scanned using micro-computed tomography (micro-CT) to acquire three-dimensional (3D) parameters of their cancellous bone microstructure. The impact of ovariectomy, the effect of oestradiol and QEP intervention on cancellous bone microstructure, and the expression of β-catenin were evaluated. RESULTS The oestradioland the QEP-treated groups exhibited a significant increase in the bone volume fraction, trabecular number, trabecular thickneßs, bone surface to bone volume ratio (BS/BV), and β-catenin expression compared with those of the model group (P <0.05). In contrast, the structure model index, trabecular separation, and BS/BV were significantly decreased compared with those of the ovariectomised osteoporosis model group (P <0.05). No differences were observed in the above parameters between animals of the QEP- and oestradiol-treated groups. CONCLUSIONS The increased β-catenin expression may be the mechanism underlying QEP's improvement of the cancellous bone microstructure in ovariectomised mice. Our findings provide a scientific rationale for using QEP as a dietary supplement to prevent bone loss in postmenopausal women.
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Affiliation(s)
- Bo Shuai
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Rui Zhu
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yan-Ping Yang
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Lin Shen
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiao-Juan Xu
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chen Ma
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lin Lu
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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Zebaze R, Libanati C, McClung MR, Zanchetta JR, Kendler DL, Høiseth A, Wang A, Ghasem-Zadeh A, Seeman E. Denosumab Reduces Cortical Porosity of the Proximal Femoral Shaft in Postmenopausal Women With Osteoporosis. J Bone Miner Res 2016; 31:1827-1834. [PMID: 27082709 DOI: 10.1002/jbmr.2855] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/06/2016] [Accepted: 04/13/2016] [Indexed: 12/12/2022]
Abstract
Hip fractures account for over one-half the morbidity, mortality, and cost associated with osteoporosis. Fragility of the proximal femur is the result of rapid and unbalanced bone remodeling events that excavate more bone than they deposit, producing a porous, thinned, and fragile cortex. We hypothesized that the slowing of remodeling during treatment with denosumab allows refilling of the many cavities excavated before treatment now opposed by excavation of fewer new resorption cavities. The resulting net effect is a reduction in cortical porosity and an increase in proximal femur strength. Images were acquired at baseline and 36 months using multidetector CT in 28 women receiving denosumab and 22 women receiving placebo in a substudy of FREEDOM, a randomized, double-blind, placebo-controlled trial involving women with postmenopausal osteoporosis. Porosity was quantified using StrAx1.0 software. Strength was estimated using finite element analysis. At baseline, the higher the serum resorption marker, CTx, the greater the porosity of the total cortex (r = 0.34, p = 0.02), and the higher the porosity, the lower the hip strength (r = -0.31, p = 0.03). By 36 months, denosumab treatment reduced porosity of the total cortex by 3.6% relative to baseline. Reductions in porosity relative to placebo at 36 months were 5.3% in total cortex, 7.9% in compact-appearing cortex, 5.6% in outer transitional zone, and 1.8% in inner transitional zone (all p < 0.01). The improvement in estimated hip integral strength of 7.9% from baseline (p < 0.0001) was associated with the reduction in total porosity (r = -0.41, p = 0.03). In summary, denosumab reduced cortical porosity of the proximal femoral shaft, resulting in increased mineralized matrix volume and improved strength, changes that may contribute to the reduction in hip and nonvertebral fractures reported with denosumab therapy. © 2016 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Roger Zebaze
- Austin Health, University of Melbourne, Melbourne, Australia
| | | | | | - José R Zanchetta
- Instituto de Investigaciones Metabólicas, Buenos Aires, Argentina
| | | | | | | | | | - Ego Seeman
- Austin Health, University of Melbourne, Melbourne, Australia.
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Effect of Denosumab on Bone Mineral Density and Markers of Bone Turnover among Postmenopausal Women with Osteoporosis. J Osteoporos 2016; 2016:8738959. [PMID: 27579211 PMCID: PMC4992763 DOI: 10.1155/2016/8738959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/24/2016] [Accepted: 07/12/2016] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the effect of denosumab (Dmab) on bone mineral density (BMD) and bone turnover markers after 1 year of treatment. Additionally, the effect of Dmab in bisphosphonate-naïve patients (BP-naïve) compared to patients previously treated with bisphosphonates (BP-prior) was analyzed. This retrospective study included 425 postmenopausal women treated with Dmab for 1 year in clinical practice conditions in specialized centers from Argentina. Participants were also divided according to previous bisphosphonate treatment into BP-naïve and BP-prior. A control group of patients treated with BP not switched to Dmab matched by sex, age, and body mass index was used. Data are expressed as mean ± SEM. After 1 year of treatment with Dmab the bone formation markers total alkaline phosphatase and osteocalcin were significantly decreased (23.36% and 43.97%, resp.), as was the bone resorption marker s-CTX (69.61%). Significant increases in BMD were observed at the lumbar spine, femoral neck, and total hip without differences between BP-naïve and BP-prior. A better BMD response was found in BP-prior group compared with BP treated patients not switched to Dmab. Conclusion. Dmab treatment increased BMD and decreased bone turnover markers in the whole group, with similar response in BP-naïve and BP-prior patients. A better BMD response in BP-prior patients versus BP treated patients not switched to Dmab was observed.
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Takeuchi T, Tanaka Y, Ishiguro N, Yamanaka H, Yoneda T, Ohira T, Okubo N, Genant HK, van der Heijde D. Response to: 'Denosumab, cortical bone and bone erosion in rheumatoid arthritis' by Rossini et al. Ann Rheum Dis 2016; 75:e71. [PMID: 27553215 DOI: 10.1136/annrheumdis-2016-210027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiyuki Yoneda
- Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Harry K Genant
- Departments of Radiology, Medicine and Orthopaedic Surgery, University of California, San Francisco, California, USA
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Tsai JN, Uihlein AV, Burnett-Bowie SM, Neer RM, Derrico NP, Lee H, Bouxsein ML, Leder BZ. Effects of Two Years of Teriparatide, Denosumab, or Both on Bone Microarchitecture and Strength (DATA-HRpQCT study). J Clin Endocrinol Metab 2016; 101:2023-30. [PMID: 26964731 PMCID: PMC4870854 DOI: 10.1210/jc.2016-1160] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT In postmenopausal osteoporosis, combining denosumab and teriparatide increases hip and spine bone mineral density more than either monotherapy. OBJECTIVE The objective of the study was to determine the effects of 2 years of combination therapy on bone microarchitecture and estimated strength. DESIGN This was an open-label, randomized controlled trial. PARTICIPANTS AND METHODS We performed high-resolution peripheral quantitative computed tomography at the distal tibia and radius in 94 postmenopausal osteoporotic women randomized to 2 years of teriparatide 20 μg sc daily, denosumab 60 mg sc every 6 months, or both. RESULTS Total volumetric bone mineral density (vBMD) at the radius and tibia, trabecular vBMD at the radius, and cortical vBMD at the tibia all increased more in the combination group than both monotherapy groups (P < .002 for all comparisons with combination). Cortical thickness at the tibia also increased more in the combination group (8.1% ± 4.3%) than both other groups (P < .001). Cortical porosity at both the radius and tibia increased progressively over the 24-month treatment period in the teriparatide group but was stable in both other groups (P < .001 teriparatide vs both other groups). Trabecular vBMD at the tibia increased similarly in all groups, whereas radius trabecular vBMD increased more in the combination group than the other groups (P < .01 for both comparisons). Finite element analysis-estimated strength improved or was maintained by all treatments at both the radius and tibia. CONCLUSIONS Two years of combined teriparatide and denosumab improves bone microarchitecture and estimated strength more than the individual treatments, particularly in cortical bone. These findings suggest that this regimen may be beneficial in postmenopausal osteoporosis.
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Affiliation(s)
- J N Tsai
- Endocrine Unit (J.N.T., A.V.U., S.M.B.-B., R.M.N., N.P.D., M.L.B., B.Z.L.), and Biostatistics Center (H.L.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Orthopedic Surgery (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115
| | - A V Uihlein
- Endocrine Unit (J.N.T., A.V.U., S.M.B.-B., R.M.N., N.P.D., M.L.B., B.Z.L.), and Biostatistics Center (H.L.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Orthopedic Surgery (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115
| | - S M Burnett-Bowie
- Endocrine Unit (J.N.T., A.V.U., S.M.B.-B., R.M.N., N.P.D., M.L.B., B.Z.L.), and Biostatistics Center (H.L.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Orthopedic Surgery (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115
| | - R M Neer
- Endocrine Unit (J.N.T., A.V.U., S.M.B.-B., R.M.N., N.P.D., M.L.B., B.Z.L.), and Biostatistics Center (H.L.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Orthopedic Surgery (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115
| | - N P Derrico
- Endocrine Unit (J.N.T., A.V.U., S.M.B.-B., R.M.N., N.P.D., M.L.B., B.Z.L.), and Biostatistics Center (H.L.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Orthopedic Surgery (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115
| | - H Lee
- Endocrine Unit (J.N.T., A.V.U., S.M.B.-B., R.M.N., N.P.D., M.L.B., B.Z.L.), and Biostatistics Center (H.L.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Orthopedic Surgery (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115
| | - M L Bouxsein
- Endocrine Unit (J.N.T., A.V.U., S.M.B.-B., R.M.N., N.P.D., M.L.B., B.Z.L.), and Biostatistics Center (H.L.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Orthopedic Surgery (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115
| | - B Z Leder
- Endocrine Unit (J.N.T., A.V.U., S.M.B.-B., R.M.N., N.P.D., M.L.B., B.Z.L.), and Biostatistics Center (H.L.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Department of Orthopedic Surgery (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115
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Cosman F, Dempster DW, Nieves JW, Zhou H, Zion M, Roimisher C, Houle Y, Lindsay R, Bostrom M. Effect of Teriparatide on Bone Formation in the Human Femoral Neck. J Clin Endocrinol Metab 2016; 101:1498-505. [PMID: 26900640 PMCID: PMC4880158 DOI: 10.1210/jc.2015-3698] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/18/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Teriparatide (TPTD) improves bone mass and microstructure resulting in reduced risk of vertebral and nonvertebral fractures. However, hip bone mineral density improvements are modest and there are no data confirming that TPTD reduces hip fracture risk. To study the effects of TPTD on the proximal femur, we performed a double-blind trial of TPTD vs placebo (PBO) in patients with osteoarthritis from whom femoral neck (FN) samples were obtained at total hip replacement (THR) surgery. METHODS Participants were randomly assigned to receive TPTD or PBO for an average of 40 days before THR. Double tetracycline labeling was initiated 21 days prior to THR to allow histomorphometric assessment of bone formation. During the THR, an intact sample of the FN was procured, fixed, and sectioned transversely. Serum levels of bone turnover markers were measured at baseline and during the THR. Standard histomorphometric parameters were measured and calculated on four bone envelopes (cancellous, endocortical, intracortical, and periosteal). The primary outcome measure was bone formation rate/bone surface (BFR/BS). RESULTS Forty individuals were enrolled (25 women, mean age, 71.5 ± 8.0 y and 15 men, mean age, 68.9 ± 7.7 y). In cancellous and endocortical envelopes, BFR/BS was 100% higher in the TPTD vs PBO group (P < .05). Bone turnover markers measured at the time of THR correlated with BFR/BS. CONCLUSIONS TPTD stimulates bone formation rapidly in cancellous and endocortical envelopes of the FN. Our findings provide a mechanistic basis for TPTD-mediated improvement in FN bone mass and ultimately hip strength. This study is the first demonstration of the effect of any osteoporosis medication on osteoblast activity in the human proximal femur.
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Affiliation(s)
- Felicia Cosman
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - David W Dempster
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Jeri W Nieves
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Hua Zhou
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Marsha Zion
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Catherine Roimisher
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Yvonne Houle
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Robert Lindsay
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Mathias Bostrom
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
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Whitmarsh T, Treece GM, Gee AH, Poole KES. The Effects on the Femoral Cortex of a 24 Month Treatment Compared to an 18 Month Treatment with Teriparatide: A Multi-Trial Retrospective Analysis. PLoS One 2016; 11:e0147722. [PMID: 26859142 PMCID: PMC4747533 DOI: 10.1371/journal.pone.0147722] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 01/07/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Teriparatide (TPTD) is an anabolic agent indicated for the treatment of severely osteoporotic patients who are at high risk of fragility fractures. The originally approved duration of TPTD treatment in several regions, including Europe, was 18 months. However, studies of areal bone mineral density (aBMD) showed additional benefit when treatment is continued beyond 18 months, and the drug is currently licenced for 24 months. Improvements in cortical structure at the proximal femur have already been shown in patients given TPTD for 24 months using quantitative computed tomography (QCT). Here, we investigate whether cortical and endocortical trabecular changes differ between an 18- and 24-month treatment. METHODS Since an 18- versus 24-month TPTD study using QCT has not been conducted, we studied combined QCT data from four previous clinical trials. Combined femoral QCT data from three 18-month TPTD studies ('18-month group') were compared with data from a fourth 24-month trial ('24-month group'). Cortical parameters were measured over the entire proximal femur which allowed for a comparison of the mean changes as well as a visual comparison of the colour maps of changes after 18 and 24 months TPTD. RESULTS For both the combined 18-month group and the 24-month group, overall cortical thickness and endocortical trabecular density increased, while overall cortical bone mineral density decreased. While the changes in the 24-month group were of greater magnitude compared to the 18-month group, the differences were only significant for the endocortical trabecular density (ECTD), corrected for age, weight, femoral neck T-score, total hip T-score and the baseline mean ECTD. CONCLUSION Although the combination of data from different clinical trials is not optimal, these data support the concept that the duration of TPTD in the 18-24 month phase is of clinical relevance when considering improvement in hip structure.
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Affiliation(s)
- Tristan Whitmarsh
- University of Cambridge, Department of Engineering, Trumpington Street, Cambridge, CB2 1PZ, United Kingdom
| | - Graham M. Treece
- University of Cambridge, Department of Engineering, Trumpington Street, Cambridge, CB2 1PZ, United Kingdom
| | - Andrew H. Gee
- University of Cambridge, Department of Engineering, Trumpington Street, Cambridge, CB2 1PZ, United Kingdom
| | - Kenneth E. S. Poole
- University of Cambridge, Department of Medicine, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
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Unmet needs and current and future approaches for osteoporotic patients at high risk of hip fracture. Arch Osteoporos 2016; 11:37. [PMID: 27800591 PMCID: PMC5306171 DOI: 10.1007/s11657-016-0292-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/25/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED This review provides a critical analysis of currently available approaches to increase bone mass, structure and strength through drug therapy and of possible direct intra-osseous interventions for the management of patients at imminent risk of hip fracture. PURPOSE Osteoporotic hip fractures represent a particularly high burden in morbidity-, mortality- and health care-related costs. There are challenges and unmet needs in the early prevention of hip fractures, opening the perspective of new developments for the management of osteoporotic patients at imminent and/or at very high risk of hip fracture. Amongst them, preventive surgical intervention needs to be considered. METHODS A European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)/International Osteoporosis Foundation (IOF) working group reviewed the presently available intervention modalities including preventive surgical options for hip fragility. This paper represents a summary of the discussions. RESULTS Prevention of hip fracture is currently based on regular physical activity; prevention of falls; correction of nutritional deficiencies, including vitamin D repletion; and pharmacological intervention. However, efficacy of these various measures to reduce hip fractures is at most 50% and may need months or years before becoming effective. To face the challenges of early prevention of hip fractures for osteoporotic patients at imminent and/or at very high risk of hip fracture, preventive surgical intervention needs further investigation. CONCLUSION Preventive surgical intervention needs to be appraised for osteoporotic patients at imminent and/or at very high risk of hip fracture.
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Lewiecki EM, Baron R, Bilezikian JP, Gagel RE, Leonard MB, Leslie WD, McClung MR, Miller PD. Proceedings of the 2015 Santa Fe Bone Symposium: Clinical Applications of Scientific Advances in Osteoporosis and Metabolic Bone Disease. J Clin Densitom 2016; 19:102-16. [PMID: 26750746 PMCID: PMC6706250 DOI: 10.1016/j.jocd.2015.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/19/2015] [Indexed: 12/30/2022]
Abstract
The 2015 Santa Fe Bone Symposium was a venue for healthcare professionals and clinical researchers to present and discuss the clinical relevance of recent advances in the science of skeletal disorders, with a focus on osteoporosis and metabolic bone disease. Symposium topics included new developments in the translation of basic bone science to improved patient care, osteoporosis treatment duration, pediatric bone disease, update of fracture risk assessment, cancer treatment-related bone loss, fracture liaison services, a review of the most significant studies of the past year, and the use of telementoring with Bone Health Extension for Community Healthcare Outcomes, a force multiplier to improve the care of osteoporosis in underserved communities.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
| | - Roland Baron
- Harvard Medical School and Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA, USA
| | - John P Bilezikian
- Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Robert E Gagel
- University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Paul D Miller
- Colorado Center for Bone Research, Lakewood, CO, USA
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Gee AH, Treece GM, Tonkin CJ, Black DM, Poole KES. Association between femur size and a focal defect of the superior femoral neck. Bone 2015; 81:60-66. [PMID: 26142930 PMCID: PMC4640978 DOI: 10.1016/j.bone.2015.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/10/2015] [Accepted: 06/29/2015] [Indexed: 11/26/2022]
Abstract
Within each sex, there is an association between hip fracture risk and the size of the proximal femur, with larger femurs apparently more susceptible to fracture. Here, we investigate whether the thickness and density of the femoral cortex play a role in this association: might larger femurs harbour focal, cortical defects? To answer this question, we used cortical bone mapping to measure the distribution of cortical mass surface density (CMSD, mg/cm(2)) in cohorts of 308 males and 125 females. Principal component analysis of the various femoral surfaces led to a measure of size that is linearly independent from shape. After mapping the data onto a canonical femur surface, we used statistical parametric mapping to identify any regions where CMSD depends on size, allowing for other confounding covariates including shape. Our principal finding was a focal patch on the superior femoral neck, where CMSD is reduced by around 1% for each 1% increase in proximal-distal size (p<0.000005 in the males, p<0.001 in the females). This finding appears to be consistent with models of functional adaptation, and may help with the design of interventional strategies for reducing fracture risk.
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Affiliation(s)
- A H Gee
- University of Cambridge Department of Engineering, Trumpington Street, Cambridge CB2 1PZ, UK.
| | - G M Treece
- University of Cambridge Department of Engineering, Trumpington Street, Cambridge CB2 1PZ, UK.
| | - C J Tonkin
- University of Cambridge Department of Medicine, Level 5, Addenbrooke's Hospital (Box 157), Hills Road, Cambridge CB2 2QQ, UK.
| | - D M Black
- University of California, San Francisco, Department of Epidemiology and Biostatistics, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107, USA.
| | - K E S Poole
- University of Cambridge Department of Medicine, Level 5, Addenbrooke's Hospital (Box 157), Hills Road, Cambridge CB2 2QQ, UK.
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44
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Gu HF, Gu LJ, Wu Y, Zhao XH, Zhang Q, Xu ZR, Yang YM. Efficacy and Safety of Denosumab in Postmenopausal Women With Osteoporosis: A Meta-Analysis. Medicine (Baltimore) 2015; 94:e1674. [PMID: 26554766 PMCID: PMC4915867 DOI: 10.1097/md.0000000000001674] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study was to perform a meta-analysis to examine the efficacy and safety of denosumab in postmenopausal women with osteoporosis.Medline, Cochrane Library, EMBASE, and Google Scholar databases were searched until October 30, 2014 using combinations of the following search terms: osteoporosis, postmenopause, postmenopausal, women, denosumab. The primary outcome was bone mineral density (BMD) change, and secondary outcomes were change in the bone turnover markers β-isomerized carboxy-terminal cross-linking telopeptide of type I collagen (CTX) and serum procollagen type I amino-terminal propeptide (P1NP), and adverse events.Patients treated with denosumab had significantly increased BMD of the lumbar spine (7.58%), total hip (4.86%), and distal third of the radius (2.92%) than those treated with placebo (all, P < 0.001). Patients treated with denosumab had a significant decrease of CTX (-66.16%) and P1NP (-64.65%) as compared with those treated with placebo (both, P < 0.001). Adverse events were similar between the 2 groups (pooled odds ratio = 1.04, P = 0.625).Denosumab increases BMD and decreases markers of bone turnover in postmenopausal women with osteoporosis, and is not associated with significant side-effects.
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Affiliation(s)
- Hai-Feng Gu
- From the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou (H-FG, YW, X-HZ, QZ, Z-RX, Y-MY); and Taizhou First People's Hospital, TaiZhou, China (L-JG)
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45
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Compston J. Emerging therapeutic concepts for muscle and bone preservation/building. Bone 2015; 80:150-156. [PMID: 26453503 DOI: 10.1016/j.bone.2015.04.013] [Citation(s) in RCA: 9] [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: 10/06/2014] [Revised: 03/24/2015] [Accepted: 04/07/2015] [Indexed: 01/16/2023]
Abstract
Loss of muscle or bone mass occurs with ageing, immobility and in association with a variety of systemic diseases. The interaction of these two processes is most evident in the major contribution of falls to the risk of fractures in the elderly population. Exercise and nutrition are key common physiological variables that allow for preservation or formation of greater muscle or bone mass. However, although several pharmacological approaches have the potential to benefit both muscle and bone health, for example vitamin D, selective androgen receptor modulators and ghrelin mimetics, clinical trials with appropriate primary outcomes are lacking. Conventional approaches to address muscle loss are being extended to include stem cell biology and conserved molecular mechanisms of atrophy/hypertrophy. Pharmacological interventions to reduce fracture risk are exploring new mechanisms of action, in particular the uncoupling of bone resorption and formation. Emerging key issues for clinical trial design include adequate phenotyping of patients (personalised medicine), optimisation of the physiological background (multimodal approach) and the use of meaningful and robust outcomes relevant to daily clinical practice. At present, effective treatments that combine beneficial effects on both muscle and bone are lacking, although this is an important target for the future. This review therefore considers current and developing strategies to improve muscle function and bone strength in separate sections.
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Affiliation(s)
- Juliet Compston
- University of Cambridge School of Clinical Medicine, Department of Medicine, Addenbrooke's Hospital, Hills Road, Cambridge UK CB2 0QQ.
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46
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Quantitative 3D analysis of bone in hip osteoarthritis using clinical computed tomography. Eur Radiol 2015; 26:2047-54. [PMID: 26443603 PMCID: PMC4902845 DOI: 10.1007/s00330-015-4048-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 09/11/2015] [Accepted: 09/24/2015] [Indexed: 12/03/2022]
Abstract
Objective To assess the relationship between proximal femoral cortical bone thickness and radiological hip osteoarthritis using quantitative 3D analysis of clinical computed tomography (CT) data. Methods Image analysis was performed on clinical CT imaging data from 203 female volunteers with a technique called cortical bone mapping (CBM). Colour thickness maps were created for each proximal femur. Statistical parametric mapping was performed to identify statistically significant differences in cortical bone thickness that corresponded with the severity of radiological hip osteoarthritis. Kellgren and Lawrence (K&L) grade, minimum joint space width (JSW) and a novel CT-based osteophyte score were also blindly assessed from the CT data. Results For each increase in K&L grade, cortical thickness increased by up to 25 % in distinct areas of the superolateral femoral head–neck junction and superior subchondral bone plate. For increasing severity of CT osteophytes, the increase in cortical thickness was more circumferential, involving a wider portion of the head–neck junction, with up to a 7 % increase in cortical thickness per increment in score. Results were not significant for minimum JSW. Conclusions These findings indicate that quantitative 3D analysis of the proximal femur can identify changes in cortical bone thickness relevant to structural hip osteoarthritis. Key Points • CT is being increasingly used to assess bony involvement in osteoarthritis • CBM provides accurate and reliable quantitative analysis of cortical bone thickness • Cortical bone is thicker at the superior femoral head–neck with worse osteoarthritis • Regions of increased thickness co-locate with impingement and osteophyte formation • Quantitative 3D bone analysis could enable clinical disease prediction and therapy development Electronic supplementary material The online version of this article (doi:10.1007/s00330-015-4048-x) contains supplementary material, which is available to authorized users.
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47
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Hinshaw WB. Can Treatment With a Strong Antiresorptive Be Expected to Increase Cortical Thickness of the Femur? J Bone Miner Res 2015; 30:1938. [PMID: 26171680 DOI: 10.1002/jbmr.2566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 11/09/2022]
Affiliation(s)
- William Banks Hinshaw
- Markle & Hinshaw Gynecology, Franklin, NC, USA.,Department of Surgery, Harris Regional Hospital, Sylva, NC, USA
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48
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Poole KE, Treece GM, Gee AH, Brown JP, McClung MR, Wang A, Libanati C. Response to: Comment on: "Denosumab Rapidly Increases Cortical Bone in Key Locations of the Femur: A 3D Bone Mapping Study in Women With Osteoporosis". J Bone Miner Res 2015; 30:1939-40. [PMID: 26174164 DOI: 10.1002/jbmr.2569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/03/2015] [Indexed: 01/22/2023]
Affiliation(s)
| | - Graham M Treece
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Andrew H Gee
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Jacques P Brown
- CHU de Québec Research Centre (CRCHU), Laval University, Quebec City, Québec, Canada
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49
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Allison SJ, Poole KES, Treece GM, Gee AH, Tonkin C, Rennie WJ, Folland JP, Summers GD, Brooke-Wavell K. The Influence of High-Impact Exercise on Cortical and Trabecular Bone Mineral Content and 3D Distribution Across the Proximal Femur in Older Men: A Randomized Controlled Unilateral Intervention. J Bone Miner Res 2015; 30:1709-16. [PMID: 25753495 DOI: 10.1002/jbmr.2499] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/23/2015] [Accepted: 03/03/2015] [Indexed: 02/02/2023]
Abstract
Regular exercisers have lower fracture risk, despite modest effects of exercise on bone mineral content (BMC). Exercise may produce localized cortical and trabecular bone changes that affect bone strength independently of BMC. We previously demonstrated that brief, daily unilateral hopping exercises increased femoral neck BMC in the exercise leg versus the control leg of older men. This study evaluated the effects of these exercises on cortical and trabecular bone and its 3D distribution across the proximal femur, using clinical CT. Fifty healthy men had pelvic CT scans before and after the exercise intervention. We used hip QCT analysis to quantify BMC in traditional regions of interest and estimate biomechanical variables. Cortical bone mapping localized cortical mass surface density and endocortical trabecular density changes across each proximal femur, which involved registration to a canonical proximal femur model. Following statistical parametric mapping, we visualized and quantified statistically significant changes of variables over time in both legs, and significant differences between legs. Thirty-four men aged mean (SD) 70 (4) years exercised for 12-months, attending 92% of prescribed sessions. In traditional regions of interest, cortical and trabecular BMC increased over time in both legs. Cortical BMC at the trochanter increased more in the exercise than control leg, whereas femoral neck buckling ratio declined more in the exercise than control leg. Across the entire proximal femur, cortical mass surface density increased significantly with exercise (2.7%; p < 0.001), with larger changes (> 6%) at anterior and posterior aspects of the femoral neck and anterior shaft. Endocortical trabecular density also increased (6.4%; p < 0.001), with localized changes of > 12% at the anterior femoral neck, trochanter, and inferior femoral head. Odd impact exercise increased cortical mass surface density and endocortical trabecular density, at regions that may be important to structural integrity. These exercise-induced changes were localized rather than being evenly distributed across the proximal femur.
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Affiliation(s)
- Sarah J Allison
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | | | | | - Andrew H Gee
- Department of Engineering, University of Cambridge
| | - Carol Tonkin
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Winston J Rennie
- Department of Radiology, University Hospitals of Leicester, Leicester, UK
| | - Jonathan P Folland
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | - Gregory D Summers
- Department of Rheumatology, Derby Hospitals NHS Foundation Trust, Derby, UK
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50
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Shuai B, Shen L, Yang Y, Ma C, Zhu R, Xu X. Assessment of the Impact of Zoledronic Acid on Ovariectomized Osteoporosis Model Using Micro-CT Scanning. PLoS One 2015; 10:e0132104. [PMID: 26148020 PMCID: PMC4492783 DOI: 10.1371/journal.pone.0132104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 06/10/2015] [Indexed: 01/13/2023] Open
Abstract
Purpose/Objective Prompted by preliminary findings, this study was conducted to investigate the impact of zoledronic acid on the cancellous bone microstructure and its effect on the level of β-catenin in a mouse model of postmenopausal osteoporosis. Methods and Materials 96 8-week-old specific-pathogen-free C57BL/6 mice were randomly divided into 4 groups (24 per group): a sham group, an ovariectomized osteoporosis model group, an estradiol-treated group, and a zoledronic acid-treated group. Five months after surgery, the third lumbar vertebra and left femur of the animals were dissected and scanned using micro-computed tomography (micro-CT) to acquire three-dimensional imagery of their cancellous bone microstructure. The impact of ovariectomy, the effect of estradiol, and the effect of zoledronic acid intervention on cancellous bone microstructure, as well as on the expression of β-catenin, were evaluated. Results The estradiol-treated and the zoledronic acid-treated group exhibited a significant increase in the bone volume fraction, trabecular number, trabecular thickness, bone surface to bone volume ratio (BS/BV), and β-catenin expression, when compared with those of the control group (P <0.01). In contrast, the structure model index, trabecular separation, and BS/BV were significantly lower compared with those of the model group (P <0.01). No differences were observed in the above parameters between animals of the zoledronic acid-treated and the estradiol-treated group. Conclusion These results suggest that increased β-catenin expression may be the mechanism underlying zoledronic acid-related improvement in the cancellous bone microstructure in ovariectomized mice. Our findings provide a scientific rationale for using zoledronic acid as a therapeutic intervention to prevent bone loss in post-menopausal women.
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Affiliation(s)
- Bo Shuai
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lin Shen
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- * E-mail:
| | - Yanping Yang
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chen Ma
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Rui Zhu
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaojuan Xu
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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