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Tolgyesi A, Huang C, Akens M, Kiss A, Hardisty M, Whyne CM. Treatment affects load to failure and microdamage accumulation in healthy and osteolytic rat vertebrae. J Mech Behav Biomed Mater 2024; 151:106382. [PMID: 38211499 DOI: 10.1016/j.jmbbm.2024.106382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
Bone turnover and microdamage are impacted by the presence of skeletal metastases which can contribute to increased fracture risk. Treatments for metastatic disease may further impact bone quality. This exploratory study aimed to establish an initial understanding of microdamage accumulation and load to failure in healthy and osteolytic rat vertebrae following focal and systemic cancer treatment (docetaxel (DTX), stereotactic body radiotherapy (SBRT), or zoledronic acid (ZA)). Osteolytic spine metastases were developed in 6-week-old athymic female rats via intracardiac injection of HeLa human cervical cancer cells (day 0). Additional rats served as healthy controls. Rats were either untreated, received SBRT to the T10-L6 vertebrae on day 14 (15 Gy, two fractions), DTX on day 7 or 14, or ZA on day 7. Rats were euthanized on day 21. Tumor burden was assessed with bioluminescence images acquired on day 14 and 21, histology of the excised T11 and L5 vertebrae, and ex-vivo μCT images of the T13-L4. Microstructural parameters (bone volume/total volume, trabecular number, spacing, thickness, and bone mineral density) were measured from L2 vertebrae. Load to failure was measured with axial compressive loading of the L1-L3 motion segments. Microdamage accumulation was labeled in T13 vertebrae with BaSO4 staining and was visualized with high resolution μCT imaging. Microdamage volume fraction was defined as the ratio of BaSO4 to bone volume. DTX administered on day 7 reduced tumor growth significantly (p < 0.05). Microdamage accumulation was found to be increased by the presence of metastases but was reduced by all treatments with ZA showing the largest improvement in HeLa cell injected rats. Load to failure was decreased in untreated and SBRT HeLa cell injected rats compared to healthy controls (p < 0.01). There was a moderate negative correlation between load to failure and microdamage volume fraction in vertebrae from rats injected with HeLa cells (R = -0.35, p = 0.031). Strong correlations were also found between microstructural parameters and load to failure and microdamage accumulation. Several factors, including the presence of osteolytic lesions and use of cancer therapies, influence microdamage accumulation and load to failure in rat vertebrae. Understanding the impact of these treatments on fracture risk of metastatic vertebrae is important to improve management of patients with spinal metastases.
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Affiliation(s)
- Allison Tolgyesi
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada; Institute of Biomedical Engineering, Faculty of Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada.
| | - Christine Huang
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada; Division of Engineering Science, Faculty of Engineering, University of Toronto, 42 St George Street, Toronto, ON, M5S 2E4, Canada
| | - Margarete Akens
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada; Techna Institute, University Health Network, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada; Department of Medical Biophysics, University of Toronto, 101 College Street, Toronto, ON, M5G 1L7, Canada
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Michael Hardisty
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada
| | - Cari M Whyne
- Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada; Institute of Biomedical Engineering, Faculty of Engineering, University of Toronto, 164 College Street, Toronto, ON, M5S 3G9, Canada; Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 149 College Street, Toronto, ON, M5T 1P5, Canada
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Verbruggen ASK, McNamara LM. Mechanoregulation may drive osteolysis during bone metastasis: A finite element analysis of the mechanical environment within bone tissue during bone metastasis and osteolytic resorption. J Mech Behav Biomed Mater 2023; 138:105662. [PMID: 36630755 DOI: 10.1016/j.jmbbm.2023.105662] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/22/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
Metastatic bone disease occurs in 70-80% of advanced breast cancer patients and bone tissue is accepted to have attractive physical properties that facilitate cancer cell attraction, adhesion, and invasion. Bone cells also facilitate tumour invasion by biochemical signalling and through resorption of the bone matrix (osteolysis), which releases factors that further stimulate tumour cell activity. The evolving mechanical environment during tumour invasion might play an important role in these processes, as the activity of both bone and cancer cells is regulated by mechanical cues. In particular bone loss and altered mineralisation have been reported, yet how these alter the mechanical environment local to bone and tumour cells is unknown. The objective of this study is to quantify changes in the mechanical environment within bone tissue, during bone metastasis and osteolytic resorption, using finite element analysis (FEA) models reconstructed from high-resolution μCT images of metastatic mouse bone. In particular, we quantify time-dependent changes in mechanical stimuli, local to and distant from an invading tumour mass, to investigate putative mechanobiological cues for osteolysis during bone metastasis. We report here that in early metastasis (3 weeks after tumour inoculation), there was a decrease in strain distribution within the proximal femur trabecular and distal cortical bone tissue. These changes in the mechanical environment preceded extensive osteolytic destruction, but coincided with the onset of early osteolysis, cortical thickening and mineralisation of proximal and distal femur bone. We propose that early changes in the mechanical environment within bone tissue may activate resorption by osteoclast cells and thereby contribute to the extensive osteolytic bone loss at later stage (6 weeks) bone metastasis.
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Affiliation(s)
- Anneke S K Verbruggen
- Mechanobiology and Medical Device Research Group (MMDRG), Biomedical Engineering, College of Science and Engineering, University of Galway, Ireland
| | - Laoise M McNamara
- Mechanobiology and Medical Device Research Group (MMDRG), Biomedical Engineering, College of Science and Engineering, University of Galway, Ireland.
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Verbruggen ASK, McCarthy EC, Dwyer RM, McNamara LM. Temporal and spatial changes in bone mineral content and mechanical properties during breast-cancer bone metastases. Bone Rep 2022; 17:101597. [PMID: 35754558 PMCID: PMC9218171 DOI: 10.1016/j.bonr.2022.101597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/02/2022] [Accepted: 06/09/2022] [Indexed: 12/29/2022] Open
Abstract
Cancer cells favour migration and metastasis to bone tissue for 70–80 % of advanced breast cancer patients and it has been proposed that bone tissue provides attractive physical properties that facilitate tumour invasion, resulting in osteolytic and or osteoblastic metastasis. However, it is not yet known how specific bone tissue composition is associated with tumour invasion. In particular, how compositional and nano-mechanical properties of bone tissue evolve during metastasis, and where in the bone they arise, may affect the overall aggressiveness of tumour invasion, but this is not well understood. The objective of this study is to develop an advanced understanding of temporal and spatial changes in nano-mechanical properties and composition of bone tissue during metastasis. Primary mammary tumours were induced by inoculation of immune-competent BALB/c mice with 4T1 breast cancer cells in the mammary fat pad local to the right femur. Microcomputed tomography and nanoindentation were conducted to quantify cortical and trabecular bone matrix mineralisation and nano-mechanical properties. Analysis was performed in proximal and distal femur regions (spatial analysis) of tumour-adjacent (ipsilateral) and contralateral femurs after 3 weeks and 6 weeks of tumour and metastasis development (temporal analysis). By 3 weeks post-inoculation there was no significant difference in bone volume fraction or nano-mechanical properties of bone tissue between the metastatic femora and healthy controls. However, early osteolysis was indicated by trabecular thinning in the distal and proximal trabecular compartment of tumour-bearing femora. Moreover, cortical thickness was significantly increased in the distal region, and the mean mineral density was significantly higher in cortical and trabecular bone tissue in both proximal and distal regions, of ipsilateral (tumour-bearing) femurs compared to healthy controls. By 6 weeks post-inoculation, overt osteolytic lesions were identified in all ipsilateral metastatic femora, but also in two of four contralateral femora of tumour-bearing mice. Bone volume fraction, cortical area, cortical and trabecular thickness were all significantly decreased in metastatic femora (both ipsilateral and contralateral). Trabecular bone tissue stiffness in the proximal femur decreased in the ipsilateral femurs compared to contralateral and control sites. Temporal and spatial analysis of bone nano-mechanical properties and mineralisation during breast cancer invasion reveals changes in bone tissue composition prior to and following overt metastatic osteolysis, local and distant from the primary tumour site. These changes may alter the mechanical environment of both the bone and tumour cells, and thereby play a role in perpetuating the cancer vicious cycle during breast cancer metastasis to bone tissue. Temporal and spatial analyses of bone tissue properties following breast cancer metastasis Trabecular thinning initiated by 3 weeks but overt osteolysis not evident until 6 weeks. Increased bone mineralisation and distal cortical thickness by 3-weeks post-inoculation
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Affiliation(s)
- Anneke S K Verbruggen
- Mechanobiology and Medical Device Research group (MMDRG), Biomedical Engineering, College of Science and Engineering, National University of Ireland Galway, Ireland
| | - Elan C McCarthy
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Ireland
| | - Roisin M Dwyer
- Discipline of Surgery, Lambe Institute for Translational Research, National University of Ireland Galway, Ireland
| | - Laoise M McNamara
- Mechanobiology and Medical Device Research group (MMDRG), Biomedical Engineering, College of Science and Engineering, National University of Ireland Galway, Ireland
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Anderson DE, Groff MW, Flood TF, Allaire BT, Davis RB, Stadelmann MA, Zysset PK, Alkalay RN. Evaluation of Load-To-Strength Ratios in Metastatic Vertebrae and Comparison With Age- and Sex-Matched Healthy Individuals. Front Bioeng Biotechnol 2022; 10:866970. [PMID: 35992350 PMCID: PMC9388746 DOI: 10.3389/fbioe.2022.866970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Vertebrae containing osteolytic and osteosclerotic bone metastases undergo pathologic vertebral fracture (PVF) when the lesioned vertebrae fail to carry daily loads. We hypothesize that task-specific spinal loading patterns amplify the risk of PVF, with a higher degree of risk in osteolytic than in osteosclerotic vertebrae. To test this hypothesis, we obtained clinical CT images of 11 cadaveric spines with bone metastases, estimated the individual vertebral strength from the CT data, and created spine-specific musculoskeletal models from the CT data. We established a musculoskeletal model for each spine to compute vertebral loading for natural standing, natural standing + weights, forward flexion + weights, and lateral bending + weights and derived the individual vertebral load-to-strength ratio (LSR). For each activity, we compared the metastatic spines' predicted LSRs with the normative LSRs generated from a population-based sample of 250 men and women of comparable ages. Bone metastases classification significantly affected the CT-estimated vertebral strength (Kruskal-Wallis, p < 0.0001). Post-test analysis showed that the estimated vertebral strength of osteosclerotic and mixed metastases vertebrae was significantly higher than that of osteolytic vertebrae (p = 0.0016 and p = 0.0003) or vertebrae without radiographic evidence of bone metastasis (p = 0.0010 and p = 0.0003). Compared with the median (50%) LSRs of the normative dataset, osteolytic vertebrae had higher median (50%) LSRs under natural standing (p = 0.0375), natural standing + weights (p = 0.0118), and lateral bending + weights (p = 0.0111). Surprisingly, vertebrae showing minimal radiographic evidence of bone metastasis presented significantly higher median (50%) LSRs under natural standing (p < 0.0001) and lateral bending + weights (p = 0.0009) than the normative dataset. Osteosclerotic vertebrae had lower median (50%) LSRs under natural standing (p < 0.0001), natural standing + weights (p = 0.0005), forward flexion + weights (p < 0.0001), and lateral bending + weights (p = 0.0002), a trend shared by vertebrae with mixed lesions. This study is the first to apply musculoskeletal modeling to estimate individual vertebral loading in pathologic spines and highlights the role of task-specific loading in augmenting PVF risk associated with specific bone metastatic types. Our finding of high LSRs in vertebrae without radiologically observed bone metastasis highlights that patients with metastatic spine disease could be at an increased risk of vertebral fractures even at levels where lesions have not been identified radiologically.
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Affiliation(s)
- Dennis E. Anderson
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Michael W. Groff
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, United States
| | - Thomas F. Flood
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Brett T. Allaire
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Roger B. Davis
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Marc A. Stadelmann
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Philippe K. Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Ron N. Alkalay
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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Bailey S, Stadelmann MA, Zysset PK, Vashishth D, Alkalay RN. Influence of Metastatic Bone Lesion Type and Tumor Origin on Human Vertebral Bone Architecture, Matrix Quality, and Mechanical Properties. J Bone Miner Res 2022; 37:896-907. [PMID: 35253282 PMCID: PMC9158727 DOI: 10.1002/jbmr.4539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/19/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022]
Abstract
Metastatic spine disease is incurable, causing increased vertebral fracture risk and severe patient morbidity. Here, we demonstrate that osteolytic, osteosclerotic, and mixed bone metastasis uniquely modify human vertebral bone architecture and quality, affecting vertebral strength and stiffness. Multivariable analysis showed bone metastasis type dominates vertebral strength and stiffness changes, with neither age nor gender having an independent effect. In osteolytic vertebrae, bone architecture rarefaction, lower tissue mineral content and connectivity, and accumulation of advanced glycation end-products (AGEs) affected low vertebral strength and stiffness. In osteosclerotic vertebrae, high trabecular number and thickness but low AGEs, suggesting a high degree of bone remodeling, yielded high vertebral strength. Our study found that bone metastasis from prostate and breast primary cancers differentially impacted the osteosclerotic bone microenvironment, yielding altered bone architecture and accumulation of AGEs. These findings indicate that therapeutic approaches should target the restoration of bone structural integrity. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Stacyann Bailey
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA
| | - Marc A. Stadelmann
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Philippe K. Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Deepak Vashishth
- Center for Biotechnology and Interdisciplinary Studies, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY
| | - Ron N. Alkalay
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Alkalay RN, Groff MW, Stadelmann MA, Buck FM, Hoppe S, Theumann N, Mektar U, Davis RB, Hackney DB. Improved estimates of strength and stiffness in pathologic vertebrae with bone metastases using CT-derived bone density compared with radiographic bone lesion quality classification. J Neurosurg Spine 2021; 36:113-124. [PMID: 34479191 DOI: 10.3171/2021.2.spine202027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/05/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to compare the ability of 1) CT-derived bone lesion quality (classification of vertebral bone metastases [BM]) and 2) computed CT-measured volumetric bone mineral density (vBMD) for evaluating the strength and stiffness of cadaver vertebrae from donors with metastatic spinal disease. METHODS Forty-five thoracic and lumbar vertebrae were obtained from cadaver spines of 11 donors with breast, esophageal, kidney, lung, or prostate cancer. Each vertebra was imaged using microCT (21.4 μm), vBMD, and bone volume to total volume were computed, and compressive strength and stiffness experimentally measured. The microCT images were reconstructed at 1-mm voxel size to simulate axial and sagittal clinical CT images. Five expert clinicians blindly classified the images according to bone lesion quality (osteolytic, osteoblastic, mixed, or healthy). Fleiss' kappa test was used to test agreement among 5 clinical raters for classifying bone lesion quality. Kruskal-Wallis ANOVA was used to test the difference in vertebral strength and stiffness based on bone lesion quality. Multivariable regression analysis was used to test the independent contribution of bone lesion quality, computed vBMD, age, gender, and race for predicting vertebral strength and stiffness. RESULTS A low interrater agreement was found for bone lesion quality (κ = 0.19). Although the osteoblastic vertebrae showed significantly higher strength than osteolytic vertebrae (p = 0.0148), the multivariable analysis showed that bone lesion quality explained 19% of the variability in vertebral strength and 13% in vertebral stiffness. The computed vBMD explained 75% of vertebral strength (p < 0.0001) and 48% of stiffness (p < 0.0001) variability. The type of BM affected vBMD-based estimates of vertebral strength, explaining 75% of strength variability in osteoblastic vertebrae (R2 = 0.75, p < 0.0001) but only 41% in vertebrae with mixed bone metastasis (R2 = 0.41, p = 0.0168), and 39% in osteolytic vertebrae (R2 = 0.39, p = 0.0381). For vertebral stiffness, vBMD was only associated with that of osteoblastic vertebrae (R2 = 0.44, p = 0.0024). Age and race inconsistently affected the model's strength and stiffness predictions. CONCLUSIONS Pathologic vertebral fracture occurs when the metastatic lesion degrades vertebral strength, rendering it unable to carry daily loads. This study demonstrated the limitation of qualitative clinical classification of bone lesion quality for predicting pathologic vertebral strength and stiffness. Computed CT-derived vBMD more reliably estimated vertebral strength and stiffness. Replacing the qualitative clinical classification with computed vBMD estimates may improve the prediction of vertebral fracture risk.
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Affiliation(s)
- Ron N Alkalay
- 1Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery
| | - Michael W Groff
- 2Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marc A Stadelmann
- 3ARTORG Center for Biomedical Engineering Research, University of Bern
| | | | - Sven Hoppe
- 5Department of Orthopedic Surgery, Inselspital, Bern University Hospital, Bern; and
| | - Nicolas Theumann
- 6Clinique Bois-Cerf, Radiology Department, Lausanne, Switzerland
| | | | | | - David B Hackney
- 9Department of Radiology, Beth Israel Deaconess Medical Center, Boston
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Alkalay RN, Adamson R, Miropolsky A, Davis RB, Groff ML, Hackney DB. Large Lytic Defects Produce Kinematic Instability and Loss of Compressive Strength in Human Spines: An in Vitro Study. J Bone Joint Surg Am 2021; 103:887-899. [PMID: 33755638 PMCID: PMC9167060 DOI: 10.2106/jbjs.19.00419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In patients with spinal metastases, kinematic instability is postulated to be a predictor of pathologic vertebral fractures. However, the relationship between this kinematic instability and the loss of spinal strength remains unknown. METHODS Twenty-four 3-level thoracic and lumbar segments from 8 cadaver spines from female donors aged 47 to 69 years were kinematically assessed in axial compression (180 N) and axial compression with a flexion or extension moment (7.5 Nm). Two patterns of lytic defects were mechanically simulated: (1) a vertebral body defect, corresponding to Taneichi model C (n = 13); and (2) the model-C defect plus destruction of the ipsilateral pedicle and facet joint, corresponding to Taneichi model E (n = 11). The kinematic response was retested, and compression strength was measured. Two-way repeated-measures analysis of variance was used to test the effect of each model on the kinematic response of the segment. Multivariable linear regression was used to test the association between the kinematic parameters and compressive strength of the segment. RESULTS Under a flexion moment, and for both models C and E, the lesioned spines exhibited greater flexion range of motion (ROM) and axial translation than the control spines. Both models C and E caused lower extension ROM and greater axial, sagittal, and transverse translation under an extension moment compared with the control spines. Two-way repeated-measures analysis revealed that model E, compared with model C, caused significantly greater changes in extension and torsional ROM under an extension moment, and greater sagittal translation under a flexion moment. For both models C and E, greater differences in flexion ROM and sagittal translation under a flexion moment, and greater differences in extension ROM and in axial and transverse translation under an extension moment, were associated with lower compressive strength of the lesioned spines. CONCLUSIONS Critical spinal lytic defects result in kinematic abnormalities and lower the compressive strength of the spine. CLINICAL RELEVANCE This experimental study demonstrates that lytic foci degrade the kinematic stability and compressive strength of the spine. Understanding the mechanisms for this degradation will help to guide treatment decisions that address inferred instability and fracture risk in patients with metastatic spinal disease.
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Affiliation(s)
- Ron N. Alkalay
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery (R.N.A. and R.A.), Division of General Medicine (R.B.D.), and Department of Radiology (D.B.H.), Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, Boston, Massachusetts
| | - Robert Adamson
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery (R.N.A. and R.A.), Division of General Medicine (R.B.D.), and Department of Radiology (D.B.H.), Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, Boston, Massachusetts
| | | | - Roger B. Davis
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery (R.N.A. and R.A.), Division of General Medicine (R.B.D.), and Department of Radiology (D.B.H.), Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, Boston, Massachusetts
| | - Mike L. Groff
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - David B. Hackney
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery (R.N.A. and R.A.), Division of General Medicine (R.B.D.), and Department of Radiology (D.B.H.), Beth Israel Deaconess Medical Center (BIDMC) and Harvard Medical School, Boston, Massachusetts
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Whyne CM, Ferguson D, Clement A, Rangrez M, Hardisty M. Biomechanical Properties of Metastatically Involved Osteolytic Bone. Curr Osteoporos Rep 2020; 18:705-715. [PMID: 33074529 DOI: 10.1007/s11914-020-00633-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Skeletal metastasis involves the uncoupling of physiologic bone remodeling resulting in abnormal bone turnover and radical changes in bony architecture, density, and quality. Bone strength assessment and fracture risk prediction are critical in clinical treatment decision-making. This review focuses on bone tissue and structural mechanisms altered by osteolytic metastasis and the resulting changes to its material and mechanical behavior. RECENT FINDINGS Both organic and mineral phases of bone tissue are altered by osteolytic metastatic disease, with diminished bone quality evident at multiple length-scales. The mechanical performance of bone with osteolytic lesions is influenced by a combination of tissue-level and structural changes. This review considers the effects of osteolytic metastasis on bone biomechanics demonstrating its negative impact at tissue and structural levels. Future studies need to assess the cumulative impact of cancer treatments on metastatically involved bone quality, and its utility in directing multimodal treatment planning.
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Affiliation(s)
- Cari M Whyne
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.
- Department of Surgery, University of Toronto, Toronto, Canada.
- Biomedical Engineering, University of Toronto, Toronto, Canada.
| | - Dallis Ferguson
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
- Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Allison Clement
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Mohammedayaz Rangrez
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Michael Hardisty
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
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Stadelmann MA, Schenk DE, Maquer G, Lenherr C, Buck FM, Bosshardt DD, Hoppe S, Theumann N, Alkalay RN, Zysset PK. Conventional finite element models estimate the strength of metastatic human vertebrae despite alterations of the bone's tissue and structure. Bone 2020; 141:115598. [PMID: 32829037 PMCID: PMC9206866 DOI: 10.1016/j.bone.2020.115598] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/05/2020] [Accepted: 08/12/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Pathologic vertebral fractures are a major clinical concern in the management of cancer patients with metastatic spine disease. These fractures are a direct consequence of the effect of bone metastases on the anatomy and structure of the vertebral bone. The goals of this study were twofold. First, we evaluated the effect of lytic, blastic and mixed (both lytic and blastic) metastases on the bone structure, on its material properties, and on the overall vertebral strength. Second, we tested the ability of bone mineral content (BMC) measurements and standard FE methodologies to predict the strength of real metastatic vertebral bodies. METHODS Fifty-seven vertebral bodies from eleven cadaver spines containing lytic, blastic, and mixed metastatic lesions from donors with breast, esophageal, kidney, lung, or prostate cancer were scanned using micro-computed tomography (μCT). Based on radiographic review, twelve vertebrae were selected for nanoindentation testing, while the remaining forty-five vertebrae were used for assessing their compressive strength. The μCT reconstruction was exploited to measure the vertebral BMC and to establish two finite element models. 1) a micro finite element (μFE) model derived at an image resolution of 24.5 μm and 2) homogenized FE (hFE) model derived at a resolution of 0.98 mm. Statistical analyses were conducted to measure the effect of the bone metastases on BV/TV, indentation modulus (Eit), ratio of plastic/total work (WPl/Wtot), and in vitro vertebral strength (Fexp). The predictive value of BMC, μFE stiffness, and hFE strength were evaluated against the in vitro measurements. RESULTS Blastic vertebral bodies exhibit significantly higher BV/TV compared to the mixed (p = 0.0205) and lytic (p = 0.0216) vertebral bodies. No significant differences were found between lytic and mixed vertebrae (p = 0.7584). Blastic bone tissue exhibited a 5.8% lower median Eit (p< 0.001) and a 3.3% lower median Wpl/Wtot (p<0.001) compared to non-involved bone tissue. No significant differences were measured between lytic and non-involved bone tissues. Fexp ranged from 1.9 to 13.8 kN, was strongly associated with hFE strength (R2=0.78, p< 0.001) and moderately associated with BMC (R2=0.66, p< 0.001) and μFE stiffness (R2=0.66, p< 0.001), independently of the lesion type. DISCUSSION Our findings show that tumour-induced osteoblastic metastases lead to slightly, but significantly lower bone tissue properties compared to controls, while osteolytic lesions appear to have a negligible impact. These effects may be attributed to the lower mineralization and woven nature of bone forming in blastic lesions whilst the material properties of bone in osteolytic vertebrae appeared little changed. The moderate association between BMC- and FE-based predictions to fracture strength suggest that vertebral strength is affected by the changes of bone mass induced by the metastatic lesions, rather than altered tissue properties. In a broader context, standard hFE approaches generated from CTs at clinical resolution are robust to the lesion type when predicting vertebral strength. These findings open the door for the development of FE-based prediction tools that overcomes the limitations of BMC in accounting for shape and size of the metastatic lesions. Such tools may help clinicians to decide whether a patient needs the prophylactic fixation of an impending fracture.
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Affiliation(s)
- Marc A Stadelmann
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Denis E Schenk
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Ghislain Maquer
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Christopher Lenherr
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Florian M Buck
- University of Zurich & MRI Schulthess Clinic, Zurich, Switzerland
| | - Dieter D Bosshardt
- Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Switzerland
| | - Sven Hoppe
- Department of Orthopedic Surgery, Inselspital, Bern University Hospital, Switzerland
| | | | - Ron N Alkalay
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Philippe K Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland.
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10
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Bailey S, Hackney D, Vashishth D, Alkalay RN. The effects of metastatic lesion on the structural determinants of bone: Current clinical and experimental approaches. Bone 2020; 138:115159. [PMID: 31759204 PMCID: PMC7531290 DOI: 10.1016/j.bone.2019.115159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/31/2019] [Accepted: 11/18/2019] [Indexed: 01/30/2023]
Abstract
Metastatic bone disease is incurable with an associated increase in skeletal-related events, particularly a 17-50% risk of pathologic fractures. Current surgical and oncological treatments are palliative, do not reduce overall mortality, and therefore optimal management of adults at risk of pathologic fractures presents an unmet medical need. Plain radiography lacks specificity and may result in unnecessary prophylactic fixation. Radionuclide imaging techniques primarily supply information on the metabolic activity of the tumor or the bone itself. Magnetic resonance imaging and computed tomography provide excellent anatomical and structural information but do not quantitatively assess bone matrix. Research has now shifted to developing unbiased data-driven tools that can predict risk of impending fractures and guide individualized treatment decisions. This review discusses the state-of-the-art in clinical and experimental approaches for prediction of pathologic fractures with bone metastases. Alterations in bone matrix quality are associated with an age-related increase in skeletal fragility but the impact of metastases on the intrinsic material properties of bone is unclear. Engineering-based analyses are non-invasive with the capability to evaluate oncological treatments and predict failure due to the progression of metastasis. The combination of these approaches may improve our understanding of the underlying deterioration in mechanical performance.
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Affiliation(s)
- Stacyann Bailey
- Center for Biotechnology and Interdisciplinary Studies, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, United States of America
| | - David Hackney
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Deepak Vashishth
- Center for Biotechnology and Interdisciplinary Studies, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, United States of America
| | - Ron N Alkalay
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America.
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11
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Costa M, Campello LB, Ryan M, Rochester J, Viceconti M, Dall'Ara E. Effect of size and location of simulated lytic lesions on the structural properties of human vertebral bodies, a micro-finite element study. Bone Rep 2020; 12:100257. [PMID: 32551335 PMCID: PMC7292861 DOI: 10.1016/j.bonr.2020.100257] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/07/2020] [Accepted: 03/06/2020] [Indexed: 11/25/2022] Open
Abstract
Currently, the Spinal Instability Neoplastic Score system is used in clinics to evaluate the risk of fracture in patients with spinal metastases. This method, however, does not always provide a clear guideline due to the complexity in accounting for the effect of metastatic lesions on vertebral stability. The aim of this study was to use a validated micro Finite Element (microFE) modelling approach to analyse the effect of the size and location of lytic metastases on the mechanical properties of human vertebral bodies. Micro Computed Tomography based microFE models were generated with and without lytic lesions simulated as holes within a human vertebral body. Single and multiple lytic lesions were simulated with four different sizes and in five different locations. Bone was assumed homogenous, isotropic and linear elastic, and each vertebra was loaded in axial compression. It was observed that the size of lytic lesions was linearly related with the reduction in structural properties of the vertebral body (reduction of stiffness between 3% and 30% for lesion volume between 4% and 35%). The location of lytic lesions did not show a clear effect on predicted structural properties. Single or multiple lesions with the same volume provided similar results. Locally, there was a homogeneous distribution of axial principal strains among the models with and without lytic lesions. This study highlights the potential of microFE models to study the effect of lesions on the mechanical properties of the human vertebral body. MicroFE models can show the effect of lytic lesions on vertebral properties. The size of the lesions was more critical than the location of the lesions. Lesions affecting the cortical shell had a larger effect on the local strains. Multiple lesions showed a similar effect to single lesions.
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Affiliation(s)
- M.C. Costa
- Department of Oncology and Metabolism, Mellanby Centre for bone Research, University of Sheffield, UK
- INSIGNEO Institute for in silico Medicine, University of Sheffield, UK
| | | | - M. Ryan
- Department of Oncology and Metabolism, Mellanby Centre for bone Research, University of Sheffield, UK
- INSIGNEO Institute for in silico Medicine, University of Sheffield, UK
| | - J. Rochester
- Academic Unit of Medical Education, Medical School, University of Sheffield, UK
| | - M. Viceconti
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Italy
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - E. Dall'Ara
- Department of Oncology and Metabolism, Mellanby Centre for bone Research, University of Sheffield, UK
- INSIGNEO Institute for in silico Medicine, University of Sheffield, UK
- Corresponding author at: The Pam Liversidge Building, Sir Robert Hadfield Building, Mappin Street, Sheffield S1 3JD, UK.
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