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Cirovic A, Djuric M, Milovanovic P. Deficiency of protein C or protein S as a possible cause of osteoporosis. Endocrine 2024; 85:558-565. [PMID: 38483687 DOI: 10.1007/s12020-024-03774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/07/2024] [Indexed: 08/16/2024]
Abstract
Proteins C and S are vitamin K-dependent anticoagulative factors that also exert a significant influence on bone quality. Clinical studies have linked the deficiency of proteins C and S to lower bone mineral density and the onset of femoral head osteonecrosis in children. Rare foundational studies analyzing this topic have demonstrated that activated protein C, upon binding to the endothelial protein C receptor expressed on the surface of osteoblasts, promotes osteoblast proliferation. It is also established that proteins C and S play crucial roles in proper collagen synthesis and in maintaining the number of osteoclasts and blood vessels. However, the association between protein C and/or S deficiency and the gradual onset of osteoporosis remains largely uninvestigated. Calculations based on data from peer-reviewed journals suggest that approximately one in every 10 individuals may develop osteoporosis due to congenital protein C or S deficiency. Moreover, when secondary causes of protein C and S deficiency are also considered, the proportion likely further increases. In this paper, we discuss the pathophysiological background of the potential relationship between protein C and S deficiency and the genesis of osteoporosis.
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Affiliation(s)
- Aleksandar Cirovic
- Center of Bone Biology, Institute of Anatomy, University of Belgrade - Faculty of Medicine, Dr Subotica 4/2, Belgrade, Serbia
| | - Marija Djuric
- Center of Bone Biology, Institute of Anatomy, University of Belgrade - Faculty of Medicine, Dr Subotica 4/2, Belgrade, Serbia
| | - Petar Milovanovic
- Center of Bone Biology, Institute of Anatomy, University of Belgrade - Faculty of Medicine, Dr Subotica 4/2, Belgrade, Serbia.
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Cirovic A, Schmidt FN, Vujacic M, Sihota P, Petrovic B, Zivkovic V, Bascarevic Z, Nikolic S, Djonic D, Djuric M, Busse B, Milovanovic P. Lower microhardness along with less heterogeneous mineralization in the femoral neck of individuals with type 2 diabetes mellitus indicates higher fracture risk. JBMR Plus 2024; 8:ziae005. [PMID: 38741606 PMCID: PMC11090112 DOI: 10.1093/jbmrpl/ziae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/02/2024] [Accepted: 01/08/2024] [Indexed: 05/16/2024] Open
Abstract
There is still limited understanding of the microstructural reasons for the higher susceptibility to fractures in individuals with type 2 diabetes mellitus (T2DM). In this study, we examined bone mineralization, osteocyte lacunar parameters, and microhardness of the femoral neck trabeculae in 18 individuals with T2DM who sustained low-energy fracture (T2DMFx: 78 ± 7 years, 15 women and 3 men) and 20 controls (74 ± 7 years, 16 women and 4 men). Femoral necks of the T2DMFx subjects were obtained at a tertiary orthopedic hospital, while those of the controls were collected at autopsy. T2DMFx individuals had lower trabecular microhardness (P = .023) and mineralization heterogeneity (P = .001), and a tendency to a lower bone area with mineralization above 95th percentile (P = .058) than the controls. There were no significant intergroup differences in the numbers of osteocyte lacunae per bone area, mineralized lacunae per bone area, and total lacunae per bone area (each P > .05). After dividing the T2DMFx group based on the presence of vascular complications (VD) to T2DMFxVD (VD present) and T2DMFxNVD (VD absent), we observed that microhardness was particularly reduced in the T2DMFxVD group (vs. control group, P = .02), while mineralization heterogeneity was significantly reduced in both T2DMFx subgroups (T2DMFxNVD vs. control, P = .002; T2DMFxVD vs. control, P = .038). The observed changes in mineralization and microhardness may contribute to the increased hip fracture susceptibility in individuals with T2DM.
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Affiliation(s)
- Aleksandar Cirovic
- Center of Bone Biology, Institute of Anatomy, University of Belgrade - Faculty of Medicine, 11000 Belgrade, Serbia
| | - Felix N Schmidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
- Interdisciplinary Competence Center for Interface Research (ICCIR), 20246 Hamburg, Germany
| | - Marko Vujacic
- Institute for Orthopedic Surgery “Banjica”; University of Belgrade - Faculty of Medicine, 11000 Belgrade, Serbia
| | - Praveer Sihota
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Bojan Petrovic
- Institute for Orthopedic Surgery “Banjica”; University of Belgrade - Faculty of Medicine, 11000 Belgrade, Serbia
| | - Vladimir Zivkovic
- Center of Bone Biology, Institute of Anatomy, University of Belgrade - Faculty of Medicine, 11000 Belgrade, Serbia
- Institute of Forensic Medicine, University of Belgrade - Faculty of Medicine, 11000 Belgrade, Serbia
| | - Zoran Bascarevic
- Institute for Orthopedic Surgery “Banjica”; University of Belgrade - Faculty of Medicine, 11000 Belgrade, Serbia
| | - Slobodan Nikolic
- Center of Bone Biology, Institute of Anatomy, University of Belgrade - Faculty of Medicine, 11000 Belgrade, Serbia
- Institute of Forensic Medicine, University of Belgrade - Faculty of Medicine, 11000 Belgrade, Serbia
| | - Danijela Djonic
- Center of Bone Biology, Institute of Anatomy, University of Belgrade - Faculty of Medicine, 11000 Belgrade, Serbia
| | - Marija Djuric
- Center of Bone Biology, Institute of Anatomy, University of Belgrade - Faculty of Medicine, 11000 Belgrade, Serbia
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
- Interdisciplinary Competence Center for Interface Research (ICCIR), 20246 Hamburg, Germany
| | - Petar Milovanovic
- Center of Bone Biology, Institute of Anatomy, University of Belgrade - Faculty of Medicine, 11000 Belgrade, Serbia
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Milovanovic P, Busse B. Micropetrosis: Osteocyte Lacunar Mineralization in Aging and Disease. Curr Osteoporos Rep 2023; 21:750-757. [PMID: 37917286 DOI: 10.1007/s11914-023-00832-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE OF REVIEW As the importance of osteocytes for bone mineral homeostasis is increasingly recognized, there is growing interest in osteocyte cell death as a relevant indicator in various physiological and pathological conditions. Micropetrosis is an established term used to describe osteocyte lacunae that are filled with minerals following osteocyte death. While the early reports of micropetrosis were purely descriptive, there is now an increasing body of literature showing quantitative data on micropetrosis in various conditions such as aging, osteoporosis, immobilization, and diabetes, and in osteoporosis treatment (denosumab and bisphosphonates). This review summarizes quantitative findings on micropetrosis, with a particular emphasis on the recent advances in the field. RECENT FINDINGS There is growing evidence that micropetrosis is more common in older, osteoporotic, and immobilized individuals, as well as in individuals with type 1 or type 2 diabetes. Denosumab and bisphosphonates seem to affect lacunar mineralization differently, where specifically bisphosphonates have been shown to prolong osteocyte viability and reduce micropetrosis. Despite continuous proceedings in the field of osteocyte-lacunar-network characteristics, more studies are necessary to further clarify the mechanisms of lacunar mineralization, the inter-site variability of micropetrosis accumulation, the relevance of micropetrosis in various diseases and conditions, and whether micropetrosis could be an indicator of bone fragility or a target for treatment.
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Affiliation(s)
- Petar Milovanovic
- Center of Bone Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Interdisciplinary Competence Center for Interface Research (ICCIR), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Cirovic A, Cirovic A. Letter to the Editor on "The relationship of multiple metals mixture and osteoporosis in elderly Chinese women: An aging and longevity study". ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 324:121351. [PMID: 36863434 DOI: 10.1016/j.envpol.2023.121351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Aleksandar Cirovic
- University of Belgrade, Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia.
| | - Ana Cirovic
- University of Belgrade, Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia
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Cifuentes-Mendiola SE, Solís-Suarez DL, Martínez-Davalos A, García-Hernández AL. Macrovascular and microvascular type 2 diabetes complications are interrelated in a mouse model. J Diabetes Complications 2023; 37:108455. [PMID: 36963291 DOI: 10.1016/j.jdiacomp.2023.108455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/07/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023]
Abstract
AIM Evaluate the development of multiple complications, their interactions, and common mechanisms in the same individual with T2D. MATERIAL AND METHODS 4-week-old male C57BL/6J mice were divided into: control (n = 6) and T2D (n = 6). T2D was induced through a high-carbohydrate-diet and low doses of streptozotocin. T2D was validated by metabolic parameters. Diabetic neuropathy was evaluated by mechanical and thermal sensitivity tests. We performed a histopathological analysis of the heart, kidney, liver, and parotid salivary glands and changes in bone microarchitecture by μCT. We calculated the relative risk (RR), odd ratios (OR) and Pearson correlation coefficients between the different complications and metabolic features. RESULTS T2D mice have cardiomyopathy, neuropathy, nephropathy, liver steatosis and fibrosis, structural damage in parotid salivary glands, and bone porosity. RR analysis shows that all complications are interrelated by hyperglycaemia, insulin resistance, obesity, and systemic inflammation. CONCLUSIONS T2D mice develop multiple complications simultaneously, which are related to each other, and this is associated with metabolic alterations. Our findings open up new approaches for the study and new therapeutic approaches of the pathophysiology of T2D and its complications.
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Affiliation(s)
- S E Cifuentes-Mendiola
- Laboratory of Dental Research, Section of Osteoimmunology and Oral Immunology, FES Iztacala, National Autonomous University of Mexico, A. Jiménez Gallardo SN, San Sebastián Xhala, Cuautitlán Izcalli, Estado de México CP 54714, Mexico
| | - D L Solís-Suarez
- Laboratory of Dental Research, Section of Osteoimmunology and Oral Immunology, FES Iztacala, National Autonomous University of Mexico, A. Jiménez Gallardo SN, San Sebastián Xhala, Cuautitlán Izcalli, Estado de México CP 54714, Mexico
| | - A Martínez-Davalos
- Physics institute, National Autonomous University of Mexico, Circuito de la Investigación Científica, Ciudad Universitaria, 04510 México City, Mexico
| | - A L García-Hernández
- Laboratory of Dental Research, Section of Osteoimmunology and Oral Immunology, FES Iztacala, National Autonomous University of Mexico, A. Jiménez Gallardo SN, San Sebastián Xhala, Cuautitlán Izcalli, Estado de México CP 54714, Mexico.
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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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Viryani NM, Soelistijo SA. Perioperative management of closed fracture subtrochanteric femur sinistra in type 2 diabetes mellitus with multiple comorbid: A case report. Int J Surg Case Rep 2022; 98:107536. [PMID: 36029658 PMCID: PMC9428833 DOI: 10.1016/j.ijscr.2022.107536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 10/27/2022] Open
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