1
|
Smit T, Aage N, Haschtmann D, Ferguson SJ, Helgason B. Anatomically and mechanically conforming patient-specific spinal fusion cages designed by full-scale topology optimization. J Mech Behav Biomed Mater 2024; 159:106695. [PMID: 39186906 DOI: 10.1016/j.jmbbm.2024.106695] [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: 11/27/2023] [Accepted: 08/18/2024] [Indexed: 08/28/2024]
Abstract
Cage subsidence after instrumented lumbar spinal fusion surgery remains a significant cause of treatment failure, specifically for posterior or transforaminal lumbar interbody fusion. Recent advancements in computational techniques and additive manufacturing, have enabled the development of patient-specific implants and implant optimization to specific functional targets. This study aimed to introduce a novel full-scale topology optimization formulation that takes the structural response of the adjacent bone structures into account in the optimization process. The formulation includes maximum and minimum principal strain constraints that lower strain concentrations in the adjacent vertebrae. This optimization approach resulted in anatomically and mechanically conforming spinal fusion cages. Subsidence risk was quantified in a commercial finite element solver for off-the-shelf, anatomically conforming and the optimized cages, in two representative patients. We demonstrated that the anatomically and mechanically conforming cages reduced subsidence risk by 91% compared to an off-the-shelf implant with the same footprint for a patient with normal bone quality and 54% for a patient with osteopenia. Prototypes of the optimized cage were additively manufactured and mechanically tested to evaluate the manufacturability and integrity of the design and to validate the finite element model.
Collapse
Affiliation(s)
- Thijs Smit
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland.
| | - Niels Aage
- Solid Mechanics, Technical University of Denmark, Denmark
| | - Daniel Haschtmann
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
| | | | | |
Collapse
|
2
|
Chen X, Huang Z, Zhang S, Li H. Assembled collagen films modified using polyacrylic acid with improved mechanical properties via mineralization. J Mater Chem B 2024; 12:6643-6653. [PMID: 38873745 DOI: 10.1039/d4tb00828f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
The imperative task of enforcing collagen materials holds paramount significance in the field of hard tissue repair. We hereby present mineralized collagen fiber films via mineralization with improved mechanical properties. Self-extracted collagen was assembled into an array with an aligned fibrous pattern and then modified with polyacrylic acid (PAA) followed by mineralization in cationic polyacrylamide (CPAM)-SBF. Biomineralization occurred at the inner and outer surface of the assembled collagen fiber films. A tensile strength of up to 40.38 ± 3.08 MPa of mineralized collagen was obtained, for the first time, which may be attributed to the synergistic effect of polyanion and polycation on the mineralization process of assembled intrafibrillar collagen fibers. It was argued that PAA may facilitate the intra-fiber interaction of collagen, which extends the elongation at break of collagen fibers. This study introduces a pioneering approach for the preparation of mineralized collagen materials with superior mechanical properties, which would be beneficial for hard tissue repair.
Collapse
Affiliation(s)
- Xiaohui Chen
- College of Chemistry and Materials Science, Jinan University, Guangdong, 511443, P.R. China.
- Engineering Research Center of Artificial Organs and Materials, Jinan University, Guangdong, 510632, P.R. China
| | - Zhilin Huang
- College of Chemistry and Materials Science, Jinan University, Guangdong, 511443, P.R. China.
- Engineering Research Center of Artificial Organs and Materials, Jinan University, Guangdong, 510632, P.R. China
| | - Shuyun Zhang
- Guangdong Second Provincial General Hospital, Postdoctoral Research Station of Basic Medicine, School of Medicine, Jinan University, Guangdong, 510220, P.R. China.
| | - Hong Li
- College of Chemistry and Materials Science, Jinan University, Guangdong, 511443, P.R. China.
- Engineering Research Center of Artificial Organs and Materials, Jinan University, Guangdong, 510632, P.R. China
| |
Collapse
|
3
|
Gezek M, Altunbek M, Torres Gouveia ME, Camci-Unal G. 3D Printed Eggshell Microparticle-Laden Thermoplastic Scaffolds for Bone Tissue Engineering. ACS APPLIED MATERIALS & INTERFACES 2024; 16:32957-32970. [PMID: 38885611 DOI: 10.1021/acsami.4c02800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Three-dimensional (3D) printing, an additive manufacturing technique, is increasingly used in the field of tissue engineering. The ability to create complex structures with high precision makes the 3D printing of this material a preferred method for constructing personalized and functional materials. However, the challenge lies in developing affordable and accessible materials with the desired physiochemical and biological properties. In this study, we used eggshell microparticles (ESPs), an example of bioceramic and unconventional biomaterials, to reinforce thermoplastic poly(ε-caprolactone) (PCL) scaffolds via extrusion-based 3D printing. The goal was to conceive a sustainable, affordable, and unique personalized medicine approach. The scaffolds were fabricated with varying concentrations of eggshells, ranging from 0 to 50% (w/w) in the PCL scaffolds. To assess the physicochemical properties, we employed scanning electron microscopy, Fourier-transform infrared spectroscopy, thermogravimetric analysis, differential scanning calorimetry, and X-ray diffraction analysis. Mechanical properties were evaluated through compression testing, and degradation kinetics were studied through accelerated degradation with the remaining mass ranging between 89.4 and 28.3%. In vitro, we evaluated the characteristics of the scaffolds using the MC3T3-E1 preosteoblasts over a 14 day period. In vitro characterization involved the use of the Alamar blue assay, confocal imaging, and real-time quantitative polymerase chain reaction. The results of this study demonstrate the potential of 3D printed biocomposite scaffolds, consisting of thermoplastic PCL reinforced with ESPs, as a promising alternative for bone-graft applications.
Collapse
Affiliation(s)
- Mert Gezek
- Department of Chemical Engineering, University of Massachusetts, Lowell, Massachusetts 01854, United States
- Biomedical Engineering and Biotechnology Graduate Program, University of Massachusetts, Lowell, Massachusetts 01854, United States
| | - Mine Altunbek
- Department of Chemical Engineering, University of Massachusetts, Lowell, Massachusetts 01854, United States
| | | | - Gulden Camci-Unal
- Department of Chemical Engineering, University of Massachusetts, Lowell, Massachusetts 01854, United States
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts 01605, United States
| |
Collapse
|
4
|
Castoldi NM, Pickering E, Sansalone V, Cooper D, Pivonka P. Bone turnover and mineralisation kinetics control trabecular BMDD and apparent bone density: insights from a discrete statistical bone remodelling model. Biomech Model Mechanobiol 2024; 23:893-909. [PMID: 38280951 PMCID: PMC11101591 DOI: 10.1007/s10237-023-01812-4] [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: 08/22/2023] [Accepted: 12/22/2023] [Indexed: 01/29/2024]
Abstract
The mechanical quality of trabecular bone is influenced by its mineral content and spatial distribution, which is controlled by bone remodelling and mineralisation. Mineralisation kinetics occur in two phases: a fast primary mineralisation and a secondary mineralisation that can last from several months to years. Variations in bone turnover and mineralisation kinetics can be observed in the bone mineral density distribution (BMDD). Here, we propose a statistical spatio-temporal bone remodelling model to study the effects of bone turnover (associated with the activation frequency Ac . f ) and mineralisation kinetics (associated with secondary mineralisation T sec ) on BMDD. In this model, individual basic multicellular units (BMUs) are activated discretely on trabecular surfaces that undergo typical bone remodelling periods. Our results highlight that trabecular BMDD is strongly regulated by Ac . f and T sec in a coupled way. Ca wt% increases with lower Ac . f and short T sec . For example, aAc . f = 4 BMU/year/mm3 and T sec = 8 years result in a mean Ca wt% of 25, which is in accordance with Ca wt% values reported in quantitative backscattered electron imaging (qBEI) experiments. However, for lower Ac . f and shorter T sec (from 0.5 to 4 years) one obtains a high Ca wt% and a very narrow skew BMDD to the right. This close link between Ac . f and T sec highlights the importance of considering both characteristics to draw meaningful conclusion about bone quality. Overall, this model represents a new approach to modelling healthy and diseased bone and can aid in developing deeper insights into disease states like osteoporosis.
Collapse
Affiliation(s)
- Natalia M Castoldi
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia.
- UMR 8208, MSME, Univ Paris Est Creteil, Univ Gustave Eiffel, CNRS, Créteil, France.
| | - Edmund Pickering
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia
| | - Vittorio Sansalone
- UMR 8208, MSME, Univ Paris Est Creteil, Univ Gustave Eiffel, CNRS, Créteil, France
| | - David Cooper
- Department of Anatomy Physiology and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Peter Pivonka
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, Australia.
| |
Collapse
|
5
|
Ghandour S, Christie I, Öhman Mägi C, Persson C. Quasi-static and dynamic mechanical properties of a linoleic acid-modified, low-modulus bone cement for spinal applications. OPEN RESEARCH EUROPE 2024; 3:203. [PMID: 39185085 PMCID: PMC11344196 DOI: 10.12688/openreseurope.16683.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 08/27/2024]
Abstract
Background Polymethylmethacrylate (PMMA) bone cement is extensively used in spinal procedures such as vertebroplasty and kyphoplasty, while its use in percutaneous cement discoplasty (PCD) is not yet widely spread. A main issue for both application sites, vertebra and disc, is the mismatch in stiffness between cement and bone, potentially resulting in adjacent vertebral fractures and adjacent segment disease. Tailoring the cement modulus using additives is hence an interesting strategy. However, there is a lack of data on the tensile and tension-compression fatigue properties of these cements, relevant to the newly researched indication of PCD. Method A commercial PMMA cement (VS) was modified with 12%vol of linoleic acid (VSLA) and tested for quasi-static tensile properties. Additionally, tension-compression fatigue testing with amplitudes ranging from +/-5MPa to +/-7MPa and +/-9MPa was performed, and a Weibull three-parameter curve fit was used to calculate the fatigue parameters. Results Quasi-static testing revealed a significant reduction in VSLA's Young's Modulus (E=581.1±126.4MPa) compared to the original cement (E=1478.1±202.9MPa). Similarly, the ultimate tensile stress decreased from 36.6±1.5MPa to 11.6±0.8MPa. Thus, VSLA offers improved compatibility with trabecular bone properties. Fatigue testing of VSLA revealed that as the stress amplitude increased the Weibull mean number decreased from 3591 to 272 and 91 cycles, respectively. In contrast, the base VS cement reached run-out at the highest stress amplitude. However, the lowest stress amplitude used exceeds the pressures recorded in the disc in vivo, and VSLA displayed a similar fatigue life range to that of the annulus fibrosis tissue. Conclusions While the relevance of fully reversed tension-compression fatigue testing can be debated for predicting cement performance in certain spinal applications, the results of this study can serve as a benchmark for comparison of low-modulus cements for the spine. Further investigations are necessary to assess the clinical feasibility and effectiveness of these cements.
Collapse
Affiliation(s)
- Salim Ghandour
- Division of Biomedical Engineering, Department of Materials Science and Engineering, Uppsala University, Uppsala, Uppsala County, 75121, Sweden
| | - Iain Christie
- Division of Biomedical Engineering, Department of Materials Science and Engineering, Uppsala University, Uppsala, Uppsala County, 75121, Sweden
- Division of Applied Materials Science, Department of Materials Science and Engineering, Uppsala University, Uppsala, Uppsala County, 75121, Sweden
| | - Caroline Öhman Mägi
- Division of Applied Materials Science, Department of Materials Science and Engineering, Uppsala University, Uppsala, Uppsala County, 75121, Sweden
| | - Cecilia Persson
- Division of Biomedical Engineering, Department of Materials Science and Engineering, Uppsala University, Uppsala, Uppsala County, 75121, Sweden
| |
Collapse
|
6
|
Chabarova O, Selivonec J, Menendez Hurtado A. Investigation of the Role of Osteoporotic Vertebra Degeneration on the Stability of the Lumbar Spine: In Silico Modelling under Compressive Loading. Bioengineering (Basel) 2024; 11:507. [PMID: 38790372 PMCID: PMC11118939 DOI: 10.3390/bioengineering11050507] [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: 03/08/2024] [Revised: 04/22/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
An evaluation of the impact of osteoporosis on loss of spinal stability, with or without intervertebral disc degeneration, using computational analysis is presented. The research also investigates the correlation between osteoporosis and intervertebral disc degeneration. Three-dimensional finite element models of human lumbar spine segments were used to assess the influence of osteoporosis on spinal stability. Five different models of age-related degeneration were created using various material properties for trabecular bone and intervertebral discs. Calculation results indicate that in a spine with osteoporosis, the deformation of the intervertebral discs can increase by more than 30% when compared to a healthy spine. Thus, intervertebral disc deformation depends not only on the degree of degeneration of the discs themselves, but their deformation is also influenced by the degree of osteoporosis of the vertebrae. Additionally, the load-bearing capacity of the spine can decrease by up to 30% with osteoporosis, regardless of the degree of intervertebral disc deformation. In conclusion, osteoporosis can contribute to intervertebral disc degeneration.
Collapse
Affiliation(s)
| | - Jelena Selivonec
- Department of Applied Mechanics, Vilnius Gediminas Technical University, LT-10223 Vilnius, Lithuania; (O.C.); (A.M.H.)
| | | |
Collapse
|
7
|
Distefano F, Epasto G. Effect of density grading on the mechanical behaviour of advanced functionally graded lattice structures. J Mech Behav Biomed Mater 2024; 153:106477. [PMID: 38428204 DOI: 10.1016/j.jmbbm.2024.106477] [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: 11/25/2023] [Revised: 02/16/2024] [Accepted: 02/24/2024] [Indexed: 03/03/2024]
Abstract
Lattice structures have found significant applications in the biomedical field due to their interesting combination of mechanical and biological properties. Among these, functionally graded structures sparked interest because of their potential of varying their mechanical properties throughout the volume, allowing the design of biomedical devices able to match the characteristics of a graded structure like human bone. The aim of this works is the study of the effect of the density grading on the mechanical response and the failure mechanisms of a novel functionally graded lattice structure, namely Triply Arranged Octagonal Rings (TAOR). The mechanical behaviour was compared with the same lattice structures having constant density ratio. Electron Beam Melting technology was used to manufacture titanium alloy specimens with global relative densities from 10% to 30%. Functionally graded structures were obtained by increasing the relative density along the specimen, by individually designing the lattice's layers. Scanning electron and a digital microscopy were used to evaluate the dimensional mismatch between actual and designed structures. Compressive tests were carried out to obtain the mechanical properties and to evaluate the collapse modes of the structures in relation to their average relative density and lattice grading. Open-source Digital Image Correlation algorithm was applied to evaluate the deformation behaviour of the structures and to calculate their elastic moduli. The results showed that uniform density structures provide higher mechanical properties than functionally graded ones. The Digital Image Correlation results showed the possibility of effectively designing the different layers of functionally graded structures selecting desired local mechanical properties to mimic the different characteristics of cortical and cancellous bone.
Collapse
Affiliation(s)
- Fabio Distefano
- Department of Engineering, University of Messina, Contrada di Dio, Vill. Sant'Agata, 98166, Messina, Italy
| | - Gabriella Epasto
- Department of Engineering, University of Messina, Contrada di Dio, Vill. Sant'Agata, 98166, Messina, Italy.
| |
Collapse
|
8
|
Berni M, Marchiori G, Baleani M, Giavaresi G, Lopomo NF. Biomechanics of the Human Osteochondral Unit: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1698. [PMID: 38612211 PMCID: PMC11012636 DOI: 10.3390/ma17071698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
The damping system ensured by the osteochondral (OC) unit is essential to deploy the forces generated within load-bearing joints during locomotion, allowing furthermore low-friction sliding motion between bone segments. The OC unit is a multi-layer structure including articular cartilage, as well as subchondral and trabecular bone. The interplay between the OC tissues is essential in maintaining the joint functionality; altered loading patterns can trigger biological processes that could lead to degenerative joint diseases like osteoarthritis. Currently, no effective treatments are available to avoid degeneration beyond tissues' recovery capabilities. A thorough comprehension on the mechanical behaviour of the OC unit is essential to (i) soundly elucidate its overall response to intra-articular loads for developing diagnostic tools capable of detecting non-physiological strain levels, (ii) properly evaluate the efficacy of innovative treatments in restoring physiological strain levels, and (iii) optimize regenerative medicine approaches as potential and less-invasive alternatives to arthroplasty when irreversible damage has occurred. Therefore, the leading aim of this review was to provide an overview of the state-of-the-art-up to 2022-about the mechanical behaviour of the OC unit. A systematic search is performed, according to PRISMA standards, by focusing on studies that experimentally assess the human lower-limb joints' OC tissues. A multi-criteria decision-making method is proposed to quantitatively evaluate eligible studies, in order to highlight only the insights retrieved through sound and robust approaches. This review revealed that studies on human lower limbs are focusing on the knee and articular cartilage, while hip and trabecular bone studies are declining, and the ankle and subchondral bone are poorly investigated. Compression and indentation are the most common experimental techniques studying the mechanical behaviour of the OC tissues, with indentation also being able to provide information at the micro- and nanoscales. While a certain comparability among studies was highlighted, none of the identified testing protocols are currently recognised as standard for any of the OC tissues. The fibril-network-reinforced poro-viscoelastic constitutive model has become common for describing the response of the articular cartilage, while the models describing the mechanical behaviour of mineralised tissues are usually simpler (i.e., linear elastic, elasto-plastic). Most advanced studies have tested and modelled multiple tissues of the same OC unit but have done so individually rather than through integrated approaches. Therefore, efforts should be made in simultaneously evaluating the comprehensive response of the OC unit to intra-articular loads and the interplay between the OC tissues. In this regard, a multidisciplinary approach combining complementary techniques, e.g., full-field imaging, mechanical testing, and computational approaches, should be implemented and validated. Furthermore, the next challenge entails transferring this assessment to a non-invasive approach, allowing its application in vivo, in order to increase its diagnostic and prognostic potential.
Collapse
Affiliation(s)
- Matteo Berni
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (M.B.); (M.B.)
| | - Gregorio Marchiori
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Massimiliano Baleani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (M.B.); (M.B.)
| | - Gianluca Giavaresi
- Scienze e Tecnologie Chirurgiche, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | | |
Collapse
|
9
|
Alassaf A, AlMohimeed I, Alghannam M, Alotaibi S, Alhussaini K, Aleid A, Alolayan S, Sikkandar MY, Alhashim MM, Sheik SB, Sudharsan NM. Time-dependent biomechanical evaluation for corrective planning of scoliosis using finite element analysis - A comprehensive approach. Heliyon 2024; 10:e26946. [PMID: 38449653 PMCID: PMC10915377 DOI: 10.1016/j.heliyon.2024.e26946] [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: 11/23/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
Scoliosis is a medical condition marked by an abnormal lateral curvature of the spine, typically forming a sideways "S" or "C" shape. Mechanically, it manifests as a three-dimensional deformation of the spine, potentially leading to diverse clinical issues such as pain, diminished lung capacity, and postural abnormalities. This research specifically concentrates on the Adolescent Idiopathic Scoliosis (AIS) population, as existing literature indicates a tendency for this type of scoliosis to deteriorate over time. The principal aim of this investigation is to pinpoint the biomechanical factors contributing to the progression of scoliosis by employing Finite Element Analysis (FEA) on computed tomography (CT) data collected from adolescent patients. By accurately modeling the spinal curvature and related deformities, the stresses and strains experienced by vertebral and intervertebral structures under diverse loading conditions can be simulated and quantified. The transient simulation incorporated damping and inertial terms, along with the static stiffness matrix, to enhance comprehension of the response. The findings of this study indicate a significant reduction in the Cobb angle, halving from its initial value, decreasing from 35° to 17°. In degenerative scoliosis, failure was predicted at 109 cycles, with the Polypropylene brace deforming by 10.34 mm, while the Nitinol brace exhibited significantly less deformation at 7.734 mm. This analysis contributes to a better understanding of the biomechanical mechanisms involved in scoliosis development and can assist in the formulation of more effective treatment strategies. The FEA simulation emerges as a valuable supplementary tool for exploring various hypothetical scenarios by applying diverse loads at different locations to enhance comprehension of the effectiveness of proposed interventions.
Collapse
Affiliation(s)
- Ahmad Alassaf
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Ibrahim AlMohimeed
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mohammed Alghannam
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Saddam Alotaibi
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Khalid Alhussaini
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Adham Aleid
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Salem Alolayan
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mohamed Yacin Sikkandar
- Department of Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Maryam M. Alhashim
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | | | - Natteri M. Sudharsan
- Department of Mechanical Engineering, Rajalakshmi Engineering College, Chennai 602105, India
| |
Collapse
|
10
|
Wang X, Fu X, Luo D, Hou R, Li P, Chen Y, Zhang X, Meng X, Yue Y, Liu J. 3D printed high-precision porous scaffolds prepared by fused deposition modeling induce macrophage polarization to promote bone regeneration. Biomed Mater 2024; 19:035006. [PMID: 38422525 DOI: 10.1088/1748-605x/ad2ed0] [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: 10/31/2023] [Accepted: 02/29/2024] [Indexed: 03/02/2024]
Abstract
Macrophage-mediated bone immune responses significantly influence the repair of bone defects when utilizing tissue-engineered scaffolds. Notably, the scaffolds' physical structure critically impacts macrophage polarization. The optimal pore size for facilitating bone repair remains a topic of debate due to the imprecision of traditional methods in controlling scaffold pore dimensions and spatial architecture. In this investigation, we utilized fused deposition modeling (FDM) technology to fabricate high-precision porous polycaprolactone (PCL) scaffolds, aiming to elucidate the impact of pore size on macrophage polarization. We assessed the scaffolds' mechanical attributes and biocompatibility. Real-time quantitative reverse transcription polymerase chain reaction was used to detect the expression levels of macrophage-related genes, and enzyme linked immunosorbent assay for cytokine secretion levels.In vitroosteogenic capacity was determined through alkaline phosphatase and alizarin red staining. Our findings indicated that macroporous scaffolds enhanced macrophage adhesion and drove their differentiation towards the M2 phenotype. This led to the increased production of anti-inflammatory factors and a reduction in pro-inflammatory agents, highlighting the scaffolds' immunomodulatory capabilities. Moreover, conditioned media from macrophages cultured on these macroporous scaffolds bolstered the osteogenic differentiation of bone marrow mesenchymal stem cells, exhibiting superior osteogenic differentiation potential. Consequently, FDM-fabricated PCL scaffolds, with precision-controlled pore sizes, present promising prospects as superior materials for bone tissue engineering, leveraging the regulation of macrophage polarization.
Collapse
Affiliation(s)
- Xiangyu Wang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, People's Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, People's Republic of China
| | - Xinyu Fu
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, People's Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, People's Republic of China
| | - Dongmei Luo
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, People's Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, People's Republic of China
| | - Ruxia Hou
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, People's Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, People's Republic of China
| | - Peiwen Li
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, People's Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, People's Republic of China
| | - Yurou Chen
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, People's Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, People's Republic of China
| | - Xinyao Zhang
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, People's Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, People's Republic of China
| | - Xiangjie Meng
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, People's Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, People's Republic of China
| | - Yingge Yue
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, People's Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, People's Republic of China
| | - Junyu Liu
- Shanxi Medical University School and Hospital of Stomatology, Taiyuan 030001, People's Republic of China
- Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan 030001, People's Republic of China
| |
Collapse
|
11
|
Ozanne H, Moubri L, Abou-Nassif L, Thoumire O, Echalard A, Morin-Grognet S, Atmani H, Ladam G, Labat B. Active Osteoblasts or Quiescent Bone Lining Cells? Preosteoblasts Fate Orchestrated by Curvature and Stiffness of an In Vitro 2.5D Biomimetic Culture System. Adv Healthc Mater 2024; 13:e2302222. [PMID: 37929897 DOI: 10.1002/adhm.202302222] [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: 07/15/2023] [Indexed: 11/07/2023]
Abstract
Biomimetic cell culture systems are required to provide more physiologically relevant microenvironments for bone cells. Here, a simple 2.5D culture platform is proposed, combining adjustable stiffness and surface features that mimic bone topography by using sandpaper grits as master molds with two stiffness formulations of polydimethylsiloxane (PDMS). The subsequent replicas perfectly conform the grits and reproduce the corresponding negative relief with cavities separated by convex edges. Biomimicry is also provided by an extracellular matrix (ECM)-like thin film coating, using the layer-by-layer (LbL) method. The topographical features, alternating concave, and convex structures drive preosteoblasts organization and morphology. Strikingly, curvature orchestrates the commitment of preosteoblasts, with i) maturation to active osteoblasts able to produce a dense collagenous matrix that ultimately mineralizes in the cavities, and ii) edges hosting quiescent cells that synthetize a very thin immature collagen layer with no mineralization. In summary, the present in vitro culture system model offers a cell-instructive 2.5D microenvironment that controls preosteoblasts fate, leading to two coexisting subpopulations: mature osteoblasts and bone lining cells (BLC). This promising culture system opens new avenues to advanced tissue-engineered modeling and can be applied to precellularized bone biomaterials.
Collapse
Affiliation(s)
- Hélène Ozanne
- Univ Rouen Normandie, INSA Rouen Normandie, CNRS, PBS UMR 6270, Evreux, F-27000, France
| | - Loïc Moubri
- Univ Rouen Normandie, INSA Rouen Normandie, CNRS, PBS UMR 6270, Evreux, F-27000, France
| | - Léa Abou-Nassif
- Univ Rouen Normandie, INSA Rouen Normandie, CNRS, PBS UMR 6270, Evreux, F-27000, France
| | - Olivier Thoumire
- Univ Rouen Normandie, INSA Rouen Normandie, CNRS, PBS UMR 6270, Evreux, F-27000, France
| | - Aline Echalard
- Univ Rouen Normandie, INSA Rouen Normandie, CNRS, PBS UMR 6270, Evreux, F-27000, France
| | | | - Hassan Atmani
- Univ Rouen Normandie, INSA Rouen Normandie, CNRS, PBS UMR 6270, Evreux, F-27000, France
| | - Guy Ladam
- Univ Rouen Normandie, INSA Rouen Normandie, CNRS, PBS UMR 6270, Evreux, F-27000, France
| | - Béatrice Labat
- Univ Rouen Normandie, INSA Rouen Normandie, CNRS, PBS UMR 6270, Evreux, F-27000, France
| |
Collapse
|
12
|
Kurz S, Gebhardt M, Grundmann F, Heyde CE, Steinke H. Approach to standardized material characterization of the human lumbopelvic system-Specification, preparation and storage. PLoS One 2023; 18:e0289482. [PMID: 37535581 PMCID: PMC10399898 DOI: 10.1371/journal.pone.0289482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
The complexity of the osseo-ligamentous lumbopelvic system has made it difficult to perform both, the overall preparation as well as specimen harvesting and material testing with a reasonable amount of time and personnel. The logistics of such studies present a hurdle for reproducibility. A structured procedure was developed and proved, which allows all necessary steps to be carried out reproducibly and in a reasonable time. This enables the extraction of 26 soft tissue, 33 trabecular and 32 cortical bone specimens from this anatomical region per cadaver. The integrity of the specimens remains maintained while keeping requirements within manageable limits. The practicability of the intended five-day specimen harvesting and testing procedure could be demonstrated on five test and two pre-test sequences. The intended minimization of physical, biological, and chemical external influences on specimens could be achieved. All protocols, instructions and models of preparation and storage devices are included in the supporting information. The high grade of applicability and reproducibility will lead to better comparability between different biomechanical investigations. This procedure proven on the human pelvis is transferable to other anatomical regions.
Collapse
Affiliation(s)
- Sascha Kurz
- ZESBO - Center for Research on Musculoskeletal Systems, Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Marc Gebhardt
- Institute of Experimental Mechanics, Faculty of Civil Engineering, Leipzig University of Applied Sciences, Leipzig, Germany
- Institute of Anatomy, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Fanny Grundmann
- Clinic of Trauma, Orthopedic and Septic Surgery, Hospital St. Georg gGmbH, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- ZESBO - Center for Research on Musculoskeletal Systems, Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Hanno Steinke
- Institute of Anatomy, Faculty of Medicine, Leipzig University, Leipzig, Germany
| |
Collapse
|
13
|
Yazdanpanah Z, Sharma NK, Raquin A, Cooper DML, Chen X, Johnston JD. Printing tissue-engineered scaffolds made of polycaprolactone and nano-hydroxyapatite with mechanical properties appropriate for trabecular bone substitutes. Biomed Eng Online 2023; 22:73. [PMID: 37474951 PMCID: PMC10360269 DOI: 10.1186/s12938-023-01135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Bone tissue engineering, based on three-dimensional (3D) printing technology, has emerged as a promising approach to treat bone defects using scaffolds. The objective of this study was to investigate the influence of porosity and internal structure on the mechanical properties of scaffolds. METHODS We fabricated composite scaffolds (which aimed to replicate trabecular bone) from polycaprolactone (PCL) reinforced with 30% (wt.) nano-hydroxyapatite (nHAp) by extrusion printing. Scaffolds with various porosities were designed and fabricated with and without an interlayer offset, termed as staggered and lattice structure, respectively. Mechanical compressive testing was performed to determine scaffold elastic modulus and yield strength. Linear regression was used to evaluate mechanical properties as a function of scaffold porosity. RESULTS Different relationships between mechanical properties and porosities were noted for the staggered and lattice structures. For elastic moduli, the two relationships intersected (porosity = 55%) such that the lattice structure exhibited higher moduli with porosity values greater than the intersection point; vice versa for the staggered structure. The lattice structure exhibited higher yield strength at all porosities. Mechanical testing results also indicated elastic moduli and yield strength properties comparable to trabecular bone (elastic moduli: 14-165 MPa; yield strength: 0.9-10 MPa). CONCLUSIONS Taken together, this study demonstrates that scaffolds printed from PCL/30% (wt.) nHAp with lattice and staggered structure offer promise for treating trabecular bone defects. This study identified the effect of porosity and internal structure on scaffold mechanical properties and provided suggestions for developing scaffolds with mechanical properties for substituting trabecular bone.
Collapse
Affiliation(s)
- Zahra Yazdanpanah
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Nitin Kumar Sharma
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK, Canada
| | - Alice Raquin
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK, Canada
- Institut Catholique Des Arts Et Métiers, 85000, La Roche-Sur-Yon, France
| | - David M L Cooper
- Department of Anatomy, Physiology, and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Xiongbiao Chen
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK, Canada
| | - James D Johnston
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, SK, Canada
| |
Collapse
|
14
|
Yazdanpanah Z, Kumar Sharma N, Zimmerling A, Cooper DML, Johnston JD, Chen X. Investigation into relationships between design parameters and mechanical properties of 3D printed PCL/nHAp bone scaffolds. PLoS One 2023; 18:e0288531. [PMID: 37450462 PMCID: PMC10348542 DOI: 10.1371/journal.pone.0288531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Scaffolds are of great importance in tissue engineering applications as they provide a mechanically supportive environment for cellular activity, which is particularly necessary for hard tissues such as bone. Notably, the mechanical properties of a scaffold vary with differing design parameters such as those related to scaffold height and internal structure. Thus, the present study aimed to explore the relationship between design parameters and mechanical properties of composite polycaprolactone (PCL) and nano-hydroxyapatite (nHAp) scaffolds fabricated by three-dimensional (3D) printing. METHODS We designed and printed scaffolds with different internal structures (lattice and staggered) and varying heights (4, 6, 8 and 10 layers), and consistent porosity (50%) for the purpose of comparison. Then, we examined the scaffold microstructure (pore size and penetration between layers) using scanning electron microscopy (SEM) and mechanical properties (elastic modulus and yield strength) using compressive testing. RESULTS Our results illustrated that the microstructural parameters were related to scaffold design. At higher heights, pore size increased while penetration between layers decreased; thus, mechanical properties were affected. Results of mechanical testing demonstrated that for lattice scaffolds, elastic modulus was similar for 6 vs 4, and 8 vs 4 layers but ~33% lower for 10 layers vs 4 layers. Similarly, yield strength was comparable for 6 vs 4, and 8 vs 4 layers but ~27% lower for 10 layers vs 4 layers. With staggered scaffolds, when compared to 4-layer results, elastic modulus was similar for 6 layers but was ~43% lower for 8 layers and ~38% lower for 10 layers. Staggered scaffolds had ~38%, ~51%, and ~76% lower yield strength when the number of layers were increased from 4 to 6, 8, and 10 layers, respectively. When comparing lattice and staggered scaffolds with the same layer number, elastic modulus was similar, apart from 8-layer scaffolds where the staggered design was ~42% lower than lattice. Yield strength was similar between 4-layer staggered and lattice scaffolds, while staggered scaffolds with 6, 8, and 10 number of layers showed ~43%, ~45%, ~68% lower strength, respectively, than those found in lattice scaffolds with the same layer numbers. CONCLUSIONS Mechanical properties of 3D printed scaffolds depended on scaffold height for both lattice and staggered internal structures. Staggered scaffolds had lower mechanical properties than the lattice scaffolds with the same height and were more sensitive to the change in scaffold height. Taken together, lattice scaffolds demonstrated the advantages of more stable mechanical properties over staggered scaffolds. Also, scaffolds with lower height were more promising in terms of mechanical properties compared to scaffolds with greater height.
Collapse
Affiliation(s)
- Zahra Yazdanpanah
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nitin Kumar Sharma
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Amanda Zimmerling
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David M. L. Cooper
- Department of Anatomy Physiology and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - James D. Johnston
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Xiongbiao Chen
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
15
|
Orthopedical Nanotechnology. Nanomedicine (Lond) 2023. [DOI: 10.1007/978-981-16-8984-0_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
16
|
Cardoso L, Khadka N, Dmochowski JP, Meneses E, Lee K, Kim S, Jin Y, Bikson M. Computational modeling of posteroanterior lumbar traction by an automated massage bed: predicting intervertebral disc stresses and deformation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:931274. [PMID: 36189059 PMCID: PMC9397988 DOI: 10.3389/fresc.2022.931274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022]
Abstract
Spinal traction is a physical intervention that provides constant or intermittent stretching axial force to the lumbar vertebrae to gradually distract spinal tissues into better alignment, reduce intervertebral disc (IVD) pressure, and manage lower back pain (LBP). However, such axial traction may change the normal lordotic curvature, and result in unwanted side effects and/or inefficient reduction of the IVD pressure. An alternative to axial traction has been recently tested, consisting of posteroanterior (PA) traction in supine posture, which was recently shown effective to increase the intervertebral space and lordotic angle using MRI. PA traction aims to maintain the lumbar lordosis curvature throughout the spinal traction therapy while reducing the intradiscal pressure. In this study, we developed finite element simulations of mechanical therapy produced by a commercial thermo-mechanical massage bed capable of spinal PA traction. The stress relief produced on the lumbar discs by the posteroanterior traction system was investigated on human subject models with different BMI (normal, overweight, moderate obese and extreme obese BMI cases). We predict typical traction levels lead to significant distraction stresses in the lumbar discs, thus producing a stress relief by reducing the compression stresses normally experienced by these tissues. Also, the stress relief experienced by the lumbar discs was effective in all BMI models, and it was found maximal in the normal BMI model. These results are consistent with prior observations of therapeutic benefits derived from spinal AP traction.
Collapse
Affiliation(s)
- Luis Cardoso
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
- *Correspondence: Luis Cardoso
| | - Niranjan Khadka
- Division of Neuropsychiatry and Neuromodulation, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Jacek P. Dmochowski
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
| | - Edson Meneses
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
| | - Kiwon Lee
- Clinical Research Institute, Ceragem Clinical Inc., Seoul, South Korea
| | - Sungjin Kim
- Clinical Research Institute, Ceragem Clinical Inc., Seoul, South Korea
| | - Youngsoo Jin
- Clinical Research Institute, Ceragem Clinical Inc., Seoul, South Korea
- Asan Medical Center, Seoul, South Korea
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
| |
Collapse
|
17
|
Evaluation of Microstructure and Mechanical Properties of a Ti10Mo8Nb Alloy for Biomedical Applications. METALS 2022. [DOI: 10.3390/met12071065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The growth of the elderly population is urging for more suitable biomaterials to allow the performance of better surgical and implant procedures and accelerate the patient’s healing because the elderly are more vulnerable to orthopedic and dental problems. β-phase Ti alloys can improve the mechanical properties of implants by reducing their elastic modulus and, consequently, the effects of stress shielding within bones. Therefore, the objective of this article is to study a novel ternary β-phase alloy of Ti10Mo8Nb produced by an electric arc furnace and rotary forge. The microstructure and mechanical properties of the Ti10Mo8Nb alloy were investigated in order to evaluate its suitability for biomedical applications and compare its characteristics with those present in Ti-alloys commerced or widely researched for prosthetic purposes. A tensile test, Vickers microhardness test, use of microstructure of optical microscopy for examination of microstructure, X-ray diffraction and hemolysis analysis were carried out. Thus, the Ti10Mo8Nb alloy showed suitable properties for biomedical applications, as well as having the potential to reduce the possibility to occur stress shielding after prosthetic implantations, especially for orthopedics and dentistry.
Collapse
|
18
|
Biomimetic glycopeptide hydrogel coated PCL/nHA scaffold for enhanced cranial bone regeneration via macrophage M2 polarization-induced osteo-immunomodulation. Biomaterials 2022; 285:121538. [DOI: 10.1016/j.biomaterials.2022.121538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/29/2022] [Accepted: 04/20/2022] [Indexed: 01/11/2023]
|
19
|
Adami G, Fassio A, Gatti D, Viapiana O, Benini C, Danila MI, Saag KG, Rossini M. Osteoporosis in 10 years time: a glimpse into the future of osteoporosis. Ther Adv Musculoskelet Dis 2022; 14:1759720X221083541. [PMID: 35342458 PMCID: PMC8941690 DOI: 10.1177/1759720x221083541] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/07/2022] [Indexed: 12/21/2022] Open
Abstract
Patients living with osteoporosis are projected to increase dramatically in the
next decade. Alongside the forecasted increased societal and economic burden, we
will live a crisis of fractures. However, we will have novel pharmacological
treatment to face this crisis and, more importantly, new optimized treatment
strategies. Fracture liaison services will be probably implemented on a large
scale worldwide, helping to prevent additional fractures in high-risk patients.
In the next decade, novel advances in the diagnostic tools will be largely
available. Moreover, new and more precise fracture risk assessment tools will
change our ability to detect patients at high risk of fractures. Finally, big
data and artificial intelligence will help us to move forward into the world of
precision medicine. In the present review, we will discuss the future
epidemiology and costs of osteoporosis, the advances in early and accurate
diagnosis of osteoporosis, with a special focus on biomarkers and imaging tools.
Then we will examine new and refined fracture risk assessment tools, the role of
fracture liaison services, and a future perspective on osteoporosis
treatment.
Collapse
Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, University of Verona, Pz Scuro 10, 37134 Verona, Italy
| | - Angelo Fassio
- Rheumatology Unit, University of Verona, Verona, Italy
| | - Davide Gatti
- Rheumatology Unit, University of Verona, Verona, Italy
| | | | | | - Maria I. Danila
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kenneth G. Saag
- Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | |
Collapse
|
20
|
Wang P, Jiang Q. Orthopedical Nanotechnology. Nanomedicine (Lond) 2022. [DOI: 10.1007/978-981-13-9374-7_15-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|