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Jadzic J, Andjelic U, Milovanovic P, Zivkovic V, Nikolic S, Djonic D, Djuric M. Improved femoral micro-architecture in adult male individuals with overweight: fracture resistance due to regional specificities. Int J Obes (Lond) 2024; 48:202-208. [PMID: 37770573 DOI: 10.1038/s41366-023-01389-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND It is still unclear whether femoral fracture risk is positively or negatively altered in individuals with overweight. Considering the lack of studies including men with overweight, this study aimed to analyze regional specificities in mechano-structural femoral properties (femoral neck and intertrochanteric region) in adult male cadavers with overweight compared to their normal-weight age-matched counterparts. METHODS Ex-vivo osteodensitometry, micro-computed tomography, and Vickers micro-indentation testing were performed on femoral samples taken from 30 adult male cadavers, divided into the group with overweight (BMI between 25 and 30 kg/m2; n = 14; age:55 ± 16 years) and control group (BMI between 18.5 and 25 kg/m2; n = 16; age:51 ± 18 years). RESULTS Better quality of trabecular and cortical microstructure in the inferomedial (higher trabecular bone volume fraction, trabecular thickness, and cortical thickness, coupled with reduced cortical pore diameter, p < 0.05) and superolateral femoral neck (higher trabecular number and tendency to lower cortical porosity, p = 0.043, p = 0.053, respectively) was noted in men with overweight compared to controls. Additionally, the intertrochanteric region of men with overweight had more numerous and denser trabeculae, coupled with a thicker and less porous cortex (p < 0.05). Still, substantial overweight-induced change in femoral osteodensitometry parameters and Vickers micro-hardness was not demonstrated in assessed femoral subregions (p > 0.05). CONCLUSIONS Despite the absence of significant changes in femoral osteodensitometry, individuals with overweight had better trabecular and cortical femoral micro-architecture implying higher femoral fracture resistance. However, the microhardness was not significantly favorable in the individuals who were overweight, indicating the necessity for further research.
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Affiliation(s)
- Jelena Jadzic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Uros Andjelic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Petar Milovanovic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Djonic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Djuric
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Balziano S, Greenstein N, Apterman S, Fogel I, Baran I, Prat D. Subtype consideration in hip fracture research: patient variances in inter- and intra-classification levels highlight the need for future research deliberation. A 2-years follow-up prospective-historical cohort. Arch Osteoporos 2023; 18:123. [PMID: 37770694 DOI: 10.1007/s11657-023-01334-7] [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: 07/05/2023] [Accepted: 09/25/2023] [Indexed: 09/30/2023]
Abstract
Current research on elderly patients with hip fractures often neglects specific subtypes, either grouping all fracture types or overlooking them entirely. By categorizing elderly patients based on fracture subtypes, we observed diverse baseline characteristics but found no discrepancies in measured outcomes. This emphasizes the need for caution in future research dealing with different or broader measured outcomes that were not covered by the scope of this research. PURPOSE/INTRODUCTION Existing research in elderly patients with hip fractures often overlooks the distinct subtypes or lumps all fracture types together. We aim to examine the differences between hip fracture subtypes to assess if these differences are meaningful for clinical outcomes and should be considered in future research. METHODS Patients above 65 years who underwent hip fracture surgeries during a three-year period were retrospectively reviewed. Cases were grouped based on fracture subtype: non-displaced femoral neck (nDFN), displaced femoral neck (DFN), stable intertrochanteric (sIT), and unstable intertrochanteric (uIT). RESULTS Among the 1,285 included cases, the nDFN-group had lower ASA scores (p = 0.009) and younger patients (p < 0.001), followed by the DFN-group (p = 0.014). The uIT-group had a higher proportion of female patients (72.3%, p = 0.004). Differences in preoperative ambulation status were observed (p = 0.001). However, no significant associations were found between fracture type and postoperative outcomes, including ambulation, transfusions, complications, reoperations, or mortality. Gender and preoperative ambulation status were predictors of mortality across all time frames. ASA score predicted mortality only within the first year after surgery. Age and gender were predictors of postoperative blood transfusions, while age and preoperative ambulation status were predictors of postoperative complications. CONCLUSIONS Variations in baseline characteristics of hip fractures were observed, but no significant differences were found in measured outcomes. This indicates that the hip fracture group is not homogeneous, emphasizing the need for caution in research involving this population. While grouping all types of proximal femur fractures may be acceptable depending on the outcome being studied, it's essential not to extrapolate these results to outcomes beyond the study's scope. Therefore, we recommend consider hip fracture subtypes when researching different outcomes not covered by this study.
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Affiliation(s)
- Snir Balziano
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel.
| | - Nechemia Greenstein
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Sagy Apterman
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Itay Fogel
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Isaac Baran
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
| | - Dan Prat
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Aviv University, Ramat Gan, Israel
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Cirovic A, Jadzic J, Djukic D, Djonic D, Zivkovic V, Nikolic S, Djuric M, Milovanovic P. Increased Cortical Porosity, Reduced Cortical Thickness, and Reduced Trabecular and Cortical Microhardness of the Superolateral Femoral Neck Confer the Increased Hip Fracture Risk in Individuals with Type 2 Diabetes. Calcif Tissue Int 2022; 111:457-465. [PMID: 35871240 PMCID: PMC9308472 DOI: 10.1007/s00223-022-01007-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/06/2022] [Indexed: 11/12/2022]
Abstract
Individuals with diabetes mellitus type 2 (T2DM) have approximately 30% increased risk of hip fracture; however, the main cause of the elevated fracture risk in those subjects remains unclear. Moreover, micromechanical and microarchitectural properties of the superolateral femoral neck-the common fracture-initiating site-are still unknown. We collected proximal femora of 16 men (eight with T2DM and eight controls; age: 61 ± 10 years) at autopsy. After performing post-mortem bone densitometry (DXA), the superolateral neck was excised and scanned with microcomputed tomography (microCT). We also conducted Vickers microindentation testing. T2DM and control subjects did not differ in age (p = 0.605), body mass index (p = 0.114), and femoral neck bone mineral density (BMD) (p = 0.841). Cortical porosity (Ct.Po) was higher and cortical thickness (Ct.Th) was lower in T2DM (p = 0.044, p = 0.007, respectively). Of trabecular microarchitectural parameters, only structure model index (p = 0.022) was significantly different between T2DM subjects and controls. Control group showed higher cortical (p = 0.002) and trabecular bone microhardness (p = 0.005). Increased Ct.Po and decreased Ct.Th in T2DM subjects increase the propensity to femoral neck fracture. Apart from the deteriorated cortical microarchitecture, decreased cortical and trabecular microhardness suggests altered bone composition of the superolateral femoral neck cortex and trabeculae in T2DM. Significantly deteriorated cortical microarchitecture of the superolateral femoral neck is not recognized by standard DXA measurement of the femoral neck.
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Affiliation(s)
- Aleksandar Cirovic
- Faculty of Medicine, Institute of Anatomy, Center of Bone Biology, Laboratory of Bone Biology and Bioanthropology, University of Belgrade, Dr Subotica 4/2, Belgrade, Serbia
| | - Jelena Jadzic
- Faculty of Medicine, Institute of Anatomy, Center of Bone Biology, Laboratory of Bone Biology and Bioanthropology, University of Belgrade, Dr Subotica 4/2, Belgrade, Serbia
| | - Danica Djukic
- Faculty of Medicine, Institute of Forensic Medicine, University of Belgrade, Deligradska 31a, Belgrade, Serbia
| | - Danijela Djonic
- Faculty of Medicine, Institute of Anatomy, Center of Bone Biology, Laboratory of Bone Biology and Bioanthropology, University of Belgrade, Dr Subotica 4/2, Belgrade, Serbia
| | - Vladimir Zivkovic
- Faculty of Medicine, Institute of Forensic Medicine, University of Belgrade, Deligradska 31a, Belgrade, Serbia
| | - Slobodan Nikolic
- Faculty of Medicine, Institute of Forensic Medicine, University of Belgrade, Deligradska 31a, Belgrade, Serbia
| | - Marija Djuric
- Faculty of Medicine, Institute of Anatomy, Center of Bone Biology, Laboratory of Bone Biology and Bioanthropology, University of Belgrade, Dr Subotica 4/2, Belgrade, Serbia
| | - Petar Milovanovic
- Faculty of Medicine, Institute of Anatomy, Center of Bone Biology, Laboratory of Bone Biology and Bioanthropology, University of Belgrade, Dr Subotica 4/2, Belgrade, Serbia.
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Cirovic A, Cirovic A, Djukic D, Djonic D, Zivkovic V, Nikolic S, Djuric M, Milovanovic P. Three-dimensional mapping of cortical porosity and thickness along the superolateral femoral neck in older women. Sci Rep 2022; 12:15544. [PMID: 36109611 PMCID: PMC9477875 DOI: 10.1038/s41598-022-19866-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/06/2022] [Indexed: 11/20/2022] Open
Abstract
Although several studies have analyzed inter-individual differences in the femoral neck cortical microstructure, intra-individual variations have not been comprehensively evaluated. By using microCT, we mapped cortical pore volume fraction (Ct.Po) and thickness (Ct.Th) along the superolateral femoral neck in 14 older women (age: 77.1 ± 9.8 years) to identify subregions and segments with high porosity and/or low thickness—potential “critical” spots where a fracture could start. We showed that Ct.Po and Ct.Th significantly differed between basicervical, midcervical, and subcapital subregions of the femoral neck (p < 0.001), where the subcapital subregion showed the lowest mean Ct.Th and the highest mean Ct.Po. These cortical parameters also varied substantially with age and with the location of the analyzed microsegments along the individual’s neck (p < 0.001), showing multiple microsegments with high porosity and/or low thickness. Although the highest ratio of these microsegments was found in the subcapital subregion, they were also present at other examined subregions, which may provide an anatomical basis for explaining the fracture initiation at various sites of the superolateral neck. Given that fractures likely start at structurally and mechanically weaker spots, intra-individual variability in Ct.Po and Ct.Th should be considered and the average values for the entire femoral neck should be interpreted with caution.
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Lu D, Demissie S, Horowitz NB, Gower AC, Lenburg ME, Alekseyev YO, Hussein AI, Bragdon B, Liu Y, Daukss D, Page JM, Webster MZ, Schlezinger JJ, Morgan EF, Gerstenfeld LC. Temporal and Quantitative Transcriptomic Differences Define Sexual Dimorphism in Murine Postnatal Bone Aging. JBMR Plus 2021; 6:e10579. [PMID: 35229061 PMCID: PMC8861981 DOI: 10.1002/jbm4.10579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 12/18/2022] Open
Abstract
Time is a central element of the sexual dimorphic patterns of development, pathology, and aging of the skeleton. Because the transcriptome is a representation of the phenome, we hypothesized that both sex and sex‐specific temporal, transcriptomic differences in bone tissues over an 18‐month period would be informative to the underlying molecular processes that lead to postnatal sexual dimorphism. Regardless of age, sex‐associated changes of the whole bone transcriptomes were primarily associated not only with bone but also vascular and connective tissue ontologies. A pattern‐based approach used to screen the entire Gene Expression Omnibus (GEO) database against those that were sex‐specific in bone identified two coordinately regulated gene sets: one related to high phosphate–induced aortic calcification and one induced by mechanical stimulation in bone. Temporal clustering of the transcriptome identified two skeletal tissue‐associated, sex‐specific patterns of gene expression. One set of genes, associated with skeletal patterning and morphology, showed peak expression earlier in females. The second set of genes, associated with coupled remodeling, had quantitatively higher expression in females and exhibited a broad peak between 3 to 12 months, concurrent with the animals' reproductive period. Results of phenome‐level structural assessments of the tibia and vertebrae, and in vivo and in vitro analysis of cells having osteogenic potential, were consistent with the existence of functionally unique, skeletogenic cell populations that are separately responsible for appositional growth and intramedullary functions. These data suggest that skeletal sexual dimorphism arises through sex‐specific, temporally different processes controlling morphometric growth and later coupled remodeling of the skeleton during the reproductive period of the animal. © 2021 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)
- Darlene Lu
- Department of Biostatistics Boston University School of Public Health Boston MA USA
| | - Serkalem Demissie
- Department of Biostatistics Boston University School of Public Health Boston MA USA
| | - Nina B Horowitz
- Department of Orthopaedic Surgery Boston University School of Medicine Boston MA USA
| | - Adam C Gower
- Department of Medicine, Section of Computational Biomedicine Boston University School of Medicine Boston MA USA
| | - Marc E Lenburg
- Department of Medicine, Section of Computational Biomedicine Boston University School of Medicine Boston MA USA
- Department of Pathology and Laboratory Medicine Boston University School of Medicine Boston MA USA
| | - Yuriy O Alekseyev
- Department of Pathology and Laboratory Medicine Boston University School of Medicine Boston MA USA
| | - Amira I Hussein
- Department of Orthopaedic Surgery Boston University School of Medicine Boston MA USA
| | - Beth Bragdon
- Department of Orthopaedic Surgery Boston University School of Medicine Boston MA USA
| | - Yu Liu
- Department of Orthopaedic Surgery Boston University School of Medicine Boston MA USA
| | - Dana Daukss
- Department of Orthopaedic Surgery Boston University School of Medicine Boston MA USA
| | - Jack M Page
- Department of Orthopaedic Surgery Boston University School of Medicine Boston MA USA
| | - Micheal Z Webster
- Department of Mechanical Engineering Boston University Boston MA USA
| | - Jennifer J Schlezinger
- Department of Environmental Health Boston University School of Public Health Boston MA USA
| | - Elise F Morgan
- Department of Orthopaedic Surgery Boston University School of Medicine Boston MA USA
- Department of Mechanical Engineering Boston University Boston MA USA
| | - Louis C Gerstenfeld
- Department of Orthopaedic Surgery Boston University School of Medicine Boston MA USA
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Jadzic J, Mijucic J, Nikolic S, Djuric M, Djonic D. The comparison of age- and sex-specific alteration in pubic bone microstructure: A cross-sectional cadaveric study. Exp Gerontol 2021; 150:111375. [PMID: 33940115 DOI: 10.1016/j.exger.2021.111375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The burden of age-associated fragility fracture of the pelvis has gradually amplified over the years. Commonly used clinical tools cannot fully explain age-associated fracture risk increase, and microstructural analysis could be required to elucidate pubic bone strength decline in elderly. MATERIAL AND METHODS The study sample encompassed 46 pubic bones obtained from cadaveric donors divided into a young women (<45 years, n = 11), aged women (>60 years, n = 11), young men (<45 years, n = 12) and aged men group (>60 years, n = 12). Micro-computed tomography was used to evaluate the cortical and trabecular microstructure of pubic bone samples. RESULTS Apart from age-associated loss in quantitative trabecular parameters, significant alteration of micro-CT parameters that more closely reflect internal trabecular microarchitectural complexity may contribute to pubic bone strength decline in men and women of advanced age (p < 0.05). Additionally, decreased cortical thickness and increased Ct.Po, Po.Dm and Po.N were found in the anterior and posterior cortical surface of pubic bone samples from the aged individuals (p < 0.05). The more pronounced alteration was noted in aged female donors, illustrated in a significant deterioration trend of the Tb.N, Tb.Sp, and thinner posterior cortical surface with decreased pore spacing (p < 0.05). CONCLUSION Our data suggest that age-associated deterioration in trabecular and cortical pubic bone micro-architecture could unravel a morphological basis for decreased pubic bone strength and increased pubic bone fragility, which leads to fracture predilection in the elderly women. Thus, the individual fracture risk assessment should be advised in the elderly, with a particular accent on aged women.
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Affiliation(s)
- Jelena Jadzic
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovana Mijucic
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Djuric
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Djonic
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Cirovic A, Cirovic A, Djonic D, Zivkovic V, Nikolic S, Djuric M, Milovanovic P. Three-Dimensional Microstructural Basis for Differential Occurrence of Subcapital versus Basicervical Hip Fractures in Men. Calcif Tissue Int 2020; 107:240-248. [PMID: 32601840 DOI: 10.1007/s00223-020-00717-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/20/2020] [Indexed: 12/29/2022]
Abstract
We analyzed the bone microarchitecture of the subcapital and basicervical subregions of the femoral neck in men, to determine whether microarchitectural differences of cortical or trabecular bone can explain differential frequency of subcapital vs. basicervical fractures, especially in aged persons. The study sample encompassed twenty male proximal femora obtained during autopsy. They were divided in two age groups: young (< 40 years, n = 10) and aged (> 60 years, n = 10). Micro-computed tomography was used to evaluate cortical and trabecular microarchitecture of the subcapital and basicervical regions of the superolateral femoral neck-typical fracture initiation site. Basicervical region showed significantly thicker and less porous cortex than subcapital region (p = 0.02, p < 0.001, respectively), along with increased distance between cortical pores (p = 0.004) and smaller pore diameters (p = 0.069). Higher trabecular number (Tb.N: p = 0.042), lower trabecular thickness (Tb.Th: p < 0.001), and lower trabecular separation (p = 0.003) were also hallmarks of the basicervical compared to subcapital region, although BV/TV was similar in both regions (p = 0.133). Age-related deterioration was mostly visible in trabecular bone (for BV/TV, Tb.Th, Tb.N and fractal dimension: p = 0.026, p = 0.049, p = 0.059, p = 0.009, respectively). Moreover, there were tendencies to age-specific patterns of trabecular separation (more pronounced inter-site differences in aged) and cortical thickness (more pronounced inter-site differences in young). Trabecular microarchitecture corresponded to cortical characteristics of each region. Our study revealed the microarchitectural basis for higher incidence of subcapital than basicervical fractures of the femoral neck. This is essential for better understanding of the fracture risk, as well as for future strategies to prevent hip fractures and their complications.
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Affiliation(s)
- Aleksandar Cirovic
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, Serbia
| | - Ana Cirovic
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, Serbia
| | - Danijela Djonic
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, Serbia
| | - Vladimir Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, 11000, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, 11000, Serbia
| | - Marija Djuric
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, Serbia
| | - Petar Milovanovic
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, Serbia.
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8
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Djukić K, Milovanović P, Milenković P, Djurić M. A microarchitectural assessment of the gluteal tuberosity suggests two possible patterns in entheseal changes. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 172:291-299. [PMID: 32154921 DOI: 10.1002/ajpa.24038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 02/15/2020] [Accepted: 02/21/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Macroscopic entheseal forms show two main features: predominant signs of bony formation or resorption. To understand the development of these forms, we investigated microarchitectural differences between the macroscopic proliferative and resorptive forms of the gluteus maximus enthesis. MATERIALS AND METHODS The macromorphological analysis of entheseal changes (EC) was based on the Villotte, visual scoring system for fibrous entheses. Gluteal tuberosity specimens of different stages of Villote's system were harvested from 16 adult males derived from an archaeological context and scanned using microcomputed tomography. RESULTS The microarchitectural analyzes of cortical bone demonstrated a trend of higher porosity in the resorptive compared to the proliferative phase in Stage B, whereas a 30% porosity reduction was detected in the resorptive compared to proliferative phase of Stage C. In terms of the trabecular bone between the resorptive and proliferative entheseal phases, there was a trend of increased connectivity density, whereas the structural model index decreased in B and increased in C. The assessment of the entire specimen showed an increase in porosity from the proliferative to the resorptive phase in the Stage B, in contrast to a decrease in the Stage C. DISCUSSION The results suggest that from an initial flat entheses, two directions of EC development are possible: (a) a bony prominence may form and, subsequently, it is subjected to trabecularization of the cortical bone inside the prominence, such cortical trabecularization can lead to visible porosity on the cortical external surface; (b) the cortical bone defect may develop with the regular underlying cortical bone.
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Affiliation(s)
- Ksenija Djukić
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Serbia
| | - Petar Milovanović
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Serbia
| | - Petar Milenković
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Serbia.,Institute of Oncology and Radiology of Serbia, National Cancer Research Center, Belgrade, Serbia
| | - Marija Djurić
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Serbia
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9
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McGivern H, Greenwood C, Márquez-Grant N, Kranioti EF, Xhemali B, Zioupos P. Age-Related Trends in the Trabecular Micro-Architecture of the Medial Clavicle: Is It of Use in Forensic Science? Front Bioeng Biotechnol 2020; 7:467. [PMID: 32039176 PMCID: PMC6988573 DOI: 10.3389/fbioe.2019.00467] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/19/2019] [Indexed: 12/02/2022] Open
Abstract
The mechanical and structural properties of bone are known to change significantly with age. Within forensic and archaeological investigations, the medial end of the clavicle is typically used for estimating the age-at-death of an unknown individual. Although, this region of the skeleton is of interest to forensic and clinical domains, alterations beyond the macro-scale have not been fully explored. For this study, non-destructive micro-computed tomography (μ-CT) was employed to characterize structural alterations to the cancellous bone of the medial clavicle. Fresh human cadaveric specimens (12-59 years) obtained at autopsy were utilized for this study, and were scanned with a voxel size of ~83 μm. Morphometric properties were quantified and indicated that the bone volume, connectivity density, mineral density, and number of trabeculae decreased with age, while the spacing between the trabeculae increased with age. In contrast to other sub-regions of the skeleton, trabecular thickness, and degree of anisotropy did not correlate with age. Collectively, this could suggest that the network is becoming increasingly perforated with age rather than exhibiting trabecular thinning. These results are used in the context of deriving a potential protocol for forensic investigations by using this particular and largely unexplored region of the skeleton, and provide inspiration for future experiments concerning micro-architectural and small scale changes in other regions of the human skeleton.
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Affiliation(s)
- Hannah McGivern
- Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, United Kingdom
| | - Charlene Greenwood
- School of Chemistry and Physical Sciences, Keele University, Keele, United Kingdom
| | - Nicholas Márquez-Grant
- Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, United Kingdom
| | - Elena F. Kranioti
- Edinburgh Unit for Forensic Anthropology, School of History Classics and Archaeology, University of Edinburgh, Edinburgh, United Kingdom
- Forensic Medicine Unit, Department of Forensic Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece
| | | | - Peter Zioupos
- Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, United Kingdom
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10
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Beresheim AC, Pfeiffer S, Grynpas M. Ontogenetic changes to bone microstructure in an archaeologically derived sample of human ribs. J Anat 2019; 236:448-462. [PMID: 31729033 DOI: 10.1111/joa.13116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 11/30/2022] Open
Abstract
There is considerable variation in the gross morphology and tissue properties among the bones of human infants, children, adolescents, and adults. Using 18 known-age individuals (nfemale = 8, nmale = 9, nunknown = 1; birth to 21 years old), from a well-documented cemetery collection, Spitalfields Christ Church, London, UK, this study explores growth-related changes in cortical and trabecular bone microstructure. Micro-CT scans of mid-shaft middle thoracic ribs are used for quantitative analysis. Results are then compared to previously quantified conventional histomorphometry of the same sample. Total area (Tt.Ar), cortical area (Ct.Ar), cortical thickness (Ct.Th), and the major (Maj.Dm) and minor (Min.Dm) diameters of the rib demonstrate positive correlations with age. Pore density (Po.Dn) increases, but age-related changes to cortical porosity (Ct.Po) appear to be non-linear. Trabecular thickness (Tb.th) and trabecular separation (Tb.Sp) increase with age, whereas trabecular bone pattern factor (Tb.Pf), structural model index (SMI), and connectivity density (Conn.D) decrease with age. Sex-based differences were not identified for any of the variables included in this study. Some samples display clear evidence of diagenetic alteration without corresponding changes in radiopacity, which compromises the reliability of bone mineral density (BMD) data in the study of past populations. Cortical porosity data are not correlated with two-dimensional measures of osteon population density (OPD). This suggests that unfilled resorption spaces contribute more significantly to cortical porosity than do the Haversian canals of secondary osteons. Continued research using complementary imaging techniques and a wide array of histological variables will increase our understanding of age- and sex-specific ontogenetic patterns within and among human populations.
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Affiliation(s)
- Amy C Beresheim
- Department of Anatomy, Des Moines University, Des Moines, IA, USA
| | - Susan Pfeiffer
- Department of Anthropology, University of Toronto, Toronto, ON, Canada.,Department of Anthropology, Center for the Advanced Study of Human Paleobiology, George Washington University, Washington, DC, USA.,Department of Archaeology, University of Cape Town, Cape Town, South Africa
| | - Marc Grynpas
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology and Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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11
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Saers JP, Ryan TM, Stock JT. Trabecular bone structure scales allometrically in the foot of four human groups. J Hum Evol 2019; 135:102654. [DOI: 10.1016/j.jhevol.2019.102654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022]
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12
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Milovanovic P, Busse B. Inter-site Variability of the Human Osteocyte Lacunar Network: Implications for Bone Quality. Curr Osteoporos Rep 2019; 17:105-115. [PMID: 30980284 DOI: 10.1007/s11914-019-00508-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW This article provides a review on the variability of the osteocyte lacunar network in the human skeleton. It highlights characteristics of the osteocyte lacunar network in relation to different skeletal sites and fracture susceptibility. RECENT FINDINGS Application of 2D analyses (quantitative backscattered electron microscopy, histology, confocal laser scanning microscopy) and 3D reconstructions (microcomputed tomography and synchrotron radiation microcomputed tomography) provides extended high-resolution information on osteocyte lacunar properties in individuals of various age (fetal, children's growth, elderly), sex, and disease states with increased fracture risk. Recent findings on the distribution of osteocytes in the human skeleton are reviewed. Quantitative data highlighting the variability of the osteocyte lacunar network is presented with special emphasis on site specificity and maintenance of bone health. The causes and consequences of heterogeneous distribution of osteocyte lacunae both within specific regions of interest and on the skeletal level are reviewed and linked to differential bone quality factors and fracture susceptibility.
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Affiliation(s)
- Petar Milovanovic
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 55A, 22529, Hamburg, Germany
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 55A, 22529, Hamburg, Germany.
- Forum Medical Technology Health Hamburg (FMTHH), Heisenberg Research Group of Biomedical Sciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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13
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Macias-Valcayo A, Pfang BG, Auñón A, Esteban J. Pharmacotherapy options and drug development in managing periprosthetic joint infections in the elderly. Expert Opin Pharmacother 2019; 20:1109-1121. [PMID: 30983431 DOI: 10.1080/14656566.2019.1602118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Prosthetic joint infections are an increasingly important problem among patients undergoing arthroplasty procedures, and are associated with significant morbidity, reduced quality of life, substantial healthcare costs, and even mortality. Arthroplasties are performed with increasing frequency in elderly patients, who present specific problems. AREAS COVERED Surgical therapy is clearly influenced by the clinical status of the patient, which in some case can contraindicate surgery. Antibiotic selection is also affected by comorbidities and underlying diseases, which in some cases reduce therapeutic options. The authors review this together with the changes in pharmacokinetics and pharmacodynamics in the elderly population and the prospects for future research on prevention and treatment. EXPERT OPINION The management of PJI in the elderly makes multidisciplinary teams even more mandatory than in other patients, because the complexity of these patients. A frequent scenario is that in which surgery is contraindicated with long-term suppressive treatment as the only available option. Treating physicians must consider the presence of multiple comorbidities, interactions with other treatments and secondary effects when choosing antibiotic treatment. An in-depth knowledge of the alterations in pharmacokinetics and pharmacodynamics in elderly patients is key for a proper treatment selection.
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Affiliation(s)
- Alicia Macias-Valcayo
- a Department of Clinical Microbiology , IIS-Fundación Jiménez Díaz , Madrid , Spain.,b Bone and Joint Infection Unit , Fundación Jiménez Díaz University Hospital , Madrid , Spain
| | - Bernadette G Pfang
- b Bone and Joint Infection Unit , Fundación Jiménez Díaz University Hospital , Madrid , Spain.,c Department of Internal Medicine , IIS-Fundación Jiménez Díaz , Madrid , Spain
| | - Alvaro Auñón
- b Bone and Joint Infection Unit , Fundación Jiménez Díaz University Hospital , Madrid , Spain.,d Department of Traumatology and Orthopaedic Surgery , IIS-Fundación Jiménez Díaz , Madrid , Spain
| | - Jaime Esteban
- a Department of Clinical Microbiology , IIS-Fundación Jiménez Díaz , Madrid , Spain.,b Bone and Joint Infection Unit , Fundación Jiménez Díaz University Hospital , Madrid , Spain
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14
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Saers JPP, Ryan TM, Stock JT. Trabecular bone functional adaptation and sexual dimorphism in the human foot. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2018; 168:154-169. [DOI: 10.1002/ajpa.23732] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Jaap P. P. Saers
- Department of Archaeology, University of Cambridge McDonald Institute for Archaeological Research Cambridge United Kingdom
| | - Timothy M. Ryan
- Department of Anthropology Pennsylvania State University State College Pennsylvania
| | - Jay T. Stock
- Department of Archaeology, University of Cambridge McDonald Institute for Archaeological Research Cambridge United Kingdom
- Department of Anthropology University of Western Ontario London Ontario Canada
- Department of Archaeology Max Planck Institute for the Science of Human History Jena Germany
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15
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Milovanovic P, Stojanovic M, Antonijevic D, Cirovic A, Radenkovic M, Djuric M. "Dangerous duo": Chronic nicotine exposure intensifies diabetes mellitus-related deterioration in bone microstructure - An experimental study in rats. Life Sci 2018; 212:102-108. [PMID: 30266406 DOI: 10.1016/j.lfs.2018.09.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/03/2018] [Accepted: 09/24/2018] [Indexed: 01/19/2023]
Abstract
AIMS Bony complications of diabetes mellitus (DM) are still insufficiently understood. Our aims were to analyze the individual and combined effects of chronic hyperglycemia and nicotine exposure on the femoral trabecular and cortical microarchitecture on a rat experimental model. MAIN METHODS The micro-computed tomography based bone microstructural evaluation was performed on male Wistar rats divided into four groups: control (n = 7), experimentally-induced DM (n = 8), chronically exposed to nicotine (n = 9) and the DM group exposed chronically to nicotine (n = 9). KEY FINDINGS Chronic hyperglycemia caused mild trabecular deterioration; yet, the combination of hyperglycemia and nicotine exposure showed more deleterious effects on the trabecular bone. Namely, the DM + nicotine group had significantly lower bone volume fraction, fewer and more rod-like shaped trabeculae, along with higher trabecular separation and lower connectivity than the control group (p < 0.05). Nicotine alone did not show any significant deterioration compared to the control group. DM and DM + nicotine groups had lower cortical porosity than control and nicotine groups (p < 0.05). Cortical thickness did not show any significant intergroup differences, whereas bone perimeter and the mean polar moment of inertia were reduced in DM + nicotine group. SIGNIFICANCE Mild effects of chronic hyperglycemia on bone structure were accentuated by the chronic nicotine exposure, although nicotine alone did not cause any significant bone changes. That suggests a synergistic effect of hyperglycemia and nicotine on bone deterioration and increased propensity to fracture. Indeed, better understanding of risk factors driving bone structural deterioration is a precondition to limit the complications associated with DM.
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Affiliation(s)
- Petar Milovanovic
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, 11000 Belgrade, Serbia
| | - Marko Stojanovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia
| | - Djordje Antonijevic
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, 11000 Belgrade, Serbia
| | - Aleksandar Cirovic
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, 11000 Belgrade, Serbia
| | - Miroslav Radenkovic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Dr Subotica 1, 11000 Belgrade, Serbia
| | - Marija Djuric
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, 11000 Belgrade, Serbia.
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16
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Rolvien T, Vom Scheidt A, Stockhausen KE, Milovanovic P, Djonic D, Hubert J, Hawellek T, Wacker A, Jebens V, Püschel K, Zimmermann EA, Djuric M, Amling M, Busse B. Inter-site variability of the osteocyte lacunar network in the cortical bone underpins fracture susceptibility of the superolateral femoral neck. Bone 2018; 112:187-193. [PMID: 29679732 DOI: 10.1016/j.bone.2018.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/02/2018] [Accepted: 04/18/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The osteocytic lacunar network is considered to be an integral player in the regulation of bone homeostasis, and reduction in osteocytes is associated with reduced bone strength. Here, we analyzed site-specific patterns in osteocyte characteristics and matrix composition in the cortical compartment of the femoral neck to reveal the structural basis of its fragility. METHODS Cross-sections of the human femoral neck - one of the most common fracture sites - were acquired from 12 female cadavers (age 34-86 years) and analyzed with backscattered scanning electron microscopy and high-resolution micro-computed tomography (μ-CT). The 2D/3D density and size of the osteocyte lacunae as well as bone mineral density distribution (BMDD) were measured in two regions subject to different biomechanical loads in vivo: the inferomedial (medial) region (habitually highly loaded in compression) and the superolateral (lateral) region (lower habitual loading intensity). Using quantitative polarized light microscopy, collagen fiber orientation was quantified in these two regions, accordingly. RESULTS In 2D measurements, the inferomedial region displayed lower mineralization heterogeneity, 19% higher osteocyte lacunar density (p = 0.005), but equal lacunar size compared to the superolateral region. 3D measurements confirmed a significantly higher osteocyte lacunar density in the inferomedial region (p = 0.015). Osteocyte lacunar density decreased in aged individuals, and inter-site differences were reduced. Site-specific osteocyte characteristics were not accompanied by changes in collagen fiber orientation. CONCLUSIONS Since osteocyte characteristics may provide valuable insights into bone mechanical competence, the variations in osteocyte properties might reflect the increased fracture susceptibility of the superolateral neck.
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Affiliation(s)
- Tim Rolvien
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529 Hamburg, Germany; Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Annika Vom Scheidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529 Hamburg, Germany
| | - Kilian E Stockhausen
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529 Hamburg, Germany
| | - Petar Milovanovic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, 11000 Belgrade, Serbia
| | - Danijela Djonic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, 11000 Belgrade, Serbia
| | - Jan Hubert
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529 Hamburg, Germany; Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Thelonius Hawellek
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529 Hamburg, Germany; Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Alexander Wacker
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529 Hamburg, Germany; Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Volker Jebens
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529 Hamburg, Germany; Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - Elizabeth A Zimmermann
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529 Hamburg, Germany
| | - Marija Djuric
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, 11000 Belgrade, Serbia
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529 Hamburg, Germany
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 22529 Hamburg, Germany.
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17
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Chang G, Rajapakse CS, Chen C, Welbeck A, Egol K, Regatte RR, Saha PK, Honig S. 3-T MR Imaging of Proximal Femur Microarchitecture in Subjects with and without Fragility Fracture and Nonosteoporotic Proximal Femur Bone Mineral Density. Radiology 2018; 287:608-619. [PMID: 29457963 DOI: 10.1148/radiol.2017170138] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose To determine if 3-T magnetic resonance (MR) imaging of proximal femur microarchitecture can allow discrimination of subjects with and without fragility fracture who do not have osteoporotic proximal femur bone mineral density (BMD). Materials and Methods Sixty postmenopausal women (30 with and 30 without fragility fracture) who had BMD T scores of greater than -2.5 in the hip were recruited. All subjects underwent dual-energy x-ray absorptiometry to assess BMD and 3-T MR imaging of the same hip to assess bone microarchitecture. World Health Organization Fracture Risk Assessment Tool (FRAX) scores were also computed. We used the Mann-Whitney test, receiver operating characteristics analyses, and Spearman correlation estimates to assess differences between groups, discriminatory ability with parameters, and correlations among BMD, microarchitecture, and FRAX scores. Results Patients with versus without fracture showed a lower trabecular plate-to-rod ratio (median, 2.41 vs 4.53, respectively), lower trabecular plate width (0.556 mm vs 0.630 mm, respectively), and lower trabecular thickness (0.114 mm vs 0.126 mm) within the femoral neck, and higher trabecular rod disruption (43.5 vs 19.0, respectively), higher trabecular separation (0.378 mm vs 0.323 mm, respectively), and lower trabecular number (0.158 vs 0.192, respectively), lower trabecular connectivity (0.015 vs 0.027, respectively) and lower trabecular plate-to-rod ratio (6.38 vs 8.09, respectively) in the greater trochanter (P < .05 for all). Trabecular plate-to-rod ratio, plate width, and thickness within the femoral neck (areas under the curve [AUCs], 0.654-0.683) and trabecular rod disruption, number, connectivity, plate-to-rod ratio, and separation within the greater trochanter (AUCs, 0.662-0.694) allowed discrimination of patients with fracture from control subjects. Femoral neck, total hip, and spine BMD did not differ between and did not allow discrimination between groups. FRAX scores including and not including BMD allowed discrimination between groups (AUCs, 0.681-0.773). Two-factor models (one MR imaging microarchitectural parameter plus a FRAX score without BMD) allowed discrimination between groups (AUCs, 0.702-0.806). There were no linear correlations between BMD and microarchitectural parameters (Spearman ρ, -0.198 to 0.196). Conclusion 3-T MR imaging of proximal femur microarchitecture allows discrimination between subjects with and without fragility fracture who have BMD T scores of greater than -2.5 and may provide different information about bone quality than that provided by dual-energy x-ray absorptiometry. © RSNA, 2018.
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Affiliation(s)
- Gregory Chang
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Chamith S Rajapakse
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Cheng Chen
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Arakua Welbeck
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Kenneth Egol
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Ravinder R Regatte
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Punam K Saha
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Stephen Honig
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
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Achievable accuracy of hip screw holding power estimation by insertion torque measurement. Clin Biomech (Bristol, Avon) 2018; 52:57-65. [PMID: 29360050 DOI: 10.1016/j.clinbiomech.2018.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To ensure stability of proximal femoral fractures, the hip screw must firmly engage into the femoral head. Some studies suggested that screw holding power into trabecular bone could be evaluated, intraoperatively, through measurement of screw insertion torque. However, those studies used synthetic bone, instead of trabecular bone, as host material or they did not evaluate accuracy of predictions. We determined prediction accuracy, also assessing the impact of screw design and host material. METHODS We measured, under highly-repeatable experimental conditions, disregarding clinical procedure complexities, insertion torque and pullout strength of four screw designs, both in 120 synthetic and 80 trabecular bone specimens of variable density. For both host materials, we calculated the root-mean-square error and the mean-absolute-percentage error of predictions based on the best fitting model of torque-pullout data, in both single-screw and merged dataset. FINDINGS Predictions based on screw-specific regression models were the most accurate. Host material impacts on prediction accuracy: the replacement of synthetic with trabecular bone decreased both root-mean-square errors, from 0.54 ÷ 0.76 kN to 0.21 ÷ 0.40 kN, and mean-absolute-percentage errors, from 14 ÷ 21% to 10 ÷ 12%. However, holding power predicted on low insertion torque remained inaccurate, with errors up to 40% for torques below 1 Nm. INTERPRETATION In poor-quality trabecular bone, tissue inhomogeneities likely affect pullout strength and insertion torque to different extents, limiting the predictive power of the latter. This bias decreases when the screw engages good-quality bone. Under this condition, predictions become more accurate although this result must be confirmed by close in-vitro simulation of the clinical procedure.
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19
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Paik JM, Kim SC, Feskanich D, Choi HK, Solomon DH, Curhan GC. Gout and Risk of Fracture in Women: A Prospective Cohort Study. Arthritis Rheumatol 2017; 69:422-428. [PMID: 27589491 DOI: 10.1002/art.39852] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/18/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Uric acid may be linked to bone health through its antioxidant or prooxidant effects, thereby affecting bone resorption and formation, or through its dual inhibition of vitamin D activation and parathyroid hormone production. Results of prior studies on the relationship between uric acid and bone mineral density have been conflicting. This prospective study was undertaken to examine the relationship between gout, a disease characterized by hyperuricemia and inflammation, and risk of hip or wrist fracture in women. METHODS We conducted a prospective observational study of gout and risk of incident wrist and hip fracture in women participating in the Nurses' Health Study (n = 103,799 at baseline, with 14 years of follow-up for the wrist fracture analysis and 22 years of follow-up for the hip fracture analysis). Gout history and incident cases of wrist and hip fracture were assessed by biennial questionnaire. Cox proportional hazards models were used to simultaneously adjust for potential confounders. RESULTS In this cohort, there were 3,769 incident wrist fractures (1990-2004) and 2,147 incident hip fractures (1990-2012), with 107 wrist fractures and 117 hip fractures occurring in participants with gout. In those women with a history of gout compared with women without gout, the multivariable-adjusted relative risk of wrist fracture was 1.12 (95% confidence interval [95% CI] 0.92-1.36) and the multivariable-adjusted relative risk of hip fracture was 1.38 (95% CI 1.14-1.68). CONCLUSION In women, a history of gout is associated with a modestly increased risk of hip fracture, but not significantly associated with a risk of wrist fracture.
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Affiliation(s)
- Julie M Paik
- Brigham and Women's Hospital, Harvard Medical School, and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Seoyoung C Kim
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Diane Feskanich
- Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Hyon K Choi
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel H Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gary C Curhan
- Brigham and Women's Hospital, Harvard Medical School, and Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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20
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Milovanovic P, Djonic D, Hahn M, Amling M, Busse B, Djuric M. Region-dependent patterns of trabecular bone growth in the human proximal femur: A study of 3D bone microarchitecture from early postnatal to late childhood period. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2017. [DOI: 10.1002/ajpa.23268] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Petar Milovanovic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine; University of Belgrade; Dr Subotica 4/2Belgrade 11000 Serbia
- Department of Osteology and Biomechanics; University Medical Center Hamburg-Eppendorf; Lottestrasse 55a Hamburg 22529 Germany
| | - Danijela Djonic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine; University of Belgrade; Dr Subotica 4/2Belgrade 11000 Serbia
| | - Michael Hahn
- Department of Osteology and Biomechanics; University Medical Center Hamburg-Eppendorf; Lottestrasse 55a Hamburg 22529 Germany
| | - Michael Amling
- Department of Osteology and Biomechanics; University Medical Center Hamburg-Eppendorf; Lottestrasse 55a Hamburg 22529 Germany
| | - Björn Busse
- Department of Osteology and Biomechanics; University Medical Center Hamburg-Eppendorf; Lottestrasse 55a Hamburg 22529 Germany
| | - Marija Djuric
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine; University of Belgrade; Dr Subotica 4/2Belgrade 11000 Serbia
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21
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Milovanovic P, Vukovic Z, Antonijevic D, Djonic D, Zivkovic V, Nikolic S, Djuric M. Porotic paradox: distribution of cortical bone pore sizes at nano- and micro-levels in healthy vs. fragile human bone. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:71. [PMID: 28357689 DOI: 10.1007/s10856-017-5878-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/28/2017] [Indexed: 06/06/2023]
Abstract
Bone is a remarkable biological nanocomposite material showing peculiar hierarchical organization from smaller (nano, micro) to larger (macro) length scales. Increased material porosity is considered as the main feature of fragile bone at larger length-scales. However, there is a shortage of quantitative information on bone porosity at smaller length-scales, as well as on the distribution of pore sizes in healthy vs. fragile bone. Therefore, here we investigated how healthy and fragile bones differ in pore volume and pore size distribution patterns, considering a wide range of mostly neglected pore sizes from nano to micron-length scales (7.5 to 15000 nm). Cortical bone specimens from four young healthy women (age: 35 ± 6 years) and five women with bone fracture (age: 82 ± 5 years) were analyzed by mercury porosimetry. Our findings showed that, surprisingly, fragile bone demonstrated lower pore volume at the measured scales. Furtnermore, pore size distribution showed differential patterns between healthy and fragile bones, where healthy bone showed especially high proportion of pores between 200 and 15000 nm. Therefore, although fragile bones are known for increased porosity at macroscopic level and level of tens or hundreds of microns as firmly established in the literature, our study with a unique assessment range of nano-to micron-sized pores reveal that osteoporosis does not imply increased porosity at all length scales. Our thorough assessment of bone porosity reveals a specific distribution of porosities at smaller length-scales and contributes to proper understanding of bone structure which is important for designing new biomimetic bone substitute materials.
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Affiliation(s)
- Petar Milovanovic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, Belgrade, 11000, Serbia
| | - Zorica Vukovic
- Department of Catalysis and Chemical Engineering, Institute of Chemistry, Technology and Metallurgy, University of Belgrade, 12 Njegoseva, Belgrade, 11000, Serbia
| | - Djordje Antonijevic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, Belgrade, 11000, Serbia
| | - Danijela Djonic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, Belgrade, 11000, Serbia
| | - Vladimir Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, 31a Deligradska, Belgrade, 11000, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, 31a Deligradska, Belgrade, 11000, Serbia
| | - Marija Djuric
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, Belgrade, 11000, Serbia.
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Janovic A, Milovanovic P, Hahn M, Rakocevic Z, Amling M, Busse B, Dimitrijevic M, Djuric M. Association between regional heterogeneity in the mid-facial bone micro-architecture and increased fragility along Le Fort lines. Dent Traumatol 2017; 33:300-306. [DOI: 10.1111/edt.12333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Aleksa Janovic
- Department of Radiology; Faculty of Dental Medicine; University of Belgrade; Belgrade Serbia
- Laboratory for Anthropology; Faculty of Medicine; Institute of Anatomy; University of Belgrade; Belgrade Serbia
- Department of Osteology & Biomechanics; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Petar Milovanovic
- Laboratory for Anthropology; Faculty of Medicine; Institute of Anatomy; University of Belgrade; Belgrade Serbia
- Department of Osteology & Biomechanics; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Michael Hahn
- Department of Osteology & Biomechanics; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Zoran Rakocevic
- Department of Radiology; Faculty of Dental Medicine; University of Belgrade; Belgrade Serbia
| | - Michael Amling
- Department of Osteology & Biomechanics; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Bjoern Busse
- Department of Osteology & Biomechanics; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Milovan Dimitrijevic
- Clinic of Otorhinolaryngology and Maxillofacial Surgery; Faculty of Medicine; Clinical Center of Serbia; University of Belgrade; Belgrade Serbia
| | - Marija Djuric
- Laboratory for Anthropology; Faculty of Medicine; Institute of Anatomy; University of Belgrade; Belgrade Serbia
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23
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Molecular mechanisms of osteoporotic hip fractures in elderly women. Exp Gerontol 2015; 73:49-58. [PMID: 26608808 DOI: 10.1016/j.exger.2015.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/28/2015] [Accepted: 11/19/2015] [Indexed: 11/24/2022]
Abstract
A common manifestation of age-related bone loss and resultant osteoporosis are fractures of the hip. Age-related osteoporosis is thought to be determined by a number of intrinsic factors including genetics, hormonal changes, changes in levels of oxidative stress, or an inflammatory status associated with the aging process. The aim of this study was to investigate gene expression and bone architecture in bone samples derived from elderly osteoporotic women with hip fractures (OP) in comparison to bone samples from age matched women with osteoarthritis of the hip (OA). Femoral heads and adjacent neck tissue were collected from 10 women with low-trauma hip fractures (mean age 83±6) and consecutive surgical hip replacement. Ten bone samples from patients undergoing hip replacement due to osteoarthritis (mean age 80±5) served as controls. One half of each bone sample was subjected to gene expression analysis. The second half of each bone sample was analyzed by microcomputed tomography. From each half, samples from four different regions, the central and subcortical region of the femoral head and neck, were analyzed. We could show a significantly decreased expression of the osteoblast related genes RUNX2, Osterix, Sclerostin, WNT10B, and Osteocalcin, a significantly increased ratio of RANKL to Osteoprotegerin, and a significantly increased expression of the enzymes superoxide dismutase 2 (SOD2) and glutathione peroxidase GPX3, and of the inflammatory cytokine IL6 in bone samples from hip fracture patients compared to controls. Major microstructural changes in OP bone were seen in the neck and were characterized by a significant decrease of bone volume, trabecular number, and connectivity density and a significant increase of trabecular separation. In conclusion, our data give evidence for a decreased expression of osteoblast related genes and increased expression of osteoclast related genes. Furthermore, increased expression of SOD2 and GPX3 suggest increased antioxidative activity in bone samples from elderly osteoporotic women with hip fractures.
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24
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Sprecher CM, Schmidutz F, Helfen T, Richards RG, Blauth M, Milz S. Histomorphometric Assessment of Cancellous and Cortical Bone Material Distribution in the Proximal Humerus of Normal and Osteoporotic Individuals: Significantly Reduced Bone Stock in the Metaphyseal and Subcapital Regions of Osteoporotic Individuals. Medicine (Baltimore) 2015; 94:e2043. [PMID: 26705200 PMCID: PMC4697966 DOI: 10.1097/md.0000000000002043] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Osteoporosis is a systemic disorder predominantly affecting postmenopausal women but also men at an advanced age. Both genders may suffer from low-energy fractures of, for example, the proximal humerus when reduction of the bone stock or/and quality has occurred.The aim of the current study was to compare the amount of bone in typical fracture zones of the proximal humerus in osteoporotic and non-osteoporotic individuals.The amount of bone in the proximal humerus was determined histomorphometrically in frontal plane sections. The donor bones were allocated to normal and osteoporotic groups using the T-score from distal radius DXA measurements of the same extremities. The T-score evaluation was done according to WHO criteria. Regional thickness of the subchondral plate and the metaphyseal cortical bone were measured using interactive image analysis.At all measured locations the amount of cancellous bone was significantly lower in individuals from the osteoporotic group compared to the non-osteoporotic one. The osteoporotic group showed more significant differences between regions of the same bone than the non-osteoporotic group. In both groups the subchondral cancellous bone and the subchondral plate were least affected by bone loss. In contrast, the medial metaphyseal region in the osteoporotic group exhibited higher bone loss in comparison to the lateral side.This observation may explain prevailing fracture patterns, which frequently involve compression fractures and certainly has an influence on the stability of implants placed in this medial region. It should be considered when planning the anchoring of osteosynthesis materials in osteoporotic patients with fractures of the proximal humerus.
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Affiliation(s)
- Christoph M Sprecher
- From the AO Research Institute Davos, Davos, Switzerland (CMS, FS, TH, RGR, SM); Department of Anatomy (CMS, SM); Department of Orthopaedic Surgery, University of Munich (LMU) (FS); Department of General-, Trauma-, Hand and Plastic Surgery, University of Munich (LMU), Munich, Germany (TH); and Department of Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria (MB)
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25
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Lee YH, Kim Y, Kim JJ, Jang IG. Homeostasis-based aging model for trabecular changes and its correlation with age-matched bone mineral densities and radiographs. Eur J Radiol 2015; 84:2261-8. [DOI: 10.1016/j.ejrad.2015.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 07/15/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
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26
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Bragdon B, Burns R, Baker AH, Belkina AC, Morgan EF, Denis GV, Gerstenfeld LC, Schlezinger JJ. Intrinsic Sex-Linked Variations in Osteogenic and Adipogenic Differentiation Potential of Bone Marrow Multipotent Stromal Cells. J Cell Physiol 2015; 230:296-307. [PMID: 24962433 DOI: 10.1002/jcp.24705] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/20/2014] [Indexed: 12/18/2022]
Abstract
Bone formation and aging are sexually dimorphic. Yet, definition of the intrinsic molecular differences between male and female multipotent mesenchymal stromal cells (MSCs) in bone is lacking. This study assessed sex-linked differences in MSC differentiation in 3-, 6-, and 9-month-old C57BL/6J mice. Analysis of tibiae showed that female mice had lower bone volume fraction and higher adipocyte content in the bone marrow compared to age-matched males. While both males and females lost bone mass in early aging, the rate of loss was higher in males. Similar expression of bone- and adipocyte-related genes was seen in males and females at 3 and 9 months, while at 6 months, females exhibited a twofold greater expression of these genes. Under osteogenic culture conditions, bone marrow MSCs from female 3- and 6-month-old mice expressed similar levels of bone-related genes, but significantly greater levels of adipocyte-related genes, than male MSCs. Female MSCs also responded to rosiglitazone-induced suppression of osteogenesis at a 5-fold lower (10 nM) concentration than male MSCs. Female MSCs grown in estrogen-stripped medium showed similar responses to rosiglitazone as MSCs grown in serum containing estrogen. MSCs from female mice that had undergone ovariectomy before sexual maturity also were sensitive to rosiglitazone-induced effects on osteogenesis. These results suggest that female MSCs are more sensitive to modulation of differentiation by PPARγ and that these differences are intrinsic to the sex of the animal from which the MSCs came. These results also may explain the sensitivity of women to the deleterious effects of rosiglitazone on bone.
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Affiliation(s)
- Beth Bragdon
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Robert Burns
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Amelia H Baker
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | - Anna C Belkina
- Department of Pharmacology, Boston University School of Medicine, Boston, Massachusetts
| | - Elise F Morgan
- Department of Mechanical Engineering, Boston University College of Engineering, Boston, Massachusetts
| | - Gerald V Denis
- Department of Pharmacology, Boston University School of Medicine, Boston, Massachusetts
| | - Louis C Gerstenfeld
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Jennifer J Schlezinger
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
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27
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Zhang R, Gong H, Zhu D, Ma R, Fang J, Fan Y. Multi-level femoral morphology and mechanical properties of rats of different ages. Bone 2015; 76:76-87. [PMID: 25857690 DOI: 10.1016/j.bone.2015.03.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 03/24/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
A macro-micro-nano-multi-level study was conducted to explore age-related structural and mechanical properties of bone, as well as the effects of aging on bone properties. A total of 70 male Wistar rats were used, ranging in the ages of 1, 3, 5, 7, 9, 11, 14, 15, 16, and 17 months (n = 7/age group). After micro-computed tomography (CT) scanning, longitudinal cortical bone specimens with a length of 5mm were cut along the femoral shaft axis from left femur shafts for mechanical testing, and the cross-sectional areas were measured. The macro-mechanical properties obtained in mechanical testing and microarchitecture parameters measured by micro-CT were significantly correlated with the animal age (r(2) = 0.96, p < 0.001). Scanning electron microscopy was used for detecting the microarchitecture features of the fractured surfaces, which exhibited age-related plate-fibrous-mixed fibrous-plate texture, resulting in changes in macro-mechanical properties (r(2) > 0.90, p < 0.001). The mineral phase of the left femoral shaft and head was analyzed by atomic force microscopy. Longitudinal and transverse trabecular bone tissues, as well as longitudinal cortical bone tissue, were used for nanoindentation test, and the chemical composition was evaluated by quantitative chemical analyses. The correlations between mineral content and bone material properties (i.e., elastic properties of the bone tissue and size and roughness of bone mineral grains) were highly significant (r > 0.95, p < 0.001). Multi-level femur morphology, mechanical property, and mineral content were significantly correlated with the animal age. The correlations between bone mineral content and bone material morphological and mechanical properties may partly explain the increase in bone fragility with aging, which will provide a theoretical basis for the investigation of age-related bone properties in clinics.
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Affiliation(s)
- Rui Zhang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China; Department of Engineering Mechanics, Nanling Campus, Jilin University, Changchun, People's Republic of China
| | - He Gong
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China.
| | - Dong Zhu
- Department of Orthopedic Surgery, No. 1 Hospital of Jilin University, Changchun, People's Republic of China
| | - Renshi Ma
- Department of Orthopedic Surgery, No. 1 Hospital of Jilin University, Changchun, People's Republic of China
| | - Juan Fang
- Department of Engineering Mechanics, Nanling Campus, Jilin University, Changchun, People's Republic of China
| | - Yobo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China; National Research Center for Rehabilitation Technical Aids, Beijing, People's Republic of China.
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28
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Milovanovic P, Adamu U, Simon MJK, Rolvien T, Djuric M, Amling M, Busse B. Age- and Sex-Specific Bone Structure Patterns Portend Bone Fragility in Radii and Tibiae in Relation to Osteodensitometry: A High-Resolution Peripheral Quantitative Computed Tomography Study in 385 Individuals. J Gerontol A Biol Sci Med Sci 2015; 70:1269-75. [DOI: 10.1093/gerona/glv052] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 04/02/2015] [Indexed: 11/12/2022] Open
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Gao J, Gong H, Zhang R, Zhu D. Age-related regional deterioration patterns and changes in nanoscale characterizations of trabeculae in the femoral head. Exp Gerontol 2015; 62:63-72. [PMID: 25582596 DOI: 10.1016/j.exger.2015.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/03/2014] [Accepted: 01/08/2015] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the mechanical properties and features of bone materials at the nanoscale level in different regions of the femoral head in elderly patients with femoral neck fracture. Ten femoral heads from female patients with femoral neck fractures were extracted during surgery (five for the Aged group, aged 65-66 years; five for the Advanced aged group, aged 85-95 years). The femoral head was divided into three equal layers (anterior, central, and posterior) in the coronal view, and each layer was segmented into five regions (superior, central, inferior, medial, and lateral). Nanoindentation testing and atomic force microscopy imaging were used to study the mechanical properties and surface morphology of the specimens. No statistical differences in grain size were found between age groups, which suggested that the nanostructure of trabeculae in the femoral heads of postmenopausal women cannot be used to predict age-related bone loss and fracture risk. Mechanical properties in the longitudinal direction deteriorated more quickly than those in the transverse direction for the whole femoral head. Comparisons between layers showed a higher deterioration rate with aging in the anterior layer than in other layers. In different regions, mechanical properties of the medial and lateral regions deteriorated more quickly than those in the three other regions, and deterioration in the longitudinal direction was more serious than that in the transverse direction. The regional deterioration patterns and material properties with aging observed in this study contribute to an understanding of the age-related fracture mechanism and provide a basis for predicting age-related fracture risk and decreasing early fixation failure in the proximal femur.
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Affiliation(s)
- Jiazi Gao
- Department of Engineering Mechanics, Jilin University, Changchun 130022, People's Republic of China
| | - He Gong
- Department of Engineering Mechanics, Jilin University, Changchun 130022, People's Republic of China.
| | - Rui Zhang
- Department of Engineering Mechanics, Jilin University, Changchun 130022, People's Republic of China
| | - Dong Zhu
- Traumatic Orthopedics, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
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30
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Djukic K, Milovanovic P, Hahn M, Busse B, Amling M, Djuric M. Bone microarchitecture at muscle attachment sites: The relationship between macroscopic scores of entheses and their cortical and trabecular microstructural design. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2014; 157:81-93. [DOI: 10.1002/ajpa.22691] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Ksenija Djukic
- Laboratory for Anthropology; Institute of Anatomy; Faculty of Medicine University of Belgrade; Belgrade Serbia
| | - Petar Milovanovic
- Laboratory for Anthropology; Institute of Anatomy; Faculty of Medicine University of Belgrade; Belgrade Serbia
| | - Michael Hahn
- Department of Osteology & Biomechanics; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Björn Busse
- Department of Osteology & Biomechanics; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Michael Amling
- Department of Osteology & Biomechanics; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - Marija Djuric
- Laboratory for Anthropology; Institute of Anatomy; Faculty of Medicine University of Belgrade; Belgrade Serbia
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31
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Janovic A, Milovanovic P, Saveljic I, Nikolic D, Hahn M, Rakocevic Z, Filipovic N, Amling M, Busse B, Djuric M. Microstructural properties of the mid-facial bones in relation to the distribution of occlusal loading. Bone 2014; 68:108-14. [PMID: 25093265 DOI: 10.1016/j.bone.2014.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/22/2014] [Accepted: 07/25/2014] [Indexed: 11/30/2022]
Abstract
Although the concept of the occlusal load transfer through the facial skeleton along the buttresses has been extensively studied, there has been no study to link microarchitecture of the mid-facial bones to the occlusal load distribution. The aim of this study was to analyze micro-structural properties of the mid-facial bones in relation to occlusal stress. The study was performed by combining the three-dimensional finite element analysis (3D FEA) and micro-computed tomography analysis (micro-CT). Clenching was simulated on the computer model of the adult male human skull which was also used as a source of bone specimens. After the FEA was run, stress was measured at the specific sites in cortical shell and trabecular bone of the model along and between the buttresses. From the corresponding sites on the skull, twenty-five cortical and thirteen cancellous bone specimens were harvested. The specimens were classified into high stress or low stress group based on the stress levels measured via the FEA. Micro-architecture of each specimen was assessed by micro-CT. In the high stress group, cortical bone showed a tendency toward greater thickness and density, lower porosity, and greater pore separation. Stress-related differences in microstructure between the groups were more pronounced in trabecular bone, which showed significantly greater bone volume fraction (BV/TV) and trabecular thickness (Tb.Th) in the high stress group. Our results suggest that the mid-facial bones in the adult dentate male skull exhibit regional variations in cortical and trabecular bone micro-architecture that could be a consequence of different occlusal stress.
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Affiliation(s)
- Aleksa Janovic
- Department of Radiology, School of Dentistry, University of Belgrade, 6 Rankeova, 11 000 Belgrade, Serbia; Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, 11 000 Belgrade, Serbia
| | - Petar Milovanovic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, 11 000 Belgrade, Serbia
| | - Igor Saveljic
- Bioengineering Research and Development Center (BioIRC), Faculty of Engineering, University of Kragujevac, 6 Prvoslava Stojanovica, 34 000 Kragujevac, Serbia
| | - Dalibor Nikolic
- Bioengineering Research and Development Center (BioIRC), Faculty of Engineering, University of Kragujevac, 6 Prvoslava Stojanovica, 34 000 Kragujevac, Serbia
| | - Michael Hahn
- Department of Osteology & Biomechanics, University Medical Center Hamburg-Eppendorf, 59 Lottestr., D-22529 Hamburg, Germany
| | - Zoran Rakocevic
- Department of Radiology, School of Dentistry, University of Belgrade, 6 Rankeova, 11 000 Belgrade, Serbia
| | - Nenad Filipovic
- Bioengineering Research and Development Center (BioIRC), Faculty of Engineering, University of Kragujevac, 6 Prvoslava Stojanovica, 34 000 Kragujevac, Serbia
| | - Michael Amling
- Department of Osteology & Biomechanics, University Medical Center Hamburg-Eppendorf, 59 Lottestr., D-22529 Hamburg, Germany
| | - Bjoern Busse
- Department of Osteology & Biomechanics, University Medical Center Hamburg-Eppendorf, 59 Lottestr., D-22529 Hamburg, Germany
| | - Marija Djuric
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, 11 000 Belgrade, Serbia.
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Milenkovic P, Djuric M, Milovanovic P, Djukic K, Zivkovic V, Nikolic S. The role of CT analyses of the sternal end of the clavicle and the first costal cartilage in age estimation. Int J Legal Med 2014; 128:825-39. [DOI: 10.1007/s00414-014-1026-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
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33
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Föger-Samwald U, Patsch JM, Schamall D, Alaghebandan A, Deutschmann J, Salem S, Mousavi M, Pietschmann P. Molecular evidence of osteoblast dysfunction in elderly men with osteoporotic hip fractures. Exp Gerontol 2014; 57:114-21. [PMID: 24862290 DOI: 10.1016/j.exger.2014.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/28/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
Osteoporosis is extremely frequent in post-menopausal women; nevertheless, osteoporosis in men is also a severe and frequently occurring but often underestimated disease. Increasing evidence links bone loss in male idiopathic osteoporosis and age related osteoporosis to osteoblast dysfunction rather than increased osteoclast activity as seen in postmenopausal osteoporosis. The aim of this study was to investigate gene expression of osteoblast related genes and of bone architecture in bone samples derived from elderly osteoporotic men with hip fractures (OP) in comparison to bone samples from age matched men with osteoarthritis of the hip (OA). Femoral heads and adjacent neck tissue were collected from 12 men with low-trauma hip fractures and consecutive surgical hip replacement. Bone samples of age matched patients undergoing hip replacement due to osteoarthritis served as controls. One half of the bone samples was subjected to RNA extraction, reverse transcription, and real-time polymerase chain reactions. The second half of the bone samples was analyzed by static histomorphometry. From each half samples from four different regions, the central and subcortical region of the femoral head and neck, were analyzed. OP patients displayed a significantly decreased RUNX2, Osterix and SOST expression compared to OA patients. Major microstructural changes in OP bone were seen in the subcortical region of the neck and were characterized by a significant decrease of bone volume, and a significant increase of trabecular separation. In conclusion, decreased local gene expression of RUNX2 and Osterix in men with hip fractures strongly supports the concept of osteoblast dysfunction in male osteoporosis. Major microstructural changes in the trabecular structure associated with osteoporotic hip fractures in men are localized in the subcortical region of the femoral neck.
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Affiliation(s)
- Ursula Föger-Samwald
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Janina M Patsch
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria; Department of Radiodiagnostics, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Doris Schamall
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Afarin Alaghebandan
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Julia Deutschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Sylvia Salem
- Department of Orthopaedics, St. Vincent Hospital Vienna, Stumpergasse 13, A-1060 Vienna, Austria.
| | - Mehdi Mousavi
- Department of Trauma Surgery, Danube Hospital, Langobardenstrasse 122, A-1220 Vienna, Austria.
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Milovanovic P, Rakocevic Z, Djonic D, Zivkovic V, Hahn M, Nikolic S, Amling M, Busse B, Djuric M. Nano-structural, compositional and micro-architectural signs of cortical bone fragility at the superolateral femoral neck in elderly hip fracture patients vs. healthy aged controls. Exp Gerontol 2014; 55:19-28. [PMID: 24614625 DOI: 10.1016/j.exger.2014.03.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 02/18/2014] [Accepted: 03/02/2014] [Indexed: 12/13/2022]
Abstract
To unravel the origins of decreased bone strength in the superolateral femoral neck, we assessed bone structural features across multiple length scales at this cortical fracture initiating region in postmenopausal women with hip fracture and in aged-matched controls. Our combined methodological approach encompassed atomic force microscopy (AFM) characterization of cortical bone nano-structure, assessment of mineral content/distribution via quantitative backscattered electron imaging (qBEI), measurement of bone material properties by reference point indentation, as well as evaluation of cortical micro-architecture and osteocyte lacunar density. Our findings revealed a wide range of differences between the fracture group and the controls, suggesting a number of detrimental changes at various levels of cortical bone hierarchical organization that may render bone fragile. Namely, mineral crystals at external cortical bone surfaces of the fracture group were larger (65.22nm±41.21nm vs. 36.75nm±18.49nm, p<0.001), and a shift to a higher mineral content and more homogenous mineralization profile as revealed via qBEI were found in the bone matrix of the fracture group. Fracture cases showed nearly 35% higher cortical porosity and showed significantly reduced osteocyte lacunar density compared to controls (226±27 vs. 247±32#/mm(2), p=0.05). Along with increased crystal size, a shift towards higher mineralization and a tendency to increased cortical porosity and reduced osteocyte lacunar number delineate that cortical bone of the superolateral femoral neck bears distinct signs of fragility at various levels of its structural organization. These results contribute to the understanding of hierarchical bone structure changes in age-related fragility.
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Affiliation(s)
- Petar Milovanovic
- Laboratory for Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade, 4/2 Dr Subotica, 11000 Belgrade, Serbia; Department of Osteology & Biomechanics, University Medical Center Hamburg-Eppendorf, 59 Lottestr., D-22529 Hamburg, Germany.
| | - Zlatko Rakocevic
- Laboratory for Atomic Physics, Institute of Nuclear Sciences Vinca, University of Belgrade, 11001 Belgrade, Serbia.
| | - Danijela Djonic
- Laboratory for Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade, 4/2 Dr Subotica, 11000 Belgrade, Serbia.
| | - Vladimir Zivkovic
- Institute of Forensic Medicine, School of Medicine, University of Belgrade, 31a Deligradska, 11000 Belgrade, Serbia.
| | - Michael Hahn
- Department of Osteology & Biomechanics, University Medical Center Hamburg-Eppendorf, 59 Lottestr., D-22529 Hamburg, Germany.
| | - Slobodan Nikolic
- Institute of Forensic Medicine, School of Medicine, University of Belgrade, 31a Deligradska, 11000 Belgrade, Serbia.
| | - Michael Amling
- Department of Osteology & Biomechanics, University Medical Center Hamburg-Eppendorf, 59 Lottestr., D-22529 Hamburg, Germany.
| | - Bjoern Busse
- Department of Osteology & Biomechanics, University Medical Center Hamburg-Eppendorf, 59 Lottestr., D-22529 Hamburg, Germany.
| | - Marija Djuric
- Laboratory for Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade, 4/2 Dr Subotica, 11000 Belgrade, Serbia.
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Vale AC, Aleixo IP, Lúcio M, Saraiva A, Caetano-Lopes J, Rodrigues A, Amaral PM, Rosa LG, Monteiro J, Fonseca JE, Vaz MF, Canhão H. At the moment of occurrence of a fragility hip fracture, men have higher mechanical properties values in comparison with women. BMC Musculoskelet Disord 2013; 14:295. [PMID: 24131745 PMCID: PMC4015558 DOI: 10.1186/1471-2474-14-295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 10/01/2013] [Indexed: 02/04/2023] Open
Abstract
Background It is well established that males have lower fracture risk in comparison with females, which suggests a higher bone resistance in men. The aim of our study was to find out if in older patients with hip fragility fractures, gender has also an impact on trabecular bone material behaviour, specifically to determine whether trabecular mechanical properties under compressive loading differ between men and women who suffered a fragility hip fracture. Methods Femoral epiphyses were consecutively collected during hip replacement surgery due to proximal femur fragility fracture. Trabecular bone cylinders were drilled and submitted to uniaxial compression tests and mechanical properties were assessed. Results Seventy-three patients, 55 women (mean age 81 years and standard deviation of 7 years) and 18 men (mean age 81 years and standard deviation of 8 years) were evaluated. The ultimate stress of trabecular bone was significantly higher in men than in women: the median values and the interquartile range (IQR) were respectively 8.04(5.35-10.90) MPa vs. 4.46(3.02-7.73) MPa, (p-value = 0.005). The same difference between male and female was observed in the Young’s modulus: 293.68(166.67-538.18) MPa vs. 174.26(73.07-322.28) MPa, (p-value = 0.028), and also in the energy to failure: 0.25(0.07-0.42) MJ/m3 vs. 0.11(0.05-0.25) MJ/m3, (p-value = 0.058). These differences were also verified after adjusting the analysis for age in a multivariate model analysis. Conclusions Our observations demonstrated that, even in a population who suffered a fragility hip fracture, men still have higher trabecular bone mechanical properties in comparison with women.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - João E Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
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Courtland HW, Kennedy OD, Wu Y, Gao Y, Sun H, Schaffler MB, Yakar S. Low levels of plasma IGF-1 inhibit intracortical bone remodeling during aging. AGE (DORDRECHT, NETHERLANDS) 2013; 35:1691-1703. [PMID: 22976122 PMCID: PMC3776121 DOI: 10.1007/s11357-012-9469-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 08/31/2012] [Indexed: 06/01/2023]
Abstract
Studies linking insulin-like growth factor-1 (IGF-1) to age-related bone loss in humans have been reported but remain only correlative. In this investigation, we characterized the bone phenotype of aged WT C57BL/6J male mice in comparison to that of C57BL/6J mice with reduced serum IGF-1 levels arising from an igfals gene deletion (ALS knockout (ALSKO)). During the aging process, WT mice showed an increase in fat mass and decrease lean mass while ALSKO mice had stable lean and fat mass values. Skeletal analyses of femora from WT mice revealed an expansion of the marrow area and a significant accumulation of intracortical porosity associated with increased intracortical remodeling. In contrast, ALSKO mice showed only small age-related declines in the amount of cortical bone tissue and minimal intracortical porosity, at 2 years of age. Accordingly, mechanical tests of femora from 2-year-old WT mice revealed reduced stiffness and maximal load when compared to bones from ALSKO mice. We show here that lifelong reductions in serum IGF-1 compromise skeletal size in development leading to slender bones; they are also associated with decreased intracortical bone remodeling and preservation of bone strength during aging.
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Affiliation(s)
- Hayden-William Courtland
- />Division of Endocrinology, Diabetes and Bone Diseases, Mount Sinai School of Medicine, New York, NY 10029 USA
| | - Oran D. Kennedy
- />Department of Biomedical Engineering, City College of New York, CUNY, New York, NY 10031 USA
| | - Yingjie Wu
- />Division of Endocrinology, Diabetes and Bone Diseases, Mount Sinai School of Medicine, New York, NY 10029 USA
- />David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010-4086 USA
| | - Ying Gao
- />Division of Endocrinology, Diabetes and Bone Diseases, Mount Sinai School of Medicine, New York, NY 10029 USA
| | - Hui Sun
- />Division of Endocrinology, Diabetes and Bone Diseases, Mount Sinai School of Medicine, New York, NY 10029 USA
- />David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010-4086 USA
| | - Mitchell B. Schaffler
- />Department of Biomedical Engineering, City College of New York, CUNY, New York, NY 10031 USA
| | - Shoshana Yakar
- />Division of Endocrinology, Diabetes and Bone Diseases, Mount Sinai School of Medicine, New York, NY 10029 USA
- />David B. Kriser Dental Center, Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010-4086 USA
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Djuric M, Milovanovic P, Djonic D, Hahn M, Marshall RP, Amling M. Issues in interstudy comparisons of bone microarchitecture. INTERNATIONAL ORTHOPAEDICS 2013; 37:2091-2. [PMID: 23963321 DOI: 10.1007/s00264-013-2069-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 08/03/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Marija Djuric
- Institute of Anatomy, Laboratory for Anthropology, University of Belgrade-School of Medicine, 4/2 Dr Subotica, 11000, Belgrade, Serbia,
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Sinclair KD, Farnsworth RW, Pham TX, Knight AN, Bloebaum RD, Skedros JG. The artiodactyl calcaneus as a potential ‘control bone’ cautions against simple interpretations of trabecular bone adaptation in the anthropoid femoral neck. J Hum Evol 2013; 64:366-79. [DOI: 10.1016/j.jhevol.2013.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 12/08/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
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Novel method to analyze post-yield mechanical properties at trabecular bone tissue level. J Mech Behav Biomed Mater 2013; 20:6-18. [DOI: 10.1016/j.jmbbm.2012.12.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/01/2012] [Accepted: 12/03/2012] [Indexed: 01/22/2023]
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40
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Milenkovic P, Djukic K, Djonic D, Milovanovic P, Djuric M. Skeletal age estimation based on medial clavicle—a test of the method reliability. Int J Legal Med 2013; 127:667-76. [DOI: 10.1007/s00414-012-0791-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 10/25/2012] [Indexed: 11/25/2022]
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41
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Djuric M, Zagorac S, Milovanovic P, Djonic D, Nikolic S, Hahn M, Zivkovic V, Bumbasirevic M, Amling M, Marshall RP. Enhanced trabecular micro-architecture of the femoral neck in hip osteoarthritis vs. healthy controls: a micro-computer tomography study in postmenopausal women. INTERNATIONAL ORTHOPAEDICS 2012. [PMID: 23180101 DOI: 10.1007/s00264-012-1713-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE A controversial relationship between osteoarthritis (OA) and bone fragility has been attracting considerable attention. However, despite interest in the effects of OA on femoral neck fracture risk and numerous studies analysing the changes in the arthritic femoral head, there is insufficient data about femoral neck 3D bone micro-architecture in individuals with hip osteoarthritis. We compared trabecular micro-architecture of the femoral neck between postmenopausal women with coxarthrosis and controls to explore whether coxarthrosis may indicate reduced bone fragility from the trabecular micro-architectural perspective. METHODS The study sample included nine women with hip osteoarthritis and 13 age-matched controls. The femoral neck sections were scanned using micro-computed tomography, evaluating the cancellous bone from the superolateral and inferomedial neck subregions. RESULTS Osteoarthritic subjects demonstrated a general trend of improved trabecular micro-architecture in both analysed subregions when compared with age-matched controls. In particular, several architectural properties that are important predictors of cancellous bone strength showed significantly better values in the OA group, even after adjusting for bone volume fraction. Namely, the OA group expressed higher trabecular connectivity (p = 0.008), lower SMI indicating more plate-like structure (p = 0.005), and reduced anisotropy (p = 0.006) particularly in the inferomedial neck. Osteoarthritic cases also trended towards higher BV/TV, particularly in the superolateral neck. All micro-architectural parameters displayed significant regional heterogeneity (p ≤ 0.01), with the inferomedial neck region showing more favourable values than the superolateral region. CONCLUSIONS Enhanced trabecular micro-architecture of the femoral neck in postmenopausal osteoarthritic subjects suggests reduced cancellous bone fragility in comparison with their age-matched healthy controls.
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Affiliation(s)
- Marija Djuric
- Institute of Anatomy, University of Belgrade, Belgrade, Serbia.
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Rutty GN, Brough A, Biggs MJP, Robinson C, Lawes SDA, Hainsworth SV. The role of micro-computed tomography in forensic investigations. Forensic Sci Int 2012; 225:60-6. [PMID: 23153801 DOI: 10.1016/j.forsciint.2012.10.030] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 08/13/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022]
Abstract
The use of micro-CT within forensic practice remains an emerging technology, principally due to its current limited availability to forensic practitioners. This review provides those with little or no previous experience of the potential roles of micro-CT in forensic practice with an illustrated overview of the technology, and the areas of practice in which micro-CT can potentially be applied to enhance forensic investigations.
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Affiliation(s)
- G N Rutty
- East Midlands Forensic Pathology Unit, University of Leicester, Leicester, UK.
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Milovanovic P, Djuric M, Rakocevic Z. Age-dependence of power spectral density and fractal dimension of bone mineralized matrix in atomic force microscope topography images: potential correlates of bone tissue age and bone fragility in female femoral neck trabeculae. J Anat 2012; 221:427-33. [PMID: 22946475 DOI: 10.1111/j.1469-7580.2012.01556.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2012] [Indexed: 11/28/2022] Open
Abstract
There is an increasing interest in bone nano-structure, the ultimate goal being to reveal the basis of age-related bone fragility. In this study, power spectral density (PSD) data and fractal dimensions of the mineralized bone matrix were extracted from atomic force microscope topography images of the femoral neck trabeculae. The aim was to evaluate age-dependent differences in the mineralized matrix of human bone and to consider whether these advanced nano-descriptors might be linked to decreased bone remodeling observed by some authors and age-related decline in bone mechanical competence. The investigated bone specimens belonged to a group of young adult women (n = 5, age: 20-40 years) and a group of elderly women (n = 5, age: 70-95 years) without bone diseases. PSD graphs showed the roughness density distribution in relation to spatial frequency. In all cases, there was a fairly linear decrease in magnitude of the power spectra with increasing spatial frequencies. The PSD slope was steeper in elderly individuals (-2.374 vs. -2.066), suggesting the dominance of larger surface morphological features. Fractal dimension of the mineralized bone matrix showed a significant negative trend with advanced age, declining from 2.467 in young individuals to 2.313 in the elderly (r = 0.65, P = 0.04). Higher fractal dimension in young women reflects domination of smaller mineral grains, which is compatible with the more freshly remodeled structure. In contrast, the surface patterns in elderly individuals were indicative of older tissue age. Lower roughness and reduced structural complexity (decreased fractal dimension) of the interfibrillar bone matrix in the elderly suggest a decline in bone toughness, which explains why aged bone is more brittle and prone to fractures.
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Affiliation(s)
- Petar Milovanovic
- Laboratory for Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade, Belgrade, Serbia
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Osterhoff G, Diederichs G, Tami A, Theopold J, Josten C, Hepp P. Influence of trabecular microstructure and cortical index on the complexity of proximal humeral fractures. Arch Orthop Trauma Surg 2012; 132:509-15. [PMID: 22200902 DOI: 10.1007/s00402-011-1446-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Poor bone quality increases the susceptibility to fractures of the proximal humerus. It is unclear whether local trabecular and cortical measures influence the severity of fracture patterns. The goal of this study was to assess parameters of trabecular and cortical bone properties and to compare these parameters with the severity of fractures and biomechanical testing. METHODS Twenty patients with displaced proximal humeral fractures planned for osteosynthesis were included. Fractures were classified as either 2-part fractures or complex fractures. Bone after core drilling was harvested during surgery from the humeral head in each patient. Twenty bone cores obtained from nonpaired cadaver humeral heads served as nonfractured controls. Micro-CT (μCT) was performed and bone volume/total volume (BV/TV), connectivity density (CD), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular spacing (Tb.Sp), and bone mineral density (BMD) were assessed. The cortical index (CI) was determined from AP plain films. Biomechanical testing was done after μCT scanning by axially loading until failure, and ultimate strength and E modulus were recorded. RESULTS BV/TV, BMD and CD showed moderate to strong correlations with biomechanical testing (r = 0.45-0.76, all p < 0.05). No significant differences were detected between the 2-part and complex fracture groups and controls regarding μCT and biomechanical parameters. CI was not significantly different between the 2-part and complex fracture groups. CONCLUSIONS In our study population local trabecular bone structure and cortical index could not predict the severity of proximal humeral fractures in the elderly. Complex fractures do not necessarily imply lower bone quality compared to simple fractures.
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Affiliation(s)
- Georg Osterhoff
- Department of Trauma and Reconstructive Surgery, University of Leipzig, Germany.
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Fisher AA, Srikusalanukul W, Davis MW, Smith PN. Clinical profiles and risk factors for outcomes in older patients with cervical and trochanteric hip fracture: similarities and differences. J Trauma Manag Outcomes 2012; 6:2. [PMID: 22333003 PMCID: PMC3295722 DOI: 10.1186/1752-2897-6-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/15/2012] [Indexed: 02/08/2023]
Abstract
Background Data on clinical characteristics and outcomes in regard to hip fracture (HF) type are controversial. This study aimed to evaluate whether clinical and laboratory predictors of poorer outcomes differ by HF type. Methods Prospective evaluation of 761 consecutively admitted patients (mean age 82.3 ± 8.8 years; 74.9% women) with low-trauma non-pathological HF. Clinical characteristics and short-term outcomes were recorded. Haematological, renal, liver and thyroid status, C-reactive protein, cardiac troponin I, serum 25(OH) vitamin D, PTH, leptin, adiponectin and resistin were determined. Results The cervical compared to the tronchanteric HF group was younger, have higher mean haemoglobin, albumin, adiponectin and resistin and lower PTH levels (all P < 0.05). In-hospital mortality, length of hospital stay (LOS), incidence of post-operative myocardial injury and need of institutionalisation were similar in both groups. Multivariate analysis revealed as independent predictors for in-hospital death in patient with cervical HF male sex, hyperparathyroidism and lower leptin levels, while in patients with trochanteric HF only hyperparathyroidism; for post-operative myocardial injury dementia, smoking and renal impairment in the former group and coronary artery disease (CAD), hyperparathyroidism and hypoleptinaemia in the latter; for LOS > 20 days CAD, and age > 75 years and hyperparathyroidism, respectively. Need of institutionalisation was predicted by age > 75 years and dementia in both groups and also by hypovitaminosis D in the cervical and by hyperparathyroidism in the trochanteric HF. Conclusions Clinical characteristics and incidence of poorer short-term outcomes in the two main HF types are rather similar but risk factors for certain outcomes are site-specific reflecting differences in underlying mechanisms.
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Affiliation(s)
- Alexander A Fisher
- Department of Geriatric Medicine, The Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia.
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Gosman JH, Stout SD, Larsen CS. Skeletal biology over the life span: a view from the surfaces. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2012; 146 Suppl 53:86-98. [PMID: 22101688 DOI: 10.1002/ajpa.21612] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The biocultural interpretation of skeletal remains is based upon the foundation of skeletal biology. In this review we examine the current state of skeletal biology research outside of the mainstream anthropology literature. The focus is on the structural changes of bone development and growth, and modeling and repair in the four bone surfaces: periosteal, Haversian, endosteal, and trabecular. The pattern of skeletal changes is placed within the framework of the human life span. New perspectives and direction of research on the environmental, biological, and genetic influences on modeling and remodeling processes are discussed chronologically at each bone surface. Implications for biological anthropologists are considered. This approach emphasizes variation in skeletal biology as a dynamic record of development, maturity, and aging.
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Affiliation(s)
- James H Gosman
- Department of Anthropology, 4034 Smith Laboratory, The Ohio State University, Columbus, OH 43210-1106, USA.
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Milovanovic P, Potocnik J, Djonic D, Nikolic S, Zivkovic V, Djuric M, Rakocevic Z. Age-related deterioration in trabecular bone mechanical properties at material level: Nanoindentation study of the femoral neck in women by using AFM. Exp Gerontol 2012; 47:154-9. [DOI: 10.1016/j.exger.2011.11.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 11/12/2011] [Accepted: 11/27/2011] [Indexed: 01/22/2023]
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Milovanovic P, Djonic D, Marshall RP, Hahn M, Nikolic S, Zivkovic V, Amling M, Djuric M. Micro-structural basis for particular vulnerability of the superolateral neck trabecular bone in the postmenopausal women with hip fractures. Bone 2012; 50:63-8. [PMID: 21964412 DOI: 10.1016/j.bone.2011.09.044] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 08/29/2011] [Accepted: 09/15/2011] [Indexed: 10/17/2022]
Abstract
In this study we analyzed the trabecular bone micro-architecture in the inferomedial and superolateral subregions of the femoral neck in a group with hip fractures and a control group of elderly women, with aim to clarify the micro-structural basis of bone fragility. Proximal femora from 29 Caucasian female cadavers were collected at Institute of Forensic Medicine in Belgrade (15 women with hip fracture: age 79.5±8.5 yrs.; and 14 women without hip fractures: age 74.1±9.3 yrs.). The femoral neck section was scanned in dry conditions using a micro-computed tomography (Scanco μCT 40), at 70 kV, 114 μA, 300 ms integration time, 36 μm resolution, isotropic, 1024×1024 pixels per slice, automatically evaluating trabecular micro-architecture using the built-in program of the micro-CT with direct 3D morphometry. The samples were foam padded to avoid any movement artifacts during scanning. Analysis of the neck section in the fracture group compared to the control cases demonstrated significantly lower bone volume fraction (mean: 6.3% vs. 11.2%, p=0.002), lower connectivity density (0.33/mm(3) vs. 0.74/mm(3), p=0.019) and higher trabecular separation (0.87 mm vs. 0.83 mm, p=0.030). Division into the superolateral and inferomedial regions of interest revealed that the superolateral neck displayed even more differences in micro-architectural properties between the fracture and non-fracture groups. Namely, while in the inferomedial neck only bone volume fraction and degree of anisotropy displayed significant inter-group variability (lower BV/TV with higher degree of anisotropy in the fracture group), in the superolateral neck almost all parameters were different between the fracture cases and the controls, where the fracture group showed a lower trabecular bone volume fraction (3.6% vs. 8.2%, p=0.001), lower connectivity (0.21 vs. 0.63/mm(3), p=0.008), more rod like trabecular structure (SMI: 2.94 vs. 2.62, p=0.049), higher separation and the thinned trabeculae (Tb.Sp: 0.89 vs. 0.85 mm, p=0.013; Tb.Th: 0.17 vs. 0.20 mm, p=0.05). In addition, after adjusting for the effects of BV/TV, the majority of differences disappeared, demonstrating that the bone loss manifests itself via the changes in micro-architectural parameters: trabecular thinning, rising the spacing between individual trabeculae, reducing trabecular connectivity and accentuating trabecular perforations leading to predominance of rod-like trabecular elements. Preferential impairment of the superolateral neck trabecular structure and organization in women with hip fracture reveals the region-dependent micro-structural basis of bone fragility in elderly women.
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Affiliation(s)
- Petar Milovanovic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, 11000 Belgrade, Serbia.
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Abstract
The age-related reduction in bone mass is disproportionally related to skeletal weakening, suggesting that microarchitectural changes are also important determinants of bone quality. The study of cortical and trabecular microstructure, which for many years was mainly based on two-dimensional histologic and scanning electron microscopy imaging, gained a tremendous momentum in the last decade and a half, due to the introduction of microcomputed tomography (μCT). This technology provides highly accurate qualitative and quantitative analyses based on three-dimensional images at micrometer resolution, which combined with finite elemental analysis predicts the biomechanical implications of microstructural changes. Global μCT analyses of trabecular bone have repeatedly suggested that the main age-related change in this compartment is a decrease in trabecular number with unaltered, or even increased, trabecular thickness. However, we show here that this may result from a bias whereby thick trabeculae near the cortex and the early clearance of thin struts mask authentic trabecular thinning. The main cortical age-related change is increased porosity due to negatively balanced osteonal remodeling and expansion of Haversian canals, which occasionally merge with endosteal and periosteal resorption bays, thus leading to rapid cortical thinning and cortical weakening. The recent emergence of CT systems with submicrometer resolution provides novel information on the age-related decrease in osteocyte lacunar density and related micropetrosis, the result of lacunar hypermineralization. Last but not least, the use of the submicrometer CT systems confirmed the occurrence of microcracks in the skeletal mineralized matrix and vastly advanced their morphologic characterization and mode of initiation and propagation.
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Affiliation(s)
- Yankel Gabet
- Department of Anatomy and Anthropology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
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Milovanovic P, Potocnik J, Stoiljkovic M, Djonic D, Nikolic S, Neskovic O, Djuric M, Rakocevic Z. Nanostructure and mineral composition of trabecular bone in the lateral femoral neck: implications for bone fragility in elderly women. Acta Biomater 2011; 7:3446-51. [PMID: 21658479 DOI: 10.1016/j.actbio.2011.05.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/16/2011] [Accepted: 05/22/2011] [Indexed: 11/17/2022]
Abstract
Despite interest in investigating age-related hip fractures, the determinants of decreased bone strength in advanced age are not clear enough. Hitherto it has been obscure how the aging process affects the femoral neck nanostructure and composition, particularly in the lateral subregion of the femoral neck, which is considered as a fracture-initiating site. The femoral bone samples used in this study were obtained at autopsy in 10 women without skeletal disease (five younger: aged 20-40 years, and five elderly: aged 73-94 years). Atomic force microscopy (AFM) was applied to explore the mineral grain size in situ in young vs. old trabecular bone samples from the lateral femoral neck. The chemical compositions of the samples were determined using inductively coupled plasma optical emission spectroscopy and direct current argon arc plasma optical emission spectrometry. Our AFM study revealed differences in trabecular bone nanostructure between young and elderly women. The mineral grain size in the trabeculae of the old women was larger than that in the young (median: 95 vs. 59nm), with a particular bimodal distribution: 45% were small grains (similar to the young) and the rest were larger. Since chemical analyses showed that levels of calcium and phosphorus were unchanged with age, our study suggests that during aging the existing bone mineral is reorganized and forms larger aggregates. Given the mechanical disadvantage of large-grained structures (decreased material strength), the observed nanostructural differences contribute to our understanding of the increased fragility of the lateral femoral neck in aged females. Moreover, increasing data on mineral grains in natural bone is essential for advancing calcium-phosphate ceramics for bone tissue replacement.
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