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Kunath BA, Beloglowka K, Rainbow R, Ploeg HL. Mechanical loading of ex vivo bovine trabecular bone in 3D printed bioreactor chambers. J Mech Behav Biomed Mater 2024; 153:106470. [PMID: 38422872 DOI: 10.1016/j.jmbbm.2024.106470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
Previous ex vivo bone culture methods have successfully implemented polycarbonate (PC) bioreactors to investigate bone adaptation to mechanical load; however, they are difficult to fabricate and have been limited to a 5 mm maximum specimen height. The objective of this study was to validate a custom-made 3D printed MED610TM bioreactor system that addresses the limitations of the PC bioreactor and assess its efficacy in ex vivo bone culture. Twenty-three viable trabecular bone cores (10 mm height by 10 mm diameter) from an 18-month-old bovine sternum were cultured in MED610TM bioreactors with culture medium at 37 °C and 5% CO2 for 21-days. Bone cores were ranked based on their day 0 apparent elastic modulus (Eapp) and evenly separated into a "Load" group (n = 12) and a control group (n = 11). The Load group was loaded five times per week with a sinusoidal strain waveform between -1000 and -5000 με for 120 cycles at 2 Hz. Eapp was assessed on day 0, 8, and 21 using quasi-static tests with a -4000 με applied strain. Over 21-days, the Eapp of Load group samples tended to increase by more than double the control group (53.4% versus 20.9%) and no visual culture contamination was observed. This study demonstrated that bone organ culture in 3D printed MED610TM bioreactors replicated Eapp trends found in previous studies with PC bioreactors. However, further studies are warranted with a larger sample size to increase statistical power and histology to assess cell viability and bone mineral apposition rate.
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Affiliation(s)
- Brian A Kunath
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada; Centre for Health Innovation, Queen's University, Kingston, ON, Canada.
| | - Kail Beloglowka
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada; Centre for Health Innovation, Queen's University, Kingston, ON, Canada.
| | - Roshni Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada; Centre for Health Innovation, Queen's University, Kingston, ON, Canada.
| | - Heidi-Lynn Ploeg
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada; Centre for Health Innovation, Queen's University, Kingston, ON, Canada.
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Billington EO, Miyagishima RC, Hasselaar C, Arain M. Women's perspectives regarding osteoporosis, fracture risk, and pharmacologic treatment: a cross-sectional study. Osteoporos Int 2023; 34:2069-2076. [PMID: 37608123 DOI: 10.1007/s00198-023-06890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023]
Abstract
We assessed women's perspectives regarding early preventative therapy for osteoporosis. More than a third of early menopausal women were concerned about bone loss and future fractures, and approximately half were willing to take an intravenous or oral bisphosphonate around the time of menopause to preserve bone health. PURPOSE Bisphosphonate medications can prevent the substantial bone loss that occurs during early menopause, but little is known about whether women would accept bisphosphonate treatment at this time in their life, when imminent fracture risk is low. We assessed women's perspectives regarding bone loss, fracture risk, and preventative pharmacotherapy in early menopause. METHODS In this cross-sectional study, Canadian women aged ≥ 45 years were recruited via Facebook advertisement to complete an electronic survey. Primary outcome was the proportion of early menopausal respondents (≤ 5 years since final menstrual period) who were worried about bone loss and fractures. Secondary outcomes were the proportion of early menopausal women willing to accept pharmacologic intervention aimed at preventing either bone loss or future fractures. We compared responses between early menopausal women and older women (> 5 years since final menstrual period). RESULTS 2033 women responded to the Facebook advertisement, 1195 eligible women (aged: 45 to 89 years) started the survey, and 966 completed it. Among early menopausal respondents (N = 98), 38 (42%) were worried about future fractures and 9 of 25 (36%) who had a prior bone mineral density scan were worried about their results. A total of 42 (47%) were willing to start medication to prevent fractures, and 48 (54%) would start medication to prevent bone loss. Responses were comparable between early menopausal women and older women. CONCLUSION Menopausal women are concerned about bone loss and fractures. Many women would consider early menopausal pharmacotherapy, with the goals of preserving bone health and lowering their risk of fractures.
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Affiliation(s)
- Emma O Billington
- Cumming School of Medicine, Division of Endocrinology & Metabolism, University of Calgary, Richmond Road Diagnostic & Treatment Centre, Room 18118, 1820 Richmond Road SW, Calgary, AB, Canada.
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada.
| | | | - Charley Hasselaar
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada
| | - Mubashir Arain
- Health Systems Knowledge & Evaluation, Alberta Health Services, Alberta, Canada
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Oliveira T, Brown J, Juby AG, Schneider P, Wani RJ, Packalen M, Avcil S, Li S, Farris M, Graves E, McMullen S, Kendler DL. Trends in osteoporosis care patterns during the COVID-19 pandemic in Alberta, Canada. Arch Osteoporos 2022; 17:110. [PMID: 35920939 PMCID: PMC9349101 DOI: 10.1007/s11657-022-01132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/13/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE/INTRODUCTION The objective of this study was to describe osteoporosis-related care patterns during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada, relative to the 3-year preceding. METHODS A repeated cross-sectional study design encompassing 3-month periods of continuous administrative health data between March 15, 2017, and September 14, 2020, described osteoporosis-related healthcare resource utilization (HCRU) and treatment patterns. Outcomes included patients with osteoporosis-related healthcare encounters, physician visits, diagnostic and laboratory test volumes, and treatment initiations and disruptions. The percent change between outcomes was calculated, averaged across the control periods (2017-2019), relative to the COVID-19 periods (2020). RESULTS Relative to the average control March to June period, all HCRU declined during the corresponding COVID-19 period. There was a reduction of 14% in patients with osteoporosis healthcare encounters, 13% in general practitioner visits, 9% in specialist practitioner visits, 47% in bone mineral density tests, and 13% in vitamin D tests. Treatment initiations declined 43%, 26%, and 35% for oral bisphosphonates, intravenous bisphosphonates, and denosumab, respectively. Slight increases were observed in the proportion of patients with treatment disruptions. In the subsequent June to September period, HCRU either returned to or surpassed pre-pandemic levels, when including telehealth visits accounting for 33-45% of healthcare encounters during the COVID periods. Oral bisphosphonate treatment initiations remained lower than pre-pandemic levels. CONCLUSIONS This study demonstrates the COVID-19 pandemic and corresponding public health lockdowns further heightened the "crisis" around the known gap in osteoporosis care and altered the provision of care (e.g., use of telehealth and initiation of treatment). Osteoporosis has a known substantial care and management disparity, which has been classified as a crisis. The COVID-19 pandemic created additional burden on osteoporosis patient care with healthcare encounters, physician visits, diagnostic and laboratory tests, and treatment initiations all declining during the initial pandemic period, relative to previous years.
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Affiliation(s)
- T Oliveira
- Amgen Canada Inc, Mississauga, ON, Canada
| | - J Brown
- Department of Medicine, Division of Rheumatology, Laval University and CHU de Québec Research Centre, Quebec City, QC, Canada
| | - A G Juby
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - P Schneider
- Division of Orthopaedic Trauma, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - R J Wani
- Amgen Canada Inc, Mississauga, ON, Canada
| | - M Packalen
- Amgen Canada Inc, Mississauga, ON, Canada
| | - S Avcil
- Amgen Canada Inc, Mississauga, ON, Canada
| | - S Li
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada
| | - M Farris
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada
| | - E Graves
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada
| | - S McMullen
- Medlior Health Outcomes Research Ltd, Calgary, AB, Canada.
| | - D L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
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Shang N, Bhullar KS, Wu J. Tripeptide IRW Protects MC3T3-E1 Cells against Ang II Stress in an AT2R Dependent Manner. Molecules 2022; 27:molecules27123684. [PMID: 35744810 PMCID: PMC9230126 DOI: 10.3390/molecules27123684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Multiple strategies including the use of bioactive peptides and other nutraceuticals are being adopted to maintain bone health. This study provides an improved and deeper understanding of the pharmacological effects that a bioactive peptide IRW (Ile-Arg-Trp) extends on bone health. Our results showed that IRW treatment protects osteoblasts against Ang II induced decline in cell proliferation and restores protein levels of collagen type I alpha 2 chain (COL1A2) and alkaline phosphatase (ALP) levels in MC3T3-E1 cells (p < 0.05). Apart from augmentation of these mineralization factors, the angiotensin II (Ang II) induced apoptotic stress in osteoblasts was mitigated by IRW as well. At the molecular level, IRW abolished the cytochrome-c release via modulation of pro-and anti-apoptotic genes in MC3T3-E1 cells (p < 0.05). Interestingly, IRW also increased cellular levels of cytoprotective local RAAS factors such as MasR, Ang (1−7), ACE2, and AT2R, and lowered the levels of Ang II effector receptor (AT1R). Further, our results indicated a lower content of inflammation and osteoclastogenesis biomarkers such as cyclooxygenase 2 (COX2), nuclear factor kappa B (NF-κB), and receptor activator of nuclear factor kappa-B ligand (RANKL) following IRW treatment in MC3T3-E1 cells (p < 0.05). The use of an antagonist-guided cell study indicated that IRW contributed to the process of cytoprotection and proliferation of osteoblasts via Runt-related transcription factor 2 (RUNX2) in face of Ang II stress in an AT2R dependent manner. The key findings of our study showed that IRW could potentially have a therapeutic role in the treatment and/or prevention of bone disorders.
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Affiliation(s)
- Nan Shang
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada; (N.S.); (K.S.B.)
- College of Engineering, China Agricultural University, Beijing 100083, China
| | - Khushwant S. Bhullar
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada; (N.S.); (K.S.B.)
| | - Jianping Wu
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2R3, Canada; (N.S.); (K.S.B.)
- Correspondence: ; Tel.: +1-780-492-6885; Fax: +1-780-492-8524
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Bell A, Kendler DL, Khan AA, Shapiro C M M, Morisset A, Leung JP, Reiner M, Colgan SM, Slatkovska L, Packalen M. A retrospective observational study of osteoporosis management after a fragility fracture in primary care. Arch Osteoporos 2022; 17:75. [PMID: 35513573 PMCID: PMC9072526 DOI: 10.1007/s11657-022-01110-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/18/2022] [Indexed: 02/03/2023]
Abstract
In many countries, osteoporosis is predominantly managed by primary care physicians; however, management after a fragility fracture has not been widely investigated. We describe osteoporosis care gaps in a real-world patient cohort. Our findings help inform initiatives to identify and overcome obstacles to effective management of patients after fragility fracture. PURPOSE A fragility fracture is a major risk factor for subsequent fracture in adults aged ≥ 50 years. This retrospective observational study aimed to characterize post-fracture management in Canadian primary care. METHODS A total of 778 patients with an index fragility fracture (low-trauma, excluding small bones) occurring between 2014 and 2016 were identified from medical records at 76 primary care centers in Canada, with follow-up until January 2018. RESULTS Of 778 patients (80.5% female, median age [IQR] 73 [64-80]), 215 were on osteoporosis treatment and 269 had osteoporosis diagnosis recorded prior to their index fracture. The median follow-up was 363 (IQR 91-808) days. Of patients not on osteoporosis treatment at their index fracture, 60.2% (n = 339/563) remained untreated after their index fracture and 62.2% (n = 23/37) continued untreated after their subsequent fracture. After their index fracture, fracture risk assessment (FRAX or CAROC) was not performed in 83.2% (n = 647/778) of patients, and 59.9% (n = 466/778) of patients did not receive bone mineral density testing. Of patients without osteoporosis diagnosis recorded prior to their index date, 61.3% (n = 300/489) remained undiagnosed after their index fracture. At least one subsequent fracture occurred in 11.5% (n = 86/778) of patients. CONCLUSION In the primary care setting, fragility fracture infrequently resulted in osteoporosis treatment or fracture risk assessment, even after multiple fragility fractures. These results suggest a fragility fracture is not recognized as a major risk factor for subsequent fracture and its occurrence does not prompt primary care physicians to intervene. These data urge initiatives to identify and overcome obstacles to primary care physicians' effective management of patients after fragility fractures.
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Affiliation(s)
- Alan Bell
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - David L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - Aliya A Khan
- Department of Medicine, Divisions of Endocrinology and Metabolism and Geriatrics, McMaster University, Hamilton, ON, Canada
| | - Marla Shapiro C M
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Anne Morisset
- Department of Medicine, Division of Internal Medicine, Sherbrooke University, Sherbrooke, QC, Canada
| | - Jean-Pierre Leung
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
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Brox WT. CORR Insights®: Comparative Interrupted Time Series Analysis of Long-term Direct Medical Costs in Patients With Hip Fractures and a Matched Cohort: A Large-database Study. Clin Orthop Relat Res 2022; 480:903-904. [PMID: 34962499 PMCID: PMC9007209 DOI: 10.1097/corr.0000000000002097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 01/31/2023]
Affiliation(s)
- W Timothy Brox
- Volunteer Associate Clinical Professor, University of California at San Francisco, Fresno, Fresno, CA, USA
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Goeree R, Burke N, Jobin M, Brown JP, Lawrence D, Stollenwerk B, Willems D, Johnson B. Cost-effectiveness of romosozumab for the treatment of postmenopausal women at very high risk of fracture in Canada. Arch Osteoporos 2022; 17:71. [PMID: 35471711 PMCID: PMC9042964 DOI: 10.1007/s11657-022-01106-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/31/2022] [Indexed: 02/03/2023]
Abstract
This study evaluated the cost-effectiveness of 1 year of romosozumab followed by alendronate versus oral bisphosphonates alone in women with postmenopausal osteoporosis at very high risk for fracture in Canada. Results showed that romosozumab sequenced to alendronate is a cost-effective treatment option, dominating both alendronate and risedronate alone. PURPOSE To demonstrate the value of romosozumab sequenced to alendronate compared to alendronate or risedronate alone, for the treatment of osteoporosis in postmenopausal women with a history of osteoporotic fracture and who are at very high risk for future fracture in Canada. METHODS A Markov model followed a hypothetical cohort of postmenopausal osteoporotic women at very high risk for future fractures, to estimate the cost-effectiveness of romosozumab and alendronate compared to oral bisphosphonates alone. A total treatment period of 5 years was assumed. Quality-adjusted life years and costs were estimated for each comparator across health states defined by different types of fragility fractures. RESULTS Romosozumab/alendronate was associated with a lifetime gain of 0.103 and 0.127 QALYs and a cost reduction of $343 and $3805, relative to alendronate and risedronate, respectively. These results were driven by a reduction of the number of fractures (2561 per 1000 patients, versus 2700 for alendronate and 2724 for risedronate over lifetime). Romosozumab/alendronate had the highest probability of being cost-effective, relative to alendronate and risedronate, at any willingness to pay threshold value. CONCLUSION Romosozumab/alendronate was associated with reduced costs and greater benefit relative to other comparators. Probabilistic, deterministic, and scenario analyses indicate that romosozumab/alendronate represents the best value for money; the uncertainty analyses are robust, and therefore romosozumab should be considered for reimbursement by public drug plans in Canada .
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Affiliation(s)
- Ron Goeree
- Goeree Consulting Inc, Mount Hope, Canada
- McMaster University, Hamilton, Canada
| | - Natasha Burke
- Amgen Canada Inc, 6775 Financial Drive, Suite 100, Mississauga, ON, L5N 0A4, Canada.
| | - Manon Jobin
- Amgen Canada Inc, 6775 Financial Drive, Suite 100, Mississauga, ON, L5N 0A4, Canada
| | - Jacques P Brown
- Department of Medicine, Division of Rheumatology, CHU de Québec Research Centre, Laval University, Quebec City, Canada
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McArthur C, Lee A, Alrob HA, Adachi JD, Giangregorio L, Griffith LE, Morin S, Thabane L, Ioannidis G, Lee J, Leslie WD, Papaioannou A. An update of the prevalence of osteoporosis, fracture risk factors, and medication use among community-dwelling older adults: results from the Canadian Longitudinal Study on Aging (CLSA). Arch Osteoporos 2022; 17:31. [PMID: 35122160 PMCID: PMC8816745 DOI: 10.1007/s11657-022-01073-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023]
Abstract
The prevalence of self-reported and DXA-confirmed osteoporosis was 7.8% (males 2.2%; females 12.7%), and 3.6% (males 1.2%; females 5.9%), respectively. We found that most community-dwelling older adults at high fracture risk are not taking osteoporosis medication, particularly males. There is a major opportunity for improved primary fracture prevention in the community. PURPOSE To provide an up-to-date prevalence estimate of osteoporosis, fracture risk factors, fracture risk, and the proportion of older Canadians at high fracture risk who are not taking an osteoporosis medication. METHODS We included Canadian Longitudinal Study on Aging (CLSA) participants: a community-dwelling cohort aged 45 to 85 years who completed the baseline (2015) comprehensive interview and had dual-energy X-ray absorptiometry (DXA) scans (N = 30,097). We describe the age- and sex-stratified prevalence of (1) self-reported osteoporosis; (2) DXA-confirmed osteoporosis; (3) fracture risk factors and people who are at high risk (FRAX® major osteoporotic fracture probability ≥ 20%); and (4) people who are at high fracture risk not taking osteoporosis medications. Sampling weights, as defined by the CLSA, were applied. RESULTS The mean age of participants was 70.0 (SD 10.3). Overall, 7.8% had self-reported osteoporosis (males 2.2%; females 12.7%) while 3.6% had DXA-confirmed osteoporosis (males 1.2%; females 5.9%), and 2.8% were at high fracture risk (males 0.3%; females 5.1%). Of people who had osteoporosis and were at high risk, 77.3% were not taking an osteoporosis medication (males 92.3%; females 76.8%). CONCLUSIONS Our study provides an up-to-date prevalence estimate of osteoporosis for community-dwelling older Canadians. We found that most community-dwelling older adults at high fracture risk are not taking an osteoporosis medication, particularly males. There is a major opportunity for improved primary fracture prevention in the community.
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Affiliation(s)
- Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Forrest Building, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada. .,GERAS Centre for Aging Research, Hamilton, Ontario, Canada.
| | - Ahreum Lee
- GERAS Centre for Aging Research, Hamilton, Ontario, Canada.,Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Hajar Abu Alrob
- GERAS Centre for Aging Research, Hamilton, Ontario, Canada.,Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan D Adachi
- GERAS Centre for Aging Research, Hamilton, Ontario, Canada.,Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.,Schlegel-UW Research Institute On Aging, Waterloo, Ontario, Canada
| | - Lauren E Griffith
- Health Research Methodology, McMaster University, Hamilton, Ontario, Canada.,McMaster Institute for Research On Aging, Hamilton, Ontario, Canada
| | - Suzanne Morin
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Lehana Thabane
- Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - George Ioannidis
- GERAS Centre for Aging Research, Hamilton, Ontario, Canada.,Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - Justin Lee
- GERAS Centre for Aging Research, Hamilton, Ontario, Canada.,Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
| | - William D Leslie
- Departments of Internal Medicine and Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alexandra Papaioannou
- GERAS Centre for Aging Research, Hamilton, Ontario, Canada.,Health Research Methodology, McMaster University, Hamilton, Ontario, Canada
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