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Weiss MB, Syed SA, Whiteson HZ, Hirani R, Etienne M, Tiwari RK. Navigating Post-Traumatic Osteoporosis: A Comprehensive Review of Epidemiology, Pathophysiology, Diagnosis, Treatment, and Future Directions. Life (Basel) 2024; 14:561. [PMID: 38792583 PMCID: PMC11122478 DOI: 10.3390/life14050561] [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: 03/11/2024] [Revised: 04/14/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
Post-traumatic osteoporosis (PTO) presents a significant challenge in clinical practice, characterized by demineralization and decreased skeletal integrity following severe traumatic injuries. This literature review manuscript addresses the knowledge gaps surrounding PTO, encompassing its epidemiology, pathophysiology, risk factors, diagnosis, treatment, prognosis, and future directions. This review emphasizes the complexity of the etiology of PTO, highlighting the dysregulation of biomineralization processes, inflammatory cytokine involvement, hormonal imbalances, glucocorticoid effects, vitamin D deficiency, and disuse osteoporosis. Moreover, it underscores the importance of multidisciplinary approaches for risk mitigation and advocates for improved diagnostic strategies to differentiate PTO from other musculoskeletal pathologies. This manuscript discusses various treatment modalities, including pharmacotherapy, dietary management, and physical rehabilitation, while also acknowledging the limited evidence on their long-term effectiveness and outcomes in PTO patients. Future directions in research are outlined, emphasizing the need for a deeper understanding of the molecular mechanisms underlying PTO and the evaluation of treatment strategies' efficacy. Overall, this review provides a comprehensive overview of PTO and highlights avenues for future investigation to enhance clinical management and patient outcomes.
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Affiliation(s)
- Matthew B. Weiss
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA (H.Z.W.); (R.H.); (M.E.)
| | - Shoaib A. Syed
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA (H.Z.W.); (R.H.); (M.E.)
| | - Harris Z. Whiteson
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA (H.Z.W.); (R.H.); (M.E.)
| | - Rahim Hirani
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA (H.Z.W.); (R.H.); (M.E.)
- Graduate School of Biomedical Sciences, New York Medical College, Valhalla, NY 10595, USA
| | - Mill Etienne
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA (H.Z.W.); (R.H.); (M.E.)
- Department of Neurology, New York Medical College, Valhalla, NY 10595, USA
| | - Raj K. Tiwari
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA (H.Z.W.); (R.H.); (M.E.)
- Graduate School of Biomedical Sciences, New York Medical College, Valhalla, NY 10595, USA
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2
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Peng Y, Langermann S, Kothari P, Liu L, Zhao W, Hu Y, Chen Z, Moraes de Lima Perini M, Li J, Cao J, Guo XE, Chen L, Bauman WA, Qin W. Anti-Siglec-15 Antibody Prevents Marked Bone Loss after Acute Spinal Cord Injury-Induced Immobilization in Rats. JBMR Plus 2023; 7:e10825. [PMID: 38130761 PMCID: PMC10731123 DOI: 10.1002/jbm4.10825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 12/23/2023] Open
Abstract
Rapid and extensive sublesional bone loss after spinal cord injury (SCI) is a difficult medical problem that has been refractory to available interventions except the antiresorptive agent denosumab (DMAB). While DMAB has shown some efficacy in inhibiting bone loss, its concurrent inhibition of bone formation limits its use. Sialic acid-binding immunoglobulin-like lectin (Siglec)-15 is expressed on the cell surface of mature osteoclasts. Anti-Siglec-15 antibody (Ab) has been shown to inhibit osteoclast maturation and bone resorption while maintaining osteoblast activity, which is distinct from current antiresorptive agents that inhibit the activity of both osteoclasts and osteoblasts. The goal of the present study is to test a Siglec-15 Ab (NP159) as a new treatment option to prevent bone loss in an acute SCI model. To this end, 4-month-old male Wistar rats underwent complete spinal cord transection and were treated with either vehicle or NP159 at 20 mg/kg once every 2 weeks for 8 weeks. SCI results in significant decreases in bone mineral density (BMD, -18.7%), trabecular bone volume (-43.1%), trabecular connectivity (-59.7%), and bone stiffness (-76.3%) at the distal femur. Treatment with NP159 almost completely prevents the aforementioned deterioration of bone after SCI. Blood and histomorphometric analyses revealed that NP159 is able to greatly inhibit bone resorption while maintaining bone formation after acute SCI. In ex vivo cultures of bone marrow cells, NP159 reduces osteoclastogenesis while increasing osteoblastogenesis. In summary, treatment with NP159 almost fully prevents sublesional loss of BMD and metaphysis trabecular bone volume and preserves bone strength in a rat model of acute SCI. Because of its unique ability to reduce osteoclastogenesis and bone resorption while promoting osteoblastogenesis to maintain bone formation, Siglec-15 Ab may hold greater promise as a therapeutic agent, compared with the exclusively antiresorptive or anabolic agents that are currently used, in mitigating the striking bone loss that occurs after SCI or other conditions associated with severe immobilization. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.
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Affiliation(s)
- Yuanzhen Peng
- Spinal Cord Damage Research Center, James J. Peters Veteran Affairs Medical CenterBronxNew YorkUSA
| | | | | | | | - Wei Zhao
- Spinal Cord Damage Research Center, James J. Peters Veteran Affairs Medical CenterBronxNew YorkUSA
| | - Yizhong Hu
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | - Zihao Chen
- Department of BiotechnologyBrown UniversityProvidenceRhode IslandUSA
| | | | - Jiliang Li
- School of Science, Indiana University Purdue UniversityIndianapolisIndianaUSA
| | - Jay Cao
- USDA‐ARS Grand Forks Human Nutrition Research CenterGrand ForksNorth DakotaUSA
| | - X. Edward Guo
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | - Lieping Chen
- NextCure, IncBeltsvilleMarylandUSA
- Cancer Research, Immunobiology and Medicine, The Yale University School of MedicineNew HavenConnecticutUSA
| | - William A. Bauman
- Spinal Cord Damage Research Center, James J. Peters Veteran Affairs Medical CenterBronxNew YorkUSA
- Departments of MedicineRehabilitation and Human Performance, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Rehabilitation and Human Performance, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Weiping Qin
- Spinal Cord Damage Research Center, James J. Peters Veteran Affairs Medical CenterBronxNew YorkUSA
- Departments of MedicineRehabilitation and Human Performance, Icahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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3
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Ponzano M, Wiest MJ, Coleman A, Newton E, Pakosh M, Patsakos EM, Magnuson DSK, Giangregorio LM, Craven BC. The use of alkaline phosphatase as a bone turnover marker after spinal cord injury: A scoping review of human and animal studies. J Spinal Cord Med 2023; 46:167-180. [PMID: 34935593 PMCID: PMC9987745 DOI: 10.1080/10790268.2021.1977905] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Serum alkaline phosphatase (ALP) is measured as an indicator of bone or liver disease. Bone-specific alkaline phosphatase (B-ALP) is an isoform of ALP found in the bone tissue which can predict fractures and heterotopic ossification. OBJECTIVE The aim of this scoping review was to explore the current use of ALP and B-ALP in studies using humans or animal models of SCI, and to identify ways to advance future research using ALP and B-ALP as a bone marker after SCI. RESULTS HUMAN STUDIES: 42 studies were included. The evidence regarding changes or differences in ALP levels in individuals with SCI compared to controls is conflicting. For example, a negative correlation between B-ALP and total femur BMD was observed in only one of three studies examining the association. B-ALP seemed to increase after administration of teriparatide, and to decrease after treatment with denosumab. The effects of exercise on ALP and B-ALP levels are heterogeneous and depend on the type of exercise performed. ANIMAL STUDIES: 11 studies were included. There is uncertainty regarding the response of ALP or B-ALP levels after SCI; levels increased after some interventions, including vibration protocols, curcumin supplementation, cycles in electromagnetic field or hyperbaric chamber. Calcitonin or bisphosphonate administration did not affect ALP levels. CONCLUSION Researchers are encouraged to measure the bone-specific isoform of ALP rather than total ALP in future studies in humans of animal models of SCI.
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Affiliation(s)
- Matteo Ponzano
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Matheus J Wiest
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - André Coleman
- Department of Physiology and Pathophysiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Emily Newton
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada
| | - Eleni M Patsakos
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - David S K Magnuson
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA
| | - Lora M Giangregorio
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Kinesiology, University of Waterloo, Waterloo, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - B Catharine Craven
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,Department of Kinesiology, University of Waterloo, Waterloo, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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4
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Dharnipragada R, Ahiarakwe U, Gupta R, Abdilahi A, Butterfield J, Naik A, Parr A, Morse LR. Pharmacologic and nonpharmacologic treatment modalities for bone loss in SCI - Proposal for combined approach. J Clin Densitom 2023; 26:101359. [PMID: 36931948 DOI: 10.1016/j.jocd.2023.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
Increased risk of bone fracture due to bone mineral density (BMD) loss is a serious consequence of spinal cord injury (SCI). Traditionally, pharmaceutical approaches, such as bisphosphonates, have been prescribed to prevent bone loss. However, there is controversy in the literature regarding efficacy of these medications to mitigate the drastic bone loss following SCI. Individuals with SCI are particularly at risk of osteoporosis because of the lack of ambulation and weight bearing activities. In the past two decades, functional electric stimulation (FES) has allowed for another approach to treat bone loss. FES approaches are expanding into various modalities such as cycling and rowing exercises and show promising outcomes with minimal consequences. In addition, these non-pharmacological treatments can elevate overall physical and mental health. This article provides an overview of efficacy of different treatment options for BMD loss for SCI and advocates for a combined approach be pursued in standard of care.
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Affiliation(s)
- Rajiv Dharnipragada
- University of Minnesota Medical School, Twin-Cities, Minneapolis, MN 55455, USA
| | | | - Ribhav Gupta
- University of Minnesota Medical School, Twin-Cities, Minneapolis, MN 55455, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Abdiasis Abdilahi
- University of Minnesota Medical School, Twin-Cities, Minneapolis, MN 55455, USA
| | - Jack Butterfield
- University of Minnesota Medical School, Twin-Cities, Minneapolis, MN 55455, USA
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign IL, 61801, USA
| | - Ann Parr
- Department of Neurosurgery, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA
| | - Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota Twin-Cities, Minneapolis, MN 55455, USA.
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5
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Shao X, Yan Z, Wang D, Yang Y, Ding Y, Luo E, Jing D, Cai J. Pulsed Electromagnetic Fields Ameliorate Skeletal Deterioration in Bone Mass, Microarchitecture, and Strength by Enhancing Canonical Wnt Signaling-Mediated Bone Formation in Rats with Spinal Cord Injury. J Neurotrauma 2021; 38:765-776. [PMID: 33108939 DOI: 10.1089/neu.2020.7296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Spinal cord injury (SCI) leads to extensive bone loss and high incidence of low-energy fractures. Pulsed electromagnetic fields (PEMF) treatment, as a non-invasive biophysical technique, has proven to be efficient in promoting osteogenesis. The potential osteoprotective effect and mechanism of PEMF on SCI-related bone deterioration, however, remain unknown. The spinal cord of rats was transected at vertebral level T12 to induce SCI. Thirty rats were assigned to the control, SCI, and SCI+PEMF groups (n = 10). One week after surgery, the SCI+PEMF rats were subjected to PEMF (2.0 mT, 15 Hz, 2 h/day) for eight weeks. Micro-computed tomography results showed that PEMF significantly ameliorated trabecular and cortical bone microarchitecture deterioration induced by SCI. Three-point bending and nanoindentation assays revealed that PEMF significantly improved bone mechanical properties in SCI rats. Serum biomarker and bone histomorphometric analyses demonstrated that PEMF enhanced bone formation, as evidenced by significant increase in serum osteocalcin and P1NP, mineral apposition rate, and osteoblast number on bone surface. The PEMF had no impact, however, on serum bone-resorbing cytokines (TRACP 5b and CTX-1) or osteoclast number on bone surface. The PEMF also attenuated SCI-induced negative changes in osteocyte morphology and osteocyte survival. Moreover, PEMF significantly increased skeletal expression of canonical Wnt ligands (Wnt1 and Wnt10b) and stimulated their downstream p-GSK3β and β-catenin expression in SCI rats. This study demonstrates that PEMF can mitigate the detrimental consequence of SCI on bone quantity/quality, which might be associated with canonical Wnt signaling-mediated bone formation, and reveals that PEMF may be a promising biophysical approach for resisting osteopenia/osteoporosis after SCI in clinics.
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Affiliation(s)
- Xi Shao
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Zedong Yan
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Dan Wang
- Lab of Tissue Engineering, Faculty of Life Sciences, Northwest University, Xi'an, China
| | - Yongqing Yang
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Yuanjun Ding
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Erping Luo
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Da Jing
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
| | - Jing Cai
- Department of Biomedical Engineering, Fourth Military Medical University, Xi'an, China
- College of Basic Medicine, Shaanxi University of Chinese Medicine, Xianyang, China
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6
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Cirnigliaro CM, La Fountaine MF, Parrott JS, Kirshblum SC, McKenna C, Sauer SJ, Shapses SA, Hao L, McClure IA, Hobson JC, Spungen AM, Bauman WA. Administration of Denosumab Preserves Bone Mineral Density at the Knee in Persons With Subacute Spinal Cord Injury: Findings From a Randomized Clinical Trial. JBMR Plus 2020; 4:e10375. [PMID: 33134767 PMCID: PMC7587457 DOI: 10.1002/jbm4.10375] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 12/21/2022] Open
Abstract
Persons with neurologically motor-complete spinal cord injury (SCI) have a marked loss of bone mineral density (BMD) of the long bones of the lower extremities, predisposing them to fragility fractures, especially at the knee. Denosumab, a commercially available human monoclonal IgG antibody to receptor activator of nuclear factor-κB ligand (RANKL), may provide an immunopharmacological solution to the rapid progressive deterioration of sublesional bone after SCI. Twenty-six SCI participants with subacute motor-complete SCI were randomized to receive either denosumab (60 mg) or placebo at baseline (BL), 6, and 12 months. Areal bone mineral density (aBMD) by dual energy x-ray absorptiometry (DXA) at 18 months at the distal femur was the primary outcome and aBMD of the proximal tibia and hip were the secondary outcomes analyzed in 18 of the 26 participants (denosumab, n = 10 and placebo, n = 8). The metrics of peripheral QCT (pQCT) were the exploratory outcomes analyzed in a subsample of the cohort (denosumab, n = 7 and placebo n = 7). The mean aBMD (±95% CI) for the denosumab versus the placebo groups demonstrated a significant group × time interactions for the following regions of interest at BL and 18 months: distal femoral metaphysis = mean aBMD 1.187; 95% CI, 1.074 to 1.300 and mean aBMD 1.202; 95% CI, 1.074 to 1.329 versus mean aBMD 1.162; 95% CI, 0.962 to 1.362 and mean aBMD 0.961; 95% CI, 0.763 to 1.159, respectively (p < 0.001); distal femoral epiphysis = mean aBMD 1.557; 95% CI, 1.437 to 1.675 and mean aBMD 1.570; 95% CI, 1.440 to 1.700 versus mean aBMD 1.565; 95% CI, 1.434 to 1.696 and mean aBMD 1.103; 95% CI, 0.898 to 1.309, respectively (p = 0.002); and proximal tibial epiphysis = mean aBMD 1.071; 95% CI, 0.957 to 1.186 and mean aBMD 1.050; 95% CI, 0.932 to 1.168 versus mean aBMD 0.994; 95% CI, 0.879 to 1.109 and mean aBMD 0.760; 95% CI, 0.601 to 0.919, respectively (p < 0.001). Analysis of pQCT imaging revealed a continued trend toward significantly greater loss in total volumetric BMD (vBMD) and trabecular vBMD at the 4% distal tibia region, with a significant percent loss for total bone mineral content. Thus, at 18 months after acute SCI, our findings show that denosumab maintained aBMD at the knee region, the site of greatest clinical relevance in the SCI population. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury James J. Peters Veterans Affairs Medical Center Bronx NY USA
| | - Michael F La Fountaine
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury James J. Peters Veterans Affairs Medical Center Bronx NY USA.,Department of Physical Therapy, School of Health and Medical Sciences Seton Hall University South Orange NJ USA.,Departments of Medical Sciences and Neurology Hackensack Meridian School of Medicine at Seton Hall University Nutley NJ USA
| | - J Scott Parrott
- Department of Interdisciplinary Studies School of Health Professions, Rutgers Biomedical and Health Sciences Newark NJ USA
| | - Steven C Kirshblum
- Kessler Institute for Rehabilitation West Orange NJ USA.,Kessler Foundation West Orange NJ USA.,Department of Physical Medicine and Rehabilitation Rutgers New Jersey Medical School Newark NJ USA
| | - Cristin McKenna
- Kessler Institute for Rehabilitation West Orange NJ USA.,Kessler Foundation West Orange NJ USA
| | - Susan J Sauer
- Kessler Institute for Rehabilitation West Orange NJ USA
| | - Sue A Shapses
- Department of Nutritional Sciences, School of Environmental and Biological Sciences Rutgers University New Brunswick NJ USA
| | - Lihong Hao
- Department of Nutritional Sciences, School of Environmental and Biological Sciences Rutgers University New Brunswick NJ USA
| | - Isa A McClure
- Kessler Institute for Rehabilitation West Orange NJ USA
| | - Joshua C Hobson
- Department of Kinesiology and Applied Physiology University of Delaware Newark DE USA
| | - Ann M Spungen
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury James J. Peters Veterans Affairs Medical Center Bronx NY USA.,Departments of Medicine and Rehabilitation and Human Performance Icahn School of Medicine at Mount Sinai New York NY USA
| | - William A Bauman
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury James J. Peters Veterans Affairs Medical Center Bronx NY USA.,Departments of Medicine and Rehabilitation and Human Performance Icahn School of Medicine at Mount Sinai New York NY USA
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7
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Zamarioli A, de Andrade Staut C, Volpon JB. Review of Secondary Causes of Osteoporotic Fractures Due to Diabetes and Spinal Cord Injury. Curr Osteoporos Rep 2020; 18:148-156. [PMID: 32147752 DOI: 10.1007/s11914-020-00571-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to gain a better understanding of osteoporotic fractures and the different mechanisms that are driven in the scenarios of bone disuse due to spinal cord injury and osteometabolic disorders due to diabetes. RECENT FINDINGS Despite major advances in understanding the pathogenesis, prevention, and treatment of osteoporosis, the high incidence of impaired fracture healing remains an important complication of bone loss, leading to marked impairment of the health of an individual and economic burden to the medical system. This review underlines several pathways leading to bone loss and increased risk for fractures. Specifically, we addressed the different mechanisms leading to bone loss after a spinal cord injury and diabetes. Finally, it also encompasses the changes responsible for impaired bone repair in these scenarios, which may be of great interest for future studies on therapeutic approaches to treat osteoporosis and osteoporotic fractures.
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Affiliation(s)
- Ariane Zamarioli
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
| | - Caio de Andrade Staut
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - José B Volpon
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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8
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Invernizzi M, de Sire A, Renò F, Cisari C, Runza L, Baricich A, Carda S, Fusco N. Spinal Cord Injury as a Model of Bone-Muscle Interactions: Therapeutic Implications From in vitro and in vivo Studies. Front Endocrinol (Lausanne) 2020; 11:204. [PMID: 32351450 PMCID: PMC7174687 DOI: 10.3389/fendo.2020.00204] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/23/2020] [Indexed: 12/15/2022] Open
Abstract
Spinal cord injuries (SCIs) represent a variety of conditions related to the damage of the spinal cord with consequent musculoskeletal repercussions. The bone and muscle tissues share several catabolic pathways that lead to variable degrees of disability in SCI patients. In this review article, we provide a comprehensive characterization of the available treatment options targeting the skeleton and the bone in the setting of SCI. Among the pharmacological intervention, bisphosphonates, anti-sclerostin monoclonal antibodies, hydrogen sulfide, parathyroid hormone, and RANKL pathway inhibitors represent valuable options for treating bone alterations. Loss phenomena at the level of the muscle can be counteracted with testosterone, anabolic-androgenic steroids, and selective androgen receptor modulators. Exercise and physical therapy are valuable strategies to increase bone and muscle mass. Nutritional interventions could enhance SCI treatment, particularly in the setting of synergistic and multidisciplinary interventions, but there are no specific guidelines available to date. The development of multidisciplinary recommendations is required for a proper clinical management of SCI patients.
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Affiliation(s)
- Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- *Correspondence: Marco Invernizzi
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Rehabilitation Unit, “Mons. L. Novarese” Hospital, Vercelli, Italy
| | - Filippo Renò
- Innovative Research Laboratory for Wound Healing, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Carlo Cisari
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Physical Medicine and Rehabilitation Unit, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Letterio Runza
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Baricich
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
- Physical Medicine and Rehabilitation Unit, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Stefano Carda
- Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience. Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Nicola Fusco
- Division of Pathology, IEO - European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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9
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Butezloff MM, Volpon JB, Ximenez JPB, Astolpho K, Correlo VM, Reis RL, Silva RB, Zamarioli A. Gene expression changes are associated with severe bone loss and deficient fracture callus formation in rats with complete spinal cord injury. Spinal Cord 2019; 58:365-376. [PMID: 31700148 DOI: 10.1038/s41393-019-0377-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Animal study. OBJECTIVES To investigate the effects of SCI on bone quality and callus formation. SETTING University and hospital-based research center, Ribeirão Preto Medical School, Brazil. METHODS Rats sustaining a complete SCI for 10 days received a fracture at the femoral diaphysis and were followed-up for 14 days. Bone callus and contralateral nonfractured tibia were assessed by DXA, µCT, ELISA, histomorphometry, immunohistochemistry, biomechanical test, and gene expression. RESULTS SCI downregulated osteoblastic-related gene expression in the nonfractured tibias, associated with a twofold increase in osteoclasts and overexpression of RANK/RANKL, which resulted in lower bone mass, impaired microarchitecture, and weaker bones. On day 14 postfracture, we revealed early and increased trabecular formation in the callus of SCI rats, despite a marked 75% decrease in OPG-positive cells, and 41% decrease in density. Furthermore, these calluses showed higher porosity and thinner newly formed trabeculae, leading to lower strength and angle failure. CONCLUSIONS SCI-induced bone loss resulted from increased bone resorption and decreased bone formation. We also evidenced accelerated bone healing in the SCI rats, which may be attributed to the predominant intramembranous ossification. However, the newly formed bone was thinner, less dense, and more porous than those in the non-SCI rats. As a result, these calluses are weaker and tolerate lesser torsion deformation than the controls, which may result in recurrent fractures and characterizes a remarkable feature that may severely impair life quality.
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Affiliation(s)
- Mariana M Butezloff
- School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - José B Volpon
- School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - João P B Ximenez
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Kelly Astolpho
- School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Vitor M Correlo
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Braga, Portugal
| | - Rui L Reis
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, Braga, Portugal
| | - Raquel B Silva
- School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Ariane Zamarioli
- School of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
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Fouasson-Chailloux A, Gross R, Dauty M, Gadbled G, Touchais S, Le Fort M, Perrouin-Verbe B. Surgical management of lower limb fractures in patients with spinal cord injury less associated with complications than non-operative management: A retrospective series of cases. J Spinal Cord Med 2019; 42:39-44. [PMID: 28488465 PMCID: PMC6340277 DOI: 10.1080/10790268.2017.1325560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To evaluate the difference in terms of overall complications between surgical and non-surgical management of lower limb fractures in patients with chronic spinal cord injury (SCI). DESIGN A 13-year retrospective study including patients with chronic spinal cord lesion admitted for sublesional lower limb fractures. SETTING University hospital SCI reference departments (Rehabilitation department and orthopedic department). PARTICIPANTS Forty patients with SCI were included, 24 men and 16 women. Fifty-six distinct fracture occurrences were responsible for a total of 59 lower limb fractures. We compared the number of overall complications between surgical and non-surgical management of fractures. RESULTS Non-surgical management was realized for 19 fractures and surgery for 40. Characteristics of operated and non-operated patients at the time of each fracture occurrence did not differ concerning age (P = 0.430), sex (P = 0.890), lesion levels (P = 0.410) and AIS classification (P = 0.790). Data analysis highlighted 20 complications directly due to the fracture site for 16 distinct fractures. Seven medical complications were found in 5 distinct fracture events. Only 10 (25.0%) of 40 surgical managements had at least one medical or post-surgical complication, whereas 12 (63.2%) of 19 non-operative managements had at least one complication. Therefore, the overall rate of complications was significantly higher after non-surgical treatment (P = 0.044). CONCLUSION Lower extremity fractures due to osteoporosis in patients with SCI are responsible for local and general complications. When possible, surgery may be the best management to propose because of fewer overall complications.
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Affiliation(s)
- Alban Fouasson-Chailloux
- Physical Medicine and Rehabilitation Department, University Hospital of Nantes, France,Laboratoire d'ingénierie ostéoarticulaire et dentaire, LIOAD INSERM U 791, Groupe STEP “Skeletal Tissue engineering and physiopathology,” University of Nantes, France,Correspondence to: Dr. Alban Fouasson-Chailloux, MPR Locomotrice et Respiratoire, CHU de Nantes, 85 rue St Jacques, 44093 Nantes Cedex 1, France.
| | - Raphael Gross
- Physical Medicine and Rehabilitation Department, University Hospital of Nantes, France
| | - Marc Dauty
- Physical Medicine and Rehabilitation Department, University Hospital of Nantes, France,Laboratoire d'ingénierie ostéoarticulaire et dentaire, LIOAD INSERM U 791, Groupe STEP “Skeletal Tissue engineering and physiopathology,” University of Nantes, France
| | - Guillaume Gadbled
- Department of Orthopedic Surgery, University Hospital of Nantes, France
| | - Sophie Touchais
- Department of Orthopedic Surgery, University Hospital of Nantes, France
| | - Marc Le Fort
- Physical Medicine and Rehabilitation Department, University Hospital of Nantes, France
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Harlow L, Sahbani K, Nyman JS, Cardozo CP, Bauman WA, Tawfeek HA. Daily parathyroid hormone administration enhances bone turnover and preserves bone structure after severe immobilization-induced bone loss. Physiol Rep 2017; 5:5/18/e13446. [PMID: 28963125 PMCID: PMC5617932 DOI: 10.14814/phy2.13446] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/10/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023] Open
Abstract
Immobilization, as a result of motor‐complete spinal cord injury (SCI), is associated with severe osteoporosis. Whether parathyroid hormone (PTH) administration would reduce bone loss after SCI remains unclear. Thus, female mice underwent sham or surgery to produce complete spinal cord transection. PTH (80 μg/kg) or vehicle was injected subcutaneously (SC) daily starting on the day of surgery and continued for 35 days. Isolated tibias and femurs were examined by microcomputed tomography scanning (micro‐CT) and histology and serum markers of bone turnover were measured. Micro‐CT analysis of tibial metaphysis revealed that the SCI‐vehicle animals exhibited 49% reduction in fractional trabecular bone volume and 18% in trabecular thickness compared to sham‐vehicle controls. SCI‐vehicle animals also had 15% lower femoral cortical thickness and 16% higher cortical porosity than sham‐vehicle counterparts. Interestingly, PTH administration to SCI animals restored 78% of bone volume, increased connectivity to 366%, and lowered structure model index by 10% compared to sham‐vehicle animals. PTH further favorably attenuated femoral cortical bone loss to 5% and prevented the SCI‐associated cortical porosity. Histomorphometry evaluation of femurs of SCI‐vehicle animals demonstrated a marked 49% and 38% decline in osteoblast and osteoclast number, respectively, and 35% reduction in bone formation rate. In contrast, SCI‐PTH animals showed preserved osteoblast and osteoclast numbers and enhanced bone formation rate. Furthermore, SCI‐PTH animals had higher levels of bone formation and resorption markers than either SCI‐ or sham‐vehicle groups. Collectively, these findings suggest that intermittent PTH receptor activation is an effective therapeutic strategy to preserve bone integrity after severe immobilization.
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Affiliation(s)
- Lauren Harlow
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Karim Sahbani
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Jeffry S Nyman
- Department of Orthopaedic Surgery & Rehabilitation, Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biomedical Engineering, Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher P Cardozo
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York.,Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Pharmacologic Science, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - William A Bauman
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York.,Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hesham A Tawfeek
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York .,Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York
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12
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Sun J, Li J, Li H, Yang H, Chen J, Yang B, Huo F, Guo W, Tian W. tBHQ Suppresses Osteoclastic Resorption in Xenogeneic-Treated Dentin Matrix-Based Scaffolds. Adv Healthc Mater 2017; 6. [PMID: 28696515 DOI: 10.1002/adhm.201700127] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/28/2017] [Indexed: 02/05/2023]
Abstract
Extracellularmatrix (ECM)-based scaffolds are important for their potential therapeutic application. Treated dentin matrix (TDM), a kind of ECM, seeded with allogeneic dental follicle stem cells (TDM/aDFC) provides a suitable inductive microenvironment for tooth root regeneration. Considering the limited sources, xenogeneic TDM (xTDM) is a possible alternative to allogeneic TDM; however, xTDM-based scaffold presents severe osteolysis and resorption lacunae causing regenerated tooth root failure. Immune response-induced excessive osteoclastogenesis plays a critical role in xenogeneic scaffold osteolysis and resorption. The impact of antioxidant, tert-butylhydroquinone (tBHQ), on xTDM/aDFCs-induced osteoclastogenesis and osteoclastic resorption in vivo and in vitro are investigated. tBHQ upregulates heme oxygenase-1 release and downregulates high mobility group box 1 mRNA expression. mRNA expression of other osteoclast-related genes including nuclear factor-kappa Bp65, receptor activator of nuclear factor kappa-B, nuclear factor of activated T-cells cytoplasmic 1, cathepsin K, and integrin β3, also decreases significantly. Furthermore, tBHQ-treated xTDM/aDFCs scaffolds implanted into rhesus macaques show reduced osteolysis and osteoclastic resorption by microcomputed tomography and tartrate-resistant acid phosphatase staining. tBHQ-induced suppression of xTDM/aDFC-induced osteoclastogenesis and osteoclastic resorption presents a new strategy for the regeneration of biological tooth root and could be applied to the regeneration of other complex tissues and organs.
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Affiliation(s)
- Jingjing Sun
- National Engineering Laboratory for Oral Regenerative Medicine West China Hospital of Stomatology Sichuan University Chengdu 610041 China
- Department of Oral and Maxillofacial Surgery West China School of Stomatology Sichuan University Chengdu 610041 China
| | - Jie Li
- National Engineering Laboratory for Oral Regenerative Medicine West China Hospital of Stomatology Sichuan University Chengdu 610041 China
- Department of Oral and Maxillofacial Surgery West China School of Stomatology Sichuan University Chengdu 610041 China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences College of Stomatology Chongqing Medical University Chongqing 401147 China
| | - Hui Li
- National Engineering Laboratory for Oral Regenerative Medicine West China Hospital of Stomatology Sichuan University Chengdu 610041 China
- Department of Oral and Maxillofacial Surgery West China School of Stomatology Sichuan University Chengdu 610041 China
| | - Hefeng Yang
- Department of Dental Research The Affiliated Stomatological Hospital of Kunming Medical University Kunming 650031 China
| | - Jinlong Chen
- National Engineering Laboratory for Oral Regenerative Medicine West China Hospital of Stomatology Sichuan University Chengdu 610041 China
- Department of Oral and Maxillofacial Surgery West China School of Stomatology Sichuan University Chengdu 610041 China
| | - Bo Yang
- National Engineering Laboratory for Oral Regenerative Medicine West China Hospital of Stomatology Sichuan University Chengdu 610041 China
- Department of Oral and Maxillofacial Surgery West China School of Stomatology Sichuan University Chengdu 610041 China
| | - Fangjun Huo
- National Engineering Laboratory for Oral Regenerative Medicine West China Hospital of Stomatology Sichuan University Chengdu 610041 China
- Department of Oral and Maxillofacial Surgery West China School of Stomatology Sichuan University Chengdu 610041 China
| | - Weihua Guo
- National Engineering Laboratory for Oral Regenerative Medicine West China Hospital of Stomatology Sichuan University Chengdu 610041 China
- Department of Oral and Maxillofacial Surgery West China School of Stomatology Sichuan University Chengdu 610041 China
- Department of Pediatric Dentistry West China School of Stomatology Sichuan University Chengdu 610041 China
| | - Weidong Tian
- National Engineering Laboratory for Oral Regenerative Medicine West China Hospital of Stomatology Sichuan University Chengdu 610041 China
- Department of Oral and Maxillofacial Surgery West China School of Stomatology Sichuan University Chengdu 610041 China
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13
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Gifre L, Ruiz-Gaspà S, Carrasco JL, Portell E, Vidal J, Muxi A, Monegal A, Guañabens N, Peris P. Effect of recent spinal cord injury on the OPG/RANKL system and its relationship with bone loss and the response to denosumab therapy. Osteoporos Int 2017; 28:2707-2715. [PMID: 28580511 DOI: 10.1007/s00198-017-4090-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED There is marked bone loss after spinal cord injury (SCI); however, its pathogenesis and clinical management remain unclear. The increased circulating levels of receptor activator of nuclear factor kB ligand (RANKL) associated with bone loss shortly after SCI and the prevention of bone loss with denosumab treatment suggest a contributory role of RANKL in SCI-induced osteoporosis. INTRODUCTION Bone turnover and bone loss are markedly increased shortly after SCI. However, the pathogenesis and clinical management of this process remain unclear, especially the role of the osteoprotegerin (OPG)/RANKL system in this disorder. The aim of this study was to analyze serum levels of OPG and RANKL in bone loss associated with recent SCI and the effect of denosumab treatment on these mediators. METHODS Twenty-three males with recent complete SCI were prospectively included. Serum OPG and RANKL levels, bone turnover markers (PINP, bone ALP, CTX), and bone mineral density (BMD) were assessed at baseline, at 6 months of follow-up, prior to initiating denosumab, and 6 months after treatment. The results were compared with a healthy control group. RESULTS At baseline, SCI patients showed higher RANKL levels vs. controls which were correlated with days-since-SCI and total hip BMD loss at 6 months. OPG levels were similar to controls at baseline. After denosumab treatment, OPG showed no changes, whereas RANKL levels became undetectable in 67% of patients. Patients with undetectable RANKL during treatment showed better response in femoral BMD and bone markers vs. patients with detectable RANKL at 6 months of denosumab. Increased parathormone (PTH) levels during treatment were negatively correlated with RANKL changes. CONCLUSIONS RANKL levels are increased after SCI and related to BMD loss at the proximal femur, becoming undetectable after denosumab treatment. The effect of denosumab on preventing sublesional bone loss, especially in patients with undetectable levels during treatment, suggests a contributory role of RANKL in this process.
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Affiliation(s)
- L Gifre
- Rheumatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Rheumatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - J L Carrasco
- Public Health Department, University of Barcelona, Barcelona, Spain
| | - E Portell
- Guttmann Neurorehabilitation Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - J Vidal
- Guttmann Neurorehabilitation Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - A Muxi
- Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - A Monegal
- Rheumatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - N Guañabens
- Rheumatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- CIBERehd, Barcelona, Spain
| | - P Peris
- Rheumatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
- CIBERehd, Barcelona, Spain.
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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14
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Liu HJ, Yan H, Yan J, Li H, Chen L, Han LR, Yang XF. Substance P Promotes the Proliferation, but Inhibits Differentiation and Mineralization of Osteoblasts from Rats with Spinal Cord Injury via RANKL/OPG System. PLoS One 2016; 11:e0165063. [PMID: 27764190 PMCID: PMC5072631 DOI: 10.1371/journal.pone.0165063] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/05/2016] [Indexed: 11/18/2022] Open
Abstract
Spinal cord injury (SCI) causes a significant amount of bone loss, which results in osteoporosis (OP). The neuropeptide substance P (SP) and SP receptors may play important roles in the pathogenesis of OP after SCI. To identify the roles of SP in the bone marrow mesenchymal stem cell derived osteoblasts (BMSC-OB) in SCI rats, we investigated the expression of neurokinin-1 receptors (NK1R) in BMSC-OB and the effects of SP on bone formation by development of BMSC-OB cultures. Sixty young male Sprague-Dawley rats were randomized into two groups: SHAM and SCI. The expression of NK1R protein in BMSC-OB was observed using immunohistochemistry and Western blot analysis. The dose- and time-dependent effects of SP on the proliferation, differentiation and mineralization of BMSC-OB and the expression of osteoblastic markers by in vitro experiments. The expression of NK1R in BMSC-OB was observed on plasma membranes and in cytoplasm. One week after osteogenic differentiation, the expression of NK1R was significantly increased after SCI at mRNA and protein levels. However, this difference was gradually attenuated at 2 or 3 weeks later. SP have the function to enhance cell proliferation, inhibite cell differentiation and mineralization at a proper concentration and incubation time, and this effect would be inhibited by adding SP or NK1R antagonist. The expression of RANKL/OPG was significantly increased in tibiae after SCI. Similarly, the RANKL/OPG expression in SCI rats was significantly increased when treating with 10-8 M SP. SP plays a very important role in the pathogenesis of OP after SCI. The direct effect of SP may lead to increased bone resorption through the RANKL/OPG axis after SCI. In addition, high expression of SP also results in the suppression of osteogenesis in SCI rats. Then, the balance between bone resorption and bone formation was broken and finally osteoporosis occurred.
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Affiliation(s)
- Hai-Juan Liu
- Department of Endocrinology, Liaocheng People's Hospital, Shandong, China
| | - Hua Yan
- Department of Medical Service, Navy General Hospital, Beijing, China
| | - Jun Yan
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Shandong, China
| | - Hao Li
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Shandong, China
| | - Liang Chen
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Shandong, China
| | - Li-Ren Han
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Shandong, China
| | - Xiao-Fei Yang
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Shandong, China
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15
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Gifre L, Vidal J, Carrasco JL, Muxi A, Portell E, Monegal A, Guañabens N, Peris P. Denosumab increases sublesional bone mass in osteoporotic individuals with recent spinal cord injury. Osteoporos Int 2016; 27:405-10. [PMID: 26423406 DOI: 10.1007/s00198-015-3333-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/18/2015] [Indexed: 01/22/2023]
Abstract
UNLABELLED Osteoporosis is a frequent complication related to spinal cord injury (SCI), and data on osteoporosis treatment after SCI is scarce. Treatment with denosumab increases lumbar and femoral BMD and decreases bone turnover markers in individuals with recent SCI. This drug may be a promising therapeutic option in SCI-related osteoporosis. INTRODUCTION Osteoporosis development is a frequent complication related to SCI, especially at the sublesional level. Nevertheless, data on osteoporosis treatment after SCI is scarce, particularly short term after injury, when the highest bone loss is produced. The aim of this study was to analyze the efficacy of denosumab in the treatment of SCI-related osteoporosis. METHODS Fourteen individuals aged 39 ± 15 years with osteoporosis secondary to recent SCI (mean injury duration 15 ± 4 months) were treated with denosumab for 12 months. Bone turnover markers (BTMs) (PINP, bone ALP, sCTx), 25-hydroxyvitamin D (25OHD) levels and bone mineral density (BMD) at the lumbar spine (LS), total hip (TH), and femoral neck (FN) were assessed at baseline and at 12 months. All participants received calcium and vitamin D supplementation. RESULTS At 12 months, SCI denosumab-treated participants showed a significant increase in BMD at TH (+2.4 ± 3.6 %, p = 0.042), FN (+3 ± 3.6 %, p = 0.006), and LS (+7.8 ± 3.7 %, p < 0.001) compared to baseline values. Denosumab treatment was associated with significant decreases in BTMs (bone ALP -42 %, p < 0.001; PINP -58 %, p < 0.001, sCTx -57 %, p = 0.002) at 12 months. BMD evolution was not related to BTM changes or 25OHD serum levels. No skeletal fractures or serious adverse events were observed during follow-up. CONCLUSIONS Treatment with denosumab increases lumbar and femoral BMD and decreases bone turnover markers in individuals with recent SCI. This drug may be a promising therapeutic option in SCI-related osteoporosis.
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Affiliation(s)
- L Gifre
- Metabolic Bone Diseases Unit, Service of Rheumatology, Hospital Clinic of Barcelona, Villarroel 170, Barcelona, 08036, Spain.
| | - J Vidal
- Guttmann Neurorehabilitation Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - J L Carrasco
- Public Health Department, University of Barcelona, Barcelona, Spain
| | - A Muxi
- Nuclear Medicine Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - E Portell
- Guttmann Neurorehabilitation Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - A Monegal
- Metabolic Bone Diseases Unit, Service of Rheumatology, Hospital Clinic of Barcelona, Villarroel 170, Barcelona, 08036, Spain
| | - N Guañabens
- Metabolic Bone Diseases Unit, Service of Rheumatology, Hospital Clinic of Barcelona, Villarroel 170, Barcelona, 08036, Spain
- CIBERehd, Madrid, Spain
| | - P Peris
- Metabolic Bone Diseases Unit, Service of Rheumatology, Hospital Clinic of Barcelona, Villarroel 170, Barcelona, 08036, Spain
- CIBERehd, Madrid, Spain
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Lin T, Tong W, Chandra A, Hsu SY, Jia H, Zhu J, Tseng WJ, Levine MA, Zhang Y, Yan SG, Liu XS, Sun D, Young W, Qin L. A comprehensive study of long-term skeletal changes after spinal cord injury in adult rats. Bone Res 2015; 3:15028. [PMID: 26528401 PMCID: PMC4621491 DOI: 10.1038/boneres.2015.28] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 12/11/2022] Open
Abstract
Spinal cord injury (SCI)-induced bone loss represents the most severe osteoporosis with no effective treatment. Past animal studies have focused primarily on long bones at the acute stage using adolescent rodents. To mimic chronic SCI in human patients, we performed a comprehensive analysis of long-term structural and mechanical changes in axial and appendicular bones in adult rats after SCI. In this experiment, 4-month-old Fischer 344 male rats received a clinically relevant T13 contusion injury. Sixteen weeks later, sublesional femurs, tibiae, and L4 vertebrae, supralesional humeri, and blood were collected from these rats and additional non-surgery rats for micro-computed tomography (µCT), micro-finite element, histology, and serum biochemical analyses. At trabecular sites, extreme losses of bone structure and mechanical competence were detected in the metaphysis of sublesional long bones after SCI, while the subchondral part of the same bones showed much milder damage. Marked reductions in bone mass and strength were also observed in sublesional L4 vertebrae but not in supralesional humeri. At cortical sites, SCI induced structural and strength damage in both sub- and supralesional long bones. These changes were accompanied by diminished osteoblast number and activity and increased osteoclast number and activity. Taken together, our study revealed site-specific effects of SCI on bone and demonstrated sustained inhibition of bone formation and elevation of bone resorption at the chronic stage of SCI.
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Affiliation(s)
- Tiao Lin
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA ; Department of Musculoskeletal Oncology, The First Affiliated Hospital of Sun Yat-sen University , Guangzhou, China
| | - Wei Tong
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA ; Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, Hubei, China
| | - Abhishek Chandra
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA
| | - Shao-Yun Hsu
- W.M. Keck Center for Collaborative Neuroscience, Rutgers, The State University of New Jersey , Piscataway, NJ, USA
| | - Haoruo Jia
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA ; Department of Orthopaedic Surgery, School of Medicine, Shihezi University , Shihezi, Xinjiang, China
| | - Ji Zhu
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA
| | - Wei-Ju Tseng
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA
| | - Michael A Levine
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania , PA, USA
| | - Yejia Zhang
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA ; Department of Physical Medicine & Rehabilitation, Perelman School of Medicine, University of Pennsylvania and Translational Musculoskeletal Research Center, Philadelphia Veterans Affairs Medical Center , Philadelphia, PA, USA
| | - Shi-Gui Yan
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou, China
| | - X Sherry Liu
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA
| | - Dongming Sun
- W.M. Keck Center for Collaborative Neuroscience, Rutgers, The State University of New Jersey , Piscataway, NJ, USA
| | - Wise Young
- W.M. Keck Center for Collaborative Neuroscience, Rutgers, The State University of New Jersey , Piscataway, NJ, USA
| | - Ling Qin
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA, USA
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Yang X, He B, Liu P, Yan L, Yang M, Li D. Treatment with curcumin alleviates sublesional bone loss following spinal cord injury in rats. Eur J Pharmacol 2015; 765:209-16. [PMID: 26300394 DOI: 10.1016/j.ejphar.2015.08.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/19/2015] [Accepted: 08/19/2015] [Indexed: 11/30/2022]
Abstract
This work aimed to investigate the therapeutic effect of curcumin on sublesional bone loss induced by spinal cord injury (SCI) in rats. SCI model in this work was generated in rats by surgical transaction of the cord at the T10-12 level. After the surgery, animals were treated with curcumin (110 mg/kg body mass/day, via oral gavages) for 2 weeks. Treatment of SCI rats with curcumin prevented the reduction of bone mass in tibiae and femurs, preserved bone microstructure including trabecular bone volume fraction, trabecular number, and trabecular thickness in proximal tibiae, and preserved mechanical properties of femoral midshaft. Treatment of SCI rats with curcumin increased osteoblast surface and reduced osteoclast surface in proximal tibiae. Treatment of SCI rats with curcumin increased osteocalcin mRNA expression and reduced mRNA levels of tartrate-resistant acid phosphatase and mRNA ratio of receptor activator of NF-κB ligand/osteoprotegerin in distal femurs. Treatment of SCI rats with curcumin reduced serum and femoral levels of thiobarbituric acid reactive substances. Treatment of SCI rats with curcumin had no significant effect on serum 25(OH)D, but enhanced mRNA and protein expression of vitamin D receptor (VDR) in distal femurs. Treatment of SCI rats with curcumin enhanced mRNA levels of Wnt3a, Lrp5, and ctnnb1 and upregulated protein expression of β-catenin in distal femurs. In conclusions, treatment with curcumin abated oxidative stress, activated VDR, and enhanced Wnt/β-catenin pathway, which might explain its beneficial effect against sublesional bone loss following SCI in rats, at least in part.
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Affiliation(s)
- Xiaobin Yang
- Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Baorong He
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Peng Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Liang Yan
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Ming Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Dichen Li
- School of Mechanical Engineering, Xi'an Jiaotong University, Xianning Western Road 28, Xi'an 710049, Shaanxi, China
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Wang HD, Shi YM, Li L, Guo JD, Zhang YP, Hou SX. Treatment with resveratrol attenuates sublesional bone loss in spinal cord-injured rats. Br J Pharmacol 2014; 170:796-806. [PMID: 23848300 DOI: 10.1111/bph.12301] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 06/27/2013] [Accepted: 07/01/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Sublesional osteoporosis predisposes individuals with spinal cord injury (SCI) to an increased risk of low-trauma fracture. The aim of the present work was to investigate the effect of treatment with resveratrol (RES) on sublesional bone loss in spinal cord-injured rats. EXPERIMENTAL APPROACH Complete SCI was generated by surgical transaction of the cord at the T10-12 level. Treatment with RES (400 mg·kg(-1) body mass per day(-1) , intragastrically) was initiated 12 h after the surgery for 10 days. Then, blood was collected and femurs and tibiae were removed for evaluation of the effects of RES on bone tissue after SCI. KEY RESULTS Treatment of SCI rats with RES prevented the reduction of bone mass including bone mineral content and bone mineral density in tibiae, preserved bone structure including trabecular bone volume fraction, trabecular number, and trabecular thickness in tibiae, and preserved mechanical strength including ultimate load, stiffness, and energy in femurs. Treatment of SCI rats with RES enhanced femoral total sulfhydryl content, reduced femoral malondialdehyde and IL-6 mRNA levels. Treatment of SCI rats with RES suppressed the up-regulation of mRNA levels of PPARγ, adipose-specific fatty-acid-binding protein and lipoprotein lipase, and restored mRNA levels of Wnt1, low-density lipoprotein-related protein 5, Axin2, ctnnb1, insulin-like growth factor 1 (IGF-1) and receptor for IGF-1 in femurs and tibiae. CONCLUSIONS AND IMPLICATIONS Treatment with RES attenuated sublesional bone loss in spinal-cord-injured rats, associated with abating oxidative stress, attenuating inflammation, depressing PPARγ signalling, and restoring Wnt/β-catenin and IGF-1 signalling.
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Affiliation(s)
- Hua-Dong Wang
- Department of Orthopedics, The First Affiliated Hospital of the General Hospital of CPLA, Beijing, China
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Zamarioli A, Maranho DA, Butezloff MM, Moura PA, Volpon JB, Shimano AC. Anatomic changes in the macroscopic morphology and microarchitecture of denervated long bone tissue after spinal cord injury in rats. BIOMED RESEARCH INTERNATIONAL 2014; 2014:853159. [PMID: 25136632 PMCID: PMC4127270 DOI: 10.1155/2014/853159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/23/2014] [Accepted: 06/24/2014] [Indexed: 11/17/2022]
Abstract
To study the effects of mechanical loading on bones after SCI, we assessed macro- and microscopic anatomy in rats submitted to passive standing (PS) and electrical stimulation (ES). The study design was based on two main groups of juvenile male Wistar rats with SCI: one was followed for 33 days with therapies starting at day 3 and the other was followed for 63 days with therapies starting at day 33. Both groups were composed of four subgroups (n = 10/group): (1) Sham, (2) SCI, (3) SCI + PS, and (4) SCI + ES. Rehabilitation protocol consisted of a 20-minute session, 3x/wk for 30 days. The animals were sequentially weighed and euthanized. The femur and tibia were assessed macroscopically and microscopically by scanning electronic microscopy (SEM). The SCI rats gained less weight than Sham-operated animals. Significant reduction of bone mass and periosteal radii was observed in the SCI rats, whereas PS and ES efficiently improved the macroscopic parameters. The SEM images showed less and thin trabecular bone in SCI rats. PS and ES efficiently ameliorated the bone microarchitecture deterioration by thickening and increasing the trabeculae. Based on the detrimental changes in bone tissue following SCI, the mechanical loading through weight bearing and muscle contraction may decrease the bone loss and restore the macro- and microanatomy.
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Affiliation(s)
- Ariane Zamarioli
- Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
- Laboratory of Bioengineering, School of Medicine of Ribeirão Preto, University of São Paulo, Pedreira de Freitas, Casa 1, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
| | - Daniel A. Maranho
- Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
| | - Mariana M. Butezloff
- Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
| | - Patrícia A. Moura
- Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
| | - José Batista Volpon
- Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
| | - Antônio C. Shimano
- Department of Biomechanics, Medicine and Rehabilitation, School of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, 14049-900 Ribeirão Preto, SP, Brazil
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Yan J, Li B, Chen JW, Jiang SD, Jiang LS. Spinal cord injury causes bone loss through peroxisome proliferator-activated receptor-γ and Wnt signalling. J Cell Mol Med 2014; 16:2968-77. [PMID: 22947224 PMCID: PMC4393725 DOI: 10.1111/j.1582-4934.2012.01624.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 08/14/2012] [Indexed: 01/08/2023] Open
Abstract
It has long been recognized that spinal cord injury (SCI) leads to a loss of bone mineral. However, the mechanisms of bone loss after SCI remain poorly understood. The aim of this study was to investigate whether SCI causes a shift in skeletal balance between osteoblastogenesis and adipogenesis. Eighty male Sprague-Dawley rats at 6 weeks of age were randomly divided into two groups: sham-operated (SHAM) group and SCI group. The rats were killed after 3 weeks, 3 months and 6 months, and their femora, tibiae and humeri were collected for mesenchymal stem cells (MSCs) culture, bone mineral density (BMD) measurement, RNA analysis and Western Blot analysis. Osteogenic and adipogenic differentiation potential of MSCs from SCI rats and SHAM rats was evaluated. We found increased marrow adiposity in sublesional tibiae of SCI rats. SCI caused increased peroxisome proliferator-activated receptor-γ (PPARγ) expression and diminished Wnt signalling in sublesional tibiae. Interestingly, in MSCs from SCI rats treated with the PPARγ inhibitor GW9662, the ratios of RANKL to OPG expression were significantly decreased. On the contrary, in MSCs from SCI rats treated with the PPARγ ligand troglitazone, the ratios of RANKL to OPG expression in SCI rats were significantly increased. High expression of PPARγ may lead to increased bone resorption through the RANKL/OPG axis after SCI. In addition, high expression also results in the suppression of osteogenesis and enhancement of adipogenesis in SCI rats. SCI causes a shift in skeletal balance between osteoblastogenesis and adipogenesis, thus leading to bone loss after SCI.
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Affiliation(s)
- Jun Yan
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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21
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Is the vertebral canal prepared to host the aged spinal cord? A morphometric assessment. ZOOMORPHOLOGY 2014. [DOI: 10.1007/s00435-013-0215-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jiang SD, Yang YH, Chen JW, Jiang LS. Isolated osteoblasts from spinal cord-injured rats respond less to mechanical loading as compared with those from hindlimb-immobilized rats. J Spinal Cord Med 2013; 36:220-4. [PMID: 23809592 PMCID: PMC3654448 DOI: 10.1179/2045772312y.0000000071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The pathogenesis of osteoporosis after spinal cord injury (SCI) may be different from disuse osteoporosis. OBJECTIVE To investigate whether there is the differential anabolic response to mechanical loading between osteoblasts from SCI rats and those from hindlimb-immobilized rats. METHODS Femoral bone-marrow was harvested for osteoblast culture from SCI rats, hindlimb-immobilized rats, and control rats 3 weeks after animal model creation. At the stage of differentiation, rat osteoblasts were plated in six-well plates for stretching. Cyclic strains were applied for 48 hours, and then alkaline phosphatase (ALPase) activity, procollagen, and osteocalcin production, and gene expression of osteocalcin, runt-related transcription factor 2 (Runx2), and osterix were measured in osteoblasts from SCI rats, hindlimb-immobilized rats, and control rats. RESULTS ALPase activity, procollagen, and osteocalcin production, and gene expression of osteocalcin, Runx2, and osterix were significantly lower in osteoblasts after stretching from SCI rats compared with those from hindlimb-immobilized rats. However, there was no significant difference of these parameters between isolated osteoblasts from hindlimb-immobilized rats and those from control rats. CONCLUSION The activity of isolated osteoblasts from SCI rats was lower than control rats, and this suggested that osteoblasts from SCI rats responded less to mechanical loading as compared with those from control rats.
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Affiliation(s)
- Sheng-Dan Jiang
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Standing Frame and Electrical Stimulation Therapies Partially Preserve Bone Strength in a Rodent Model of Acute Spinal Cord Injury. Am J Phys Med Rehabil 2013; 92:402-10. [DOI: 10.1097/phm.0b013e318287697c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ding WG, Yan WH, Wei ZX, Liu JB. Difference in intraosseous blood vessel volume and number in osteoporotic model mice induced by spinal cord injury and sciatic nerve resection. J Bone Miner Metab 2012; 30:400-7. [PMID: 22065237 DOI: 10.1007/s00774-011-0328-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 10/03/2011] [Indexed: 01/01/2023]
Abstract
In the present study, we examined intraosseous blood vessel parameters of the tibial metaphysis in mice using microcomputed tomography (µCT) to investigate the relationship between post-nerve-injury osteoporosis and local intraosseous blood vessel volume and number. Mice were randomly divided into groups receiving spinal cord injury (SCI), sciatic nerve resection group (NX), or intact controls (30 mice/group). Four weeks after surgery, mice were perfused with silicone and the distribution of intraosseous blood vessels analyzed by μCT. The bone density, μCT microstructure, biomechanical properties, and the immunohistochemical and biochemical indicators of angiogenesis were also measured. The SCI group showed significantly reduced tibial metaphysis bone density, μCT bone microstructure, tibial biomechanical properties, indicators of angiogenesis, and intraosseous blood vessel parameters compared to the NX group. Furthermore, the spinal cord-injured mice exhibited significantly decreased intraosseous blood vessel volume and number during the development of osteoporosis. In conclusion, these data suggest that decreased intraosseous blood vessel volume and number may play an important role in the development of post-nerve-injury osteoporosis.
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Affiliation(s)
- Wen-Ge Ding
- Department of Orthopaedics, Third Affiliated Hospital of Suzhou University, Changzhou 213001, China
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Voor MJ, Brown EH, Xu Q, Waddell SW, Burden RL, Burke DA, Magnuson DSK. Bone loss following spinal cord injury in a rat model. J Neurotrauma 2012; 29:1676-82. [PMID: 22181016 DOI: 10.1089/neu.2011.2037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The current study was undertaken to follow the time course of bone loss in the proximal tibia of rats over several weeks following thoracic contusion spinal cord injury (SCI) of varying severity. It was hypothesized that bone loss would be more pronounced in the more severely injured animals, and that hindlimb weight bearing would help prevent bone loss. Twenty-six female Sprague-Dawley rats (200-225 g, 6-7 weeks old) received standard thoracic (T9) injuries at energies of 6.25, 12.5, 25, or 50 g-cm. The rats were scored weekly for hindlimb function during locomotion. At 0, 2 or 3, and 8 weeks, high-resolution micro-CT images of each right tibia were obtained. Mechanical indentation testing was done to measure the compressive strength of the cancellous bone structure. The 6.25 g-cm group showed near normal locomotion, the 12.5 and 25 g-cm groups showed the ability to frequently or occasionally generate weight-supported plantar steps, respectively, and the 50 g-cm group showed only movement without weight-supported plantar stepping. The 6.25, 12.5 and 25 g-cm groups remained at the same level of bone volume fraction (cancBV/TV=0.24±0.07), while the 50 g-cm group experienced severe bone loss (67%), resulting in significantly lower (p<0.05) bone volume fraction (cancBV/TV=0.11±0.05) at 8 weeks. Proximal tibia cancellous bone strength was reduced by approximately 50% in these severely injured rats. Instead of a linear proportionality between injury severity and bone loss, there appears to be a distinct functional threshold, marked by occasional weight-supported stepping, above which bone loss does not occur.
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Affiliation(s)
- Michael J Voor
- Department of Orthopaedic Surgery, Orthopaedic Bioengineering Laboratory, University of Louisville, Louisville, KY, USA.
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26
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Alexandre C, Vico L. Pathophysiology of bone loss in disuse osteoporosis. Joint Bone Spine 2011; 78:572-6. [DOI: 10.1016/j.jbspin.2011.04.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2011] [Indexed: 12/31/2022]
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Ding WG, Liu JB, Wei ZX. Spinal cord injury causes more damage to fracture healing of later phase than ovariectomy in young mice. Connect Tissue Res 2011; 53:142-8. [PMID: 21966971 DOI: 10.3109/03008207.2011.614365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare the effects of spinal cord injury (SCI) and ovariectomy (OVX) on femoral fracture healing of later phase in young mice. Sixty young female C57 mice were randomized into three groups: SCI, OVX, and age-matched intact control. The femoral fracture was generated at 3 weeks after SCI or OVX. At 1 month after fracture, the femoral fracture area was evaluated through the healing status using radiograph; bone mineral density using dual X-ray absorptometry; callus formation and mineralization and neovascularization in callus using micro-computed tomography; biomechanical analysis using testing machine; and histology analysis by staining with hematoxylin-eosin stain. SCI mice showed lower bone mineral density in the femoral callus as compared with OVX mice. Callus geometric microstructural parameters of the femora in SCI mice were significantly lower than OVX mice. SCI induced significant changes of biomechanical parameters in the femoral fracture healing area. The callus formation and callus neovascularization in SCI mice were significantly lower than in OVX mice. SCI induces more deterioration of fracture healing in the femoral diaphysis than OVX.
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Affiliation(s)
- Wen-Ge Ding
- Department of Orthopaedics, Changzhou No. 1 People's Hospital, Changzhou, PR China
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28
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Ding WG, Jiang SD, Zhang YH, Jiang LS, Dai LY. Bone loss and impaired fracture healing in spinal cord injured mice. Osteoporos Int 2011; 22:507-15. [PMID: 20445963 DOI: 10.1007/s00198-010-1256-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 03/29/2010] [Indexed: 10/19/2022]
Abstract
UNLABELLED Spinal cord injury (SCI) results in impaired fracture healing in mice while leading to significant bone loss. Poor fracture healing following SCI is consistent with significant bone loss. INTRODUCTION SCI leads to significant bone loss in sublesional limbs, but there is few data concerning the relationship between fracture healing and bone loss following SCI. This study was undertaken to investigate the effect of SCI on fracture healing using a mouse femur fracture model. METHODS One hundred twenty male C57BL/6J mice were randomly divided into SCI and control groups (n=60, respectively). A femoral shaft fracture was generated and fixed with intramedullary pins 3 weeks after SCI. Fracture healing was evaluated by micro-computed tomography (micro-CT) for callus formation and mineralization and neovascularization, and bone mineral density (BMD) was measured by DXA at 1, 2, and 4 weeks after fracture. Serum vascular endothelial growth factor (VEGF), osteocalcin, and alkaline phosphatase (ALP) were assessed using ELISA at each time point. Biomechanical testing was performed at 2 and 4 weeks. RESULTS BMD in SCI mice was significantly lower compared to control mice at each time point, with callus volume and all vessel parameters reduced as measured by micro-CT. Ultimate stress of the femora was significantly lower in SCI mice than in control mice at 2 and 4 weeks after fracture, whereas Young's modulus between the SCI and control mice turned to be significantly different at 4 weeks. Serum VEGF was lower in SCI mice than in the control group at 2 and 4 weeks, whereas serum osteocalcin and ALP were lower in SCI mice than in control ones at each time point. CONCLUSION Significant bone loss and fracture healing impairment was noted in SCI mice. Decreased angiogenesis is consistent with the changes of microarchitecture and biomechanical properties during fracture healing.
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Affiliation(s)
- W-G Ding
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
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Jiang SD, Yan J, Jiang LS, Dai LY. Down-regulation of the Wnt, estrogen receptor, insulin-like growth factor-I, and bone morphogenetic protein pathways in osteoblasts from rats with chronic spinal cord injury. Joint Bone Spine 2011; 78:488-92. [PMID: 21273111 DOI: 10.1016/j.jbspin.2010.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the anabolic response of osteoblasts to chronic spinal cord injury and to identify potential signaling pathways that are associated with the osteogenic response after spinal cord injury by using in-house microarray analyses in osteoblasts. METHODS Ten young male Sprague-Dawley rats were randomized into spinal cord injury (SCI) and SHAM groups. The tibiae were assessed for DXA and bone histomorphometry, and osteoblasts from femora were used for microarray analysis. RESULTS SCI rats showed lower BMD and deteriorated microstructure in the proximal tibiae as compared with SHAM rats. The Wnt, BMP/TGF, estrogen receptor (ER), and IGF-I pathways were down-regulated in osteoblasts from spinal cord-injured rats. CONCLUSION Down-regulation of the Wnt, BMP/TGF, ER, and growth hormone/IGF-I pathways is associated with decreased bone formation after spinal cord injury.
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Affiliation(s)
- Sheng-Dan Jiang
- Department of Orthopaedic Surgery, Xinhua Hospital, 1665 Kongjiang Road, Shanghai 200092, Jiaotong University School of Medicine, Shanghai, China
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Qin W, Bauman WA, Cardozo C. Bone and muscle loss after spinal cord injury: organ interactions. Ann N Y Acad Sci 2010; 1211:66-84. [PMID: 21062296 DOI: 10.1111/j.1749-6632.2010.05806.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Spinal cord injury (SCI) results in paralysis and marked loss of skeletal muscle and bone below the level of injury. Modest muscle activity prevents atrophy, whereas much larger--and as yet poorly defined--bone loading seems necessary to prevent bone loss. Once established, bone loss may be irreversible. SCI is associated with reductions in growth hormone, IGF-1, and testosterone, deficiencies likely to exacerbate further loss of muscle and bone. Reduced muscle mass and inactivity are assumed to be contributors to the high prevalence of insulin resistance and diabetes in this population. Alterations in muscle gene expression after SCI share common features with other muscle loss states, but even so, show distinct profiles, possibly reflecting influences of neuromuscular activity due to spasticity. Changes in bone cells and markers after SCI have similarities with other conditions of unloading, although after SCI these changes are much more dramatic, perhaps reflecting the much greater magnitude of unloading. Adiposity and marrow fat are increased after SCI with intriguing, though poorly understood, implications for the function of skeletal muscle and bone cells.
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Affiliation(s)
- Weiping Qin
- Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.
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Ding WG, Zhang ZM, Zhang YH, Jiang SD, Jiang LS, Dai LY. Changes of substance P during fracture healing in ovariectomized mice. ACTA ACUST UNITED AC 2010; 159:28-34. [PMID: 19903498 DOI: 10.1016/j.regpep.2009.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 09/24/2009] [Accepted: 11/01/2009] [Indexed: 01/31/2023]
Abstract
Neuropeptides may play an important role in the healing process of osteoporotic fractures. The objective of this study was to determine the role of substance P during osteoporotic fracture healing. One hundred ninety-two mice were randomized into ovariectomy (OVX) and control (CON) group (n=96, respectively). Femoral shaft fracture was created 3 weeks after OVX. Bone mineral density (BMD), micro-CT (microCT) analysis of fracture callus formation and mineralization, microCT analysis of fracture site neovascularization and biomechanical property as well as substance P levels were evaluated 1, 2, 4, and 8 weeks after fracture and compared with CON group. Following OVX-induced bone loss, fracture healing in OVX mice was significantly poorer than that in CON mice, with a significant decrease of substance P at the fracture site at all time points and with the level at early stage (1 and 2 weeks) higher than later stage (4 and 8 weeks). Impaired angiogenesis was also noted in OVX mice. No significant change of substance P level in serum was found between different groups or time points. In conclusion, fracture healing is inferior in OVX-induced bone loss and associated with a significant decrease of substance P. Substance P may play an important role during osteoporotic fracture healing.
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Affiliation(s)
- Wen-Ge Ding
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Liu D, Zhao CQ, Li H, Jiang SD, Jiang LS, Dai LY. Effects of spinal cord injury and hindlimb immobilization on sublesional and supralesional bones in young growing rats. Bone 2008; 43:119-125. [PMID: 18482879 DOI: 10.1016/j.bone.2008.03.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2007] [Revised: 03/17/2008] [Accepted: 03/18/2008] [Indexed: 12/23/2022]
Abstract
Both spinal cord injury (SCI) and hindlimb cast immobilization (HCI) cause reduction in maturation-related bone gain in young rats, but the effects of the two interventions on bone pathophysiology may be different. The objective of this study was to compare the effects of SCI and HCI on the sublesional/supralesional bones and bone turnover indicators in young rats. Forty male Sprague-Dawley rats (six-week-old) were randomized into four groups, with ten rats in each group. The groups were classified as follows: base-line control, age-matched intact control, HCI, and SCI groups. Bone tissues, blood, and urine samples were studied at 4 weeks after treatments. The tibial dry weights and ash weights in SCI were remarkably reduced by 7.5% (dry weights) and 8.2% (ash weights) compared with HCI. SCI rats showed lower areal bone mineral density in the proximal tibiae compared with HCI rats (- 14%). Cortical thickness and cortical area of the tibial midshaft in SCI were lower than HCI (- 23%, - 33% respectively). The bone surface/bone volume, trabecular separation, trabecular number, connectivity of the trabecular network, and structure model index of the proximal tibiae were remarkably different between SCI and HCI groups. In SCI tibiae, the mineralizing surface, mineral apposition rate, and surface-based bone formation rate were significantly higher than HCI groups (12%, 47%, and 29% respectively). In the compression test, the ultimate load, the energy of ultimate load, and Young's modulus of the proximal tibiae in SCI rats were significantly lower than HCI rats. The serum levels of osteocalcin and the urinary levels of deoxypyridinoline in SCI were higher than those in HCI. There were no significant changes in supralesional bones between SCI and HCI rats. SCI results in a rapid bone loss with more deterioration of trabecular microstructure and cortical bone geometric structure in sublesional bones. High bone turnover rate and low biomechanics strength were found in tibiae in SCI rats. This might be the result of the imbalance of bone resorption and bone formation induced by the impaired neuronal function.
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Affiliation(s)
- Da Liu
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Chang-Qing Zhao
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hai Li
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Sheng-Dan Jiang
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Lei-Sheng Jiang
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Li-Yang Dai
- Department of Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China.
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Morse L, Teng YD, Pham L, Newton K, Yu D, Liao WL, Kohler T, Müller R, Graves D, Stashenko P, Battaglino R. Spinal cord injury causes rapid osteoclastic resorption and growth plate abnormalities in growing rats (SCI-induced bone loss in growing rats). Osteoporos Int 2008; 19:645-52. [PMID: 17987335 PMCID: PMC4370281 DOI: 10.1007/s00198-007-0494-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Accepted: 09/21/2007] [Indexed: 01/08/2023]
Abstract
UNLABELLED Spinal cord injury causes severe bone loss. We report osteoclast resorption with severe trabecular and cortical bone loss, decreased bone mineral apposition, and growth plate abnormalities in a rodent model of contusion spinal cord injury. These findings will help elucidate the mechanisms of osteoporosis following neurological trauma. INTRODUCTION Limited understanding of the mechanism(s) that underlie spinal cord injury (SCI)-induced bone loss has led to few treatment options. As SCI-induced osteoporosis carries significant morbidity and can worsen already profound disability, there is an urgency to advance knowledge regarding this pathophysiology. METHODS A clinically relevant contusion model of experimental spinal cord injury was used to generate severe lower thoracic SCI by weight-drop (10 g x 50 mm) in adolescent male Sprague-Dawley rats. Body weight and gender-matched naïve (no surgery) rats served as controls. Bone microarchitecture was determined by micro-computed tomographic imaging. Mature osteoclasts were identified by TRAP staining and bone apposition rate was determined by dynamic histomorphometry. RESULTS At 10 days post-injury we detected a marked 48% decrease in trabecular bone and a 35% decrease in cortical bone at the distal femoral metaphysis by micro-CT. A 330% increase in the number of mature osteoclasts was detected at the growth plate in the injured animals that corresponded with cellular disorganization at the chondro-osseous junction. Appositional growth studies demonstrated decreased new bone formation with a mineralization defect indicative of osteoblast dysfunction. CONCLUSIONS Contusion SCI results in a rapid bone loss that is the result of increased bone resorption and decreased bone formation.
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Affiliation(s)
- L Morse
- Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, MA 02115, USA.
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