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Antonacci G, Vanna R, Ventura M, Schiavone ML, Sobacchi C, Behrouzitabar M, Polli D, Manzoni C, Cerullo G. Birefringence-induced phase delay enables Brillouin mechanical imaging in turbid media. Nat Commun 2024; 15:5202. [PMID: 38898004 PMCID: PMC11187154 DOI: 10.1038/s41467-024-49419-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Acoustic vibrations of matter convey fundamental viscoelastic information that can be optically retrieved by hyperfine spectral analysis of the inelastic Brillouin scattered light. Increasing evidence of the central role of the viscoelastic properties in biological processes has stimulated the rise of non-contact Brillouin microscopy, yet this method faces challenges in turbid samples due to overwhelming elastic background light. Here, we introduce a common-path Birefringence-Induced Phase Delay (BIPD) filter to disentangle the polarization states of the Brillouin and Rayleigh signals, enabling the rejection of the background light using a polarizer. We demonstrate a 65 dB extinction ratio in a single optical pass collecting Brillouin spectra in extremely scattering environments and across highly reflective interfaces. We further employ the BIPD filter to image bone tissues from a mouse model of osteopetrosis, highlighting altered biomechanical properties compared to the healthy control. Results herald new opportunities in mechanobiology where turbid biological samples remain poorly characterized.
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Affiliation(s)
| | - Renzo Vanna
- CNR-Istituto di Fotonica e Nanotecnologie, CNR-IFN, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
| | - Marco Ventura
- CNR-Istituto di Fotonica e Nanotecnologie, CNR-IFN, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
| | | | - Cristina Sobacchi
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano (Milano), Italy
- CNR-Istituto di Ricerca Genetica e Biomedica (CNR-IRGB), UOS di Milano, via Fantoli 16/15, 20138, Milano, Italy
| | - Morteza Behrouzitabar
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
| | - Dario Polli
- Specto Photonics, Via Giulio e Corrado Venini 18, 20127, Milano, Italy
- CNR-Istituto di Fotonica e Nanotecnologie, CNR-IFN, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
| | - Cristian Manzoni
- CNR-Istituto di Fotonica e Nanotecnologie, CNR-IFN, Piazza Leonardo da Vinci 32, 20133, Milano, Italy.
| | - Giulio Cerullo
- CNR-Istituto di Fotonica e Nanotecnologie, CNR-IFN, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy
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2
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Kovács K, Váncsa S, Agócs G, Harnos A, Hegyi P, Weninger V, Baross K, Kovács B, Soós G, Kocsis G. Anisotropy, Anatomical Region, and Additional Variables Influence Young's Modulus of Bone: A Systematic Review and Meta-Analysis. JBMR Plus 2023; 7:e10835. [PMID: 38130752 PMCID: PMC10731124 DOI: 10.1002/jbm4.10835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/09/2023] [Accepted: 09/25/2023] [Indexed: 12/23/2023] Open
Abstract
The importance of finite element analysis (FEA) is growing in orthopedic research, especially in implant design. However, Young's modulus (E) values, one of the most fundamental parameters, can range across a wide scale. Therefore, our study aimed to identify factors influencing E values in human bone specimens. We report our systematic review and meta-analysis based on the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. We conducted the analysis on November 21, 2021. We included studies investigating healthy human bone specimens and reported on E values regarding demographic data, specimen characteristics, and measurement specifics. In addition, we included study types reporting individual specimen measurements. From the acquired data, we created a cohort in which we performed an exploratory data analysis that included the explanatory variables selected by random forest and regression trees methods, and the comparison of groups using independent samples Welch's t test. A total of 756 entries were included from 48 articles. Eleven different bones of the human body were included in these articles. The range of E values is between 0.008 and 33.7 GPa. The E values were most heavily influenced by the cortical or cancellous type of bone tested. Measuring method (compression, tension, bending, and nanoindentation), the anatomical region within a bone, the position of the bone within the skeleton, and the bone specimen size had a decreasing impact on the E values. Bone anisotropy, specimen condition, patient age, and sex were selected as important variables considering the value of E. On the basis of our results, E values of a bone change with bone characteristics, measurement techniques, and demographic variables. Therefore, the evaluation of FEA should be performed after the standardization of in vitro measurement protocol. © 2023 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)
- Krisztián Kovács
- Department of OrthopaedicsSemmelweis UniversityBudapestHungary
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - Szilárd Váncsa
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Institute for Translational Medicine, Szentágothai Research Centre, Medical SchoolUniversity of PécsPécsHungary
- Division of Pancreatic Diseases, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Gergely Agócs
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Department of Biophysics and Radiation BiologySemmelweis UniversityBudapestHungary
| | - Andrea Harnos
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Department of BiostatisticsUniversity of Veterinary MedicineBudapestHungary
| | - Péter Hegyi
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
- Institute for Translational Medicine, Szentágothai Research Centre, Medical SchoolUniversity of PécsPécsHungary
- Division of Pancreatic Diseases, Heart and Vascular CenterSemmelweis UniversityBudapestHungary
| | - Viktor Weninger
- Department of OrthopaedicsSemmelweis UniversityBudapestHungary
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - Katinka Baross
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - Bence Kovács
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - Gergely Soós
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
| | - György Kocsis
- Department of OrthopaedicsSemmelweis UniversityBudapestHungary
- Centre for Translational MedicineSemmelweis UniversityBudapestHungary
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3
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Colazo JM, Quirion J, Judice AD, Halpern J, Schwartz HS, Tanner SB, Lawrenz JM, Dahir KM, Holt GE. Utility of iliac crest tetracycline-labelled bone biopsy in osteoporosis and metabolic bone disease: An evaluation of 95 cases over a period of 25 years. Bone Rep 2023; 19:101715. [PMID: 37811524 PMCID: PMC10558706 DOI: 10.1016/j.bonr.2023.101715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background Metabolic bone diseases (MBD) are typically diagnosed by non-invasive imaging and clinical biomarkers. However, imaging does not provide structural information, and biomarkers can be transiently affected by many systemic factors. Bone biopsy and pathologic evaluation is the gold standard for diagnosis of MBD, however, it is rarely utilized. We describe our technique for iliac crest tetracycline-labelled bone using a cannulated drill and assess the utility of bone biopsies to provide diagnostic and therapeutic guidance. Methods In the 25-year period between March 1998 and January 2023, a total of 95 bone biopsies were performed on 94 patients for an osteological indication at Vanderbilt University Medical Center (VUMC). Patient demographics, bone biopsy indications, complications, diagnostic utility, and subsequent therapeutic guidance were retrospectively reviewed and analyzed. Results The procedure had minimal complications and was well tolerated by patients. This technique provided good quality specimens for pathology, which helped establish a diagnosis and treatment change in most patients. Patients that had biopsy-guided treatment alterations showed significant increases in Dual-Energy X-ray Absorptiometry (DEXA) bone mineral density (BMD) scores post-biopsy and subsequent treatment. Conclusion Despite scientific and technological progress in non-invasive diagnostic imaging, clinical biomarkers, and procedures for MBD, there remains a small but significant subset of patients who may benefit from inclusion of tetracycline-labelled bone biopsy into the diagnostic and therapeutic picture. Future prospective comparison studies are warranted. Mini abstract Tetracycline-labelled bone biopsies are under-utilized. Biopsy led to a histological diagnosis and ensuing treatment alteration in most patients with significant increases in bone mineral density. The biopsy procedure used herein provided good specimens with low pain/adverse events. Bone biopsy remains a valuable tool in a small, though significant, subset of patients.
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Affiliation(s)
- Juan M. Colazo
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Julia Quirion
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anthony D. Judice
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Halpern
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Herbert S. Schwartz
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S. Bobo Tanner
- Department of Medicine, Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua M. Lawrenz
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathryn M. Dahir
- Department of Medicine, Division of Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ginger E. Holt
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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4
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Qian W, Gamsjaeger S, Paschalis EP, Graeff-Armas LA, Bare SP, Turner JA, Lappe JM, Recker RR, Akhter MP. Bone intrinsic material and compositional properties in postmenopausal women diagnosed with long-term Type-1 diabetes. Bone 2023; 174:116832. [PMID: 37385427 PMCID: PMC11302406 DOI: 10.1016/j.bone.2023.116832] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
The incidence of diabetes mellitus and the associated complications are growing worldwide, affecting the patients' quality of life and exerting a considerable burden on health systems. Yet, the increase in fracture risk in type 1 diabetes (T1D) patients is not fully captured by bone mineral density (BMD), leading to the hypothesis that alterations in bone quality are responsible for the increased risk. Material/compositional properties are important aspects of bone quality, yet information on human bone material/compositional properties in T1D is rather sparse. The purpose of the present study is to measure both the intrinsic material behaviour by nanoindentation, and material compositional properties by Raman spectroscopy as a function of tissue age and microanatomical location (cement lines) in bone tissue from iliac crest biopsies from postmenopausal women diagnosed with long-term T1D (N = 8), and appropriate sex-, age-, BMD- and clinically-matched controls (postmenopausal women; N = 5). The results suggest elevation of advanced glycation endproducts (AGE) content in the T1D and show significant differences in mineral maturity / crystallinity (MMC) and glycosaminoglycan (GAG) content between the T1D and control groups. Furthermore, both hardness and modulus by nanoindentation are greater in T1D. These data suggest a significant deterioration of material strength properties (toughness) and compositional properties in T1D compared with controls.
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Affiliation(s)
- Wen Qian
- University of Nebraska, Lincoln, NE, USA
| | | | | | | | - Sue P Bare
- Osteoporosis Research Center, Creighton University, Omaha, NE, USA
| | | | - Joan M Lappe
- Osteoporosis Research Center, Creighton University, Omaha, NE, USA
| | - Robert R Recker
- Osteoporosis Research Center, Creighton University, Omaha, NE, USA
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5
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Ketsiri T, Uppuganti S, Harkins KD, Gochberg DF, Nyman JS, Does MD. Finite element analysis of bone mechanical properties using MRI-derived bound and pore water concentration maps. Comput Methods Biomech Biomed Engin 2023; 26:905-916. [PMID: 35822868 PMCID: PMC9837311 DOI: 10.1080/10255842.2022.2098016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/10/2022] [Accepted: 06/30/2022] [Indexed: 01/17/2023]
Abstract
Ultrashort echo time (UTE) MRI techniques can be used to image the concentration of water in bones. Particularly, quantitative MRI imaging of collagen-bound water concentration (Cbw) and pore water concentration (Cpw) in cortical bone have been shown as potential biomarkers for bone fracture risk. To investigate the effect of Cbw and Cpw on the evaluation of bone mechanical properties, MRI-based finite element models of cadaver radii were generated with tissue material properties derived from 3 D maps of Cbw and Cpw measurements. Three-point bending tests were simulated by means of the finite element method to predict bending properties of the bone and the results were compared with those from direct mechanical testing. The study results demonstrate that these MRI-derived measures of Cbw and Cpw improve the prediction of bone mechanical properties in cadaver radii and have the potential to be useful in assessing patient-specific bone fragility risk.
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Affiliation(s)
- Thammathida Ketsiri
- Biomedical Engineering, Vanderbilt University, Nashville, TN, United States
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, United States
| | - Sasidhar Uppuganti
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University, Nashville, TN, United States
- Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN, United States
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Kevin D. Harkins
- Biomedical Engineering, Vanderbilt University, Nashville, TN, United States
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, United States
- Radiology & Radiological Sciences, Vanderbilt University, Nashville, TN, United States
| | - Daniel F. Gochberg
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, United States
- Radiology & Radiological Sciences, Vanderbilt University, Nashville, TN, United States
- Department of Physics and Astronomy, Vanderbilt University, Nashville, TN, United States
| | - Jeffry S. Nyman
- Biomedical Engineering, Vanderbilt University, Nashville, TN, United States
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, United States
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University, Nashville, TN, United States
- Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN, United States
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mark D. Does
- Biomedical Engineering, Vanderbilt University, Nashville, TN, United States
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, United States
- Radiology & Radiological Sciences, Vanderbilt University, Nashville, TN, United States
- Electrical Engineering, Vanderbilt University, Nashville, TN, United States
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6
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Xia N, Cai Y, Kan Q, Xiao J, Cui L, Zhou J, Xu W, Liu D. The role of microscopic properties on cortical bone strength of femoral neck. BMC Musculoskelet Disord 2023; 24:133. [PMID: 36803341 PMCID: PMC9940427 DOI: 10.1186/s12891-023-06248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Femoral neck fractures are serious consequence of osteoporosis (OP), numbers of people are working on the micro-mechanisms of femoral neck fractures. This study aims to investigate the role and weight of microscopic properties on femoral neck maximum load (Lmax), funding the indicator which effects Lmax most. METHODS A total of 115 patients were recruited from January 2018 to December 2020. Femoral neck samples were collected during the total hip replacement surgery. Femoral neck Lmax, micro-structure, micro-mechanical properties, micro-chemical composition were all measured and analyzed. Multiple linear regression analyses were performed to identify significant factors that affected the femoral neck Lmax. RESULTS The Lmax, cortical bone mineral density (cBMD), cortical bone thickness (Ct. Th), elastic modulus, hardness and collagen cross-linking ratio were all significantly decreased, whereas other parameters were significantly increased during the progression of OP (P < 0.05). In micro-mechanical properties, elastic modulus has the strongest correlation with Lmax (P < 0.05). The cBMD has the strongest association with Lmax in micro-structure (P < 0.05). In micro-chemical composition, crystal size has the strongest correlation with Lmax (P < 0.05). Multiple linear regression analysis showed that elastic modulus was most strongly related to Lmax (β = 0.920, P = 0.000). CONCLUSIONS Compared with other parameters, elastic modulus has the greatest influence on Lmax. Evaluation of microscopic parameters on femoral neck cortical bone can clarify the effects of microscopic properties on Lmax, providing a theoretical basis for the femoral neck OP and fragility fractures.
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Affiliation(s)
- Ning Xia
- Department of Orthopedics, The General Hospital of Western Theater Command, Chengdu, 610083 China
| | - Yun Cai
- grid.443397.e0000 0004 0368 7493Department of Critical Care Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, 570311 China
| | - Qianhua Kan
- grid.263901.f0000 0004 1791 7667School of Mechanics and Aerospace Engineering, Southwest Jiaotong University, Chengdu, 611756 China
| | - Jian Xiao
- Department of Endocrinology, The General Hospital of Western Theater Command, Chengdu, 610083 China
| | - Lin Cui
- Department of Orthopedics, The General Hospital of Western Theater Command, Chengdu, 610083 China
| | - Jiangjun Zhou
- Department of Orthopedic, The 908Th Hospital of Joint Logistic Support Force of PLA, Nanchang, 330001 China
| | - Wei Xu
- Trauma Center, The General Hospital of Western Theater Command, Chengdu, 610083, China.
| | - Da Liu
- Department of Orthopedics, The General Hospital of Western Theater Command, Chengdu, 610083, China.
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Bonicelli A, Tay T, Cobb JP, Boughton OR, Hansen U, Abel RL, Zioupos P. Association between nanoscale strains and tissue level nanoindentation properties in age-related hip-fractures. J Mech Behav Biomed Mater 2023; 138:105573. [PMID: 36525874 DOI: 10.1016/j.jmbbm.2022.105573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022]
Abstract
Measurement of the properties of bone as a material can happen in various length scales in its hierarchical and composite structure. The aim of this study was to test the tissue level properties of clinically-relevant human bone samples which were collected from donors belonging to three groups: ageing donors who suffered no fractures (Control); untreated fracture patients (Fx-Untreated) and patient who experienced hip fracture despite being treated with bisphosphonates (Fx-BisTreated). Tissue level properties were assessed by (a) nanoindentation and (b) synchrotron tensile tests (STT) where strains were measured at the 'tissue', 'fibril' and 'mineral' levels by using simultaneous Wide-angle - (WAXD) and Small angle- X-ray diffraction (SAXD). The composition was analysed by thermogravimetric analysis and material level endo- and exo-thermic reactions by differential scanning calorimetry (TGA/DSC3+). Irrespective of treatment fracture donors exhibited significantly lower tissue, fibril and mineral strain at the micro and nanoscale respectively and had a higher mineral content than controls. In nanoindentation only nanohardness was significantly greater for Controls and Fx-BisTreated versus Fx-Untreated. The other nanoindentation parameters did not vary significantly across the three groups. There was a highly significant positive correlation (p < 0.001) between organic content and tissue level strain behaviour. Overall hip-fractures were associated with lower STT nanostrains and it was behaviour measured by STT which proved to be a more effective approach for predicting fracture risk because evidently it was able to demonstrate the mechanical deficit for the bone tissue of the donors who had experienced fractures.
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Affiliation(s)
- Andrea Bonicelli
- School of Natural Sciences, University of Central Lancashire, Preston, PR1 2HE, UK; Musculoskeletal & Medicolegal Research Group, Cranfield Forensic Institute, Defence Academy of the UK, Shrivenham, Swindon, SN6 8LA, UK
| | - Tabitha Tay
- MSk Laboratory, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W6 8PR, UK
| | - Justin P Cobb
- MSk Laboratory, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W6 8PR, UK
| | - Oliver R Boughton
- MSk Laboratory, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W6 8PR, UK
| | - Ulrich Hansen
- The Biomechanics Group, Department of Mechanical Engineering, Faculty of Engineering, London, SW7 2AZ, Imperial College London, London, UK
| | - Richard L Abel
- MSk Laboratory, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, W6 8PR, UK
| | - Peter Zioupos
- Musculoskeletal & Medicolegal Research Group, Cranfield Forensic Institute, Defence Academy of the UK, Shrivenham, Swindon, SN6 8LA, UK.
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8
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Sinnott AM, Krajewski KT, LaGoy AD, Beckner ME, Proessl F, Canino MC, Nindl BC, Turner RL, Lovalekar MT, Connaboy C, Flanagan SD. Prevention of Lower Extremity Musculoskeletal Injuries in Tactical and First Responder Populations: A Systematic Review and Meta-Analysis of Randomized Trials From 1955 to 2020. J Strength Cond Res 2023; 37:239-252. [PMID: 36026481 DOI: 10.1519/jsc.0000000000004293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT Sinnott, AM, Krajewski, KT, LaGoy, AD, Beckner, ME, Proessl, F, Canino, MC, Nindl, BC, Turner, RL, Lovalekar, MT, Connaboy, C, and Flanagan, SD. Prevention of lower extremity musculoskeletal injuries in tactical and first responder populations: A systematic review and meta-analysis of randomized trials from 1955 to 2020. J Strength Cond Res 37(1): 239-252, 2023-Lower extremity musculoskeletal injuries (LEMSIs) impose a significant burden on tactical and first responder populations. To determine the effectiveness of LEMSI prevention strategies, we performed a systematic review and meta-analysis of randomized controlled trials published in English from 1955 to 2020 (PROSPERO: CRD42018081799). MEDLINE, EMBASE, Cochrane, CINAHL, ProQuest, and DTIC databases were searched for trials that assigned military service members, police, firefighters, or paramedics to LEMSI prevention interventions with a minimum surveillance period of 12 weeks. Evidence was synthesized as odds ratios (OR) for LEMSI occurrence between individuals assigned to interventions and those assigned to standard activities. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0. Random-effects meta-analyses were conducted for (a) physical training and (b) footwear modifications to reduce LEMSI and (c) footwear modifications to reduce stress fractures specifically. Certainty in the body of evidence was determined with the GRADE approach. Of 28,499 records, 18 trials comprised of more than 11,000 subjects were synthesized. Interventions included physical training (8, N = 6,838), footwear modifications (8, N = 3,792), nutritional supplementation (1, N = 324), and training modifications (1, N = 350). Overall risk of bias was generally moderate ( N = 7 of 18) or high ( N = 9 of 18). Physical training (OR = 0.87, 95% CI [0.71, 1.08], p = 0.22, I 2 = 58.4%) and footwear modification (OR = 1.13, 95% CI [0.85, 1.49], p = 0.42, I 2 = 0.0%) did not reduce LEMSI or stress fractures (OR = 0.76, 95% CI [0.45, 1.28], p = 0.30, I 2 = 70.7%). Our results indicate that there is weak evidence to support current LEMSI prevention strategies. Future efforts will benefit from longer surveillance periods, assessment of women and nonmilitary populations, improved methodological rigor, and a greater breadth of approaches.
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Affiliation(s)
- Aaron M Sinnott
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Kellen T Krajewski
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Alice D LaGoy
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Meaghan E Beckner
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Felix Proessl
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Maria C Canino
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Bradley C Nindl
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Rose L Turner
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mita T Lovalekar
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Chris Connaboy
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Shawn D Flanagan
- Neuromuscular Research Laboratory and Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania; and
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9
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Gamsjaeger S, Rauch F, Glorieux FH, Paschalis EP. Cortical bone material / compositional properties in growing children and young adults aged 1.5-23 years, as a function of gender, age, metabolic activity, and growth spurt. Bone 2022; 165:116548. [PMID: 36122648 DOI: 10.1016/j.bone.2022.116548] [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: 04/21/2022] [Revised: 06/22/2022] [Accepted: 09/13/2022] [Indexed: 11/02/2022]
Abstract
Bone material / compositional properties are significant determinants of bone quality, thus strength. Raman spectroscopic analysis provides information on the quantity and quality of all three bone tissue components (mineral, organic matrix, and tissue water). The overwhelming majority of the published reports on the subject concern adults. We have previously reported on these properties in growing children and young adults, in the cancellous compartment. The purpose of the present study was to create normative reference data of bone material / compositional properties for children and young adults, in the cortical compartment. We performed Raman (Senterra (Bruker Optik GmbH), 50× objective, with an excitation of 785 nm (100 mW) and a lateral resolution of ~0.6 μm) microspectroscopic analysis of transiliac bone samples from 54 individuals between 1.5 and 23 years of age, with no known metabolic bone disease, and which have been previously used to establish histomorphometric, bone mineralization density distribution, and cancellous bone quality reference values. The bone quality indices that were determined were: mineral/matrix ratio (MM) from the integrated areas of the v2PO4 (410-460 cm-1) and the amide III (1215-1300 cm-1) bands, tissue water in nanopores approximated by the ratio of the integrated spectral area ~ 494-509 cm-1 to Amide III band, the glycosaminoglycan (GAG) content (ratio of integrated area 1365-1390 cm-1 to the Amide III band, the sulfated proteoglycan (sPG) content as the ratio of the integrated peaks ~1062 cm-1 and 1365-1390 cm-1, the pyridinoline (Pyd) content estimated from the ratio of the absorbance height at 1660 cm-1 / area of the amide I (1620-1700 cm-1) band, and the mineral maturity / crystallinity (MMC) estimated from the inverse of the full width at half height of the v1PO4 (930-980 cm-1) band. Analyses were performed at the three distinct cortical surfaces (endosteal, osteonal, periosteal) at specific anatomical microlocations, namely the osteoid, and the three precisely known tissue ages based on the presence of fluorescence double labels. Measurements were also taken in interstitial bone, a much older tissue that has undergone extensive secondary mineralization. Overall, significant dependencies of the measured parameters on tissue age were observed, while at any given tissue age, sex and subject age were minimal confounders. The established Raman database in the cortical compartments complements the previously published one in cancellous bone, and provides healthy baseline bone quality indices that may serve as a valuable tool to identify alterations due to pediatric disease.
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Affiliation(s)
- S Gamsjaeger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Heinrich Collin Str. 30, A-1140 Vienna, Austria
| | - F Rauch
- Shriners Hospitals for Children and McGill University, Montreal, QC H4A 0A9, Canada
| | - F H Glorieux
- Shriners Hospitals for Children and McGill University, Montreal, QC H4A 0A9, Canada
| | - E P Paschalis
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Heinrich Collin Str. 30, A-1140 Vienna, Austria.
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10
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Koirala N, Joshi J, Duffy SF, McLennan G. Percutaneous-Reinforced Osteoplasty: A Review of Emerging Treatment Strategies for Bone Interventions. J Clin Med 2022; 11:jcm11195572. [PMID: 36233434 PMCID: PMC9571370 DOI: 10.3390/jcm11195572] [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: 07/16/2022] [Revised: 09/11/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Percutaneous-reinforced osteoplasty is currently being investigated as a possible therapeutic procedure for fracture stabilization in high-risk patients, primarily in patients with bone metastases or osteoporosis. For these patients, a percutaneous approach, if structurally sound, can provide a viable method for treating bone fractures without the physiologic stress of anesthesia and open surgery. However, the low strength of fixation is a common limitation that requires further refinement in scaffold design and selection of materials, and may potentially benefit from tissue-engineering-based regenerative approaches. Scaffolds that have tissue regenerative properties and low inflammatory response promote rapid healing at the fracture site and are ideal for percutaneous applications. On the other hand, preclinical mechanical tests of fracture-repaired specimens provide key information on restoration strength and long-term stability and enable further design optimization. This review presents an overview of percutaneous-reinforced osteoplasty, emerging treatment strategies for bone repair, and basic concepts of in vitro mechanical characterization.
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Affiliation(s)
- Nischal Koirala
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH 44115, USA
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jyotsna Joshi
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH 44115, USA
| | - Stephen F. Duffy
- Department of Civil and Environmental Engineering, Cleveland State University, Cleveland, OH 44115, USA
| | - Gordon McLennan
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
- Correspondence:
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11
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Paschalis EP, Gamsjaeger S, Klaushofer K, Shane E, Cohen A, Stepan J, Pavo I, Eriksen EF, Taylor KA, Dempster DW. Treatment of postmenopausal osteoporosis patients with teriparatide for 24 months reverts forming bone quality indices to premenopausal healthy control values. Bone 2022; 162:116478. [PMID: 35779845 DOI: 10.1016/j.bone.2022.116478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022]
Abstract
Postmenopausal osteoporosis (PMOP) therapies are frequently evaluated by bone mineral density (BMD) gains against patients receiving placebo (calcium and vitamin D supplementation, a mild bone turnover-suppressing intervention), which is not equivalent to either healthy or treatment-naive PMOP. The aim of the present observational study was to assess the effects of TPTD treatment in PMOP (20 μg, once daily) at 6 (TPTD 6m; n = 28, age 65 ± 7.3 years), and 24 (TPTD 24m; n = 32, age 67.4 ± 6.15 years) months on bone quality indices at actively forming trabecular surfaces (with fluorescent double labels). Data from the TPTD-treated PMOP patients were compared with those in healthy adult premenopausal women (HC; n = 62, age 40.5 ± 10.6 years), and PMOP receiving placebo (PMOP-PLC; n = 94, age 70.6 ± 4.5 years). Iliac crest biopsies were analyzed by Raman microspectroscopy at three distinct tissue ages: mid-distance between the second label and the bone surface, mid-distance between the two labels, and 1 μm behind the first label. Mineral to matrix ratio (MM), mineral maturity/crystallinity (MMC), tissue water (TW), glycosaminoglycan (GAGs), and pyridinoline (Pyd) content were determined. Outcomes were compared by ANCOVA with subject age and tissue age as covariates, and health status as a fixed factor, followed by Sidak's post-hoc testing (significance assigned to p < 0.05). Both TPTD groups increased MM compared to PMOP-PLC. While TPTD 6m had values similar to HC, TPTD 24m had higher values compared to either HC or TPTD 6m. Both TPTD groups had lower MMC values compared to PMOP-PLC and similar to HC. TPTD 6m patients had higher TW content compared to HC, while TPTD 24m had values similar to HC and lower than either PMOP-PLC or TPTD 6m. Both TPTD groups had lower GAG content compared to HC group, while TPTD 6m had higher values compared to PMOP-PLC. Finally, TPTD 6m patients had higher Pyd content compared to HC and lower compared to PMOP-PLC, while TPTD 24m had lower values compared to PMOP-PLC and TPTD 6m, and similar to HC group. The results of the present study indicate that effects of TPTD on forming trabecular bone quality indices depend on treatment duration. At the recommended length of 24 m, TPTD restores bone mineral and organic matrix quality indices (MMC, TW, Pyd content) to premenopausal healthy (HC) levels.
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Affiliation(s)
- Eleftherios P Paschalis
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria.
| | - Sonja Gamsjaeger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Adi Cohen
- Early Onset Osteoporosis Center, Metabolic Bone Diseases Program, Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians & Surgeons, New York, NY, USA
| | - Jan Stepan
- Institute of Rheumatology, Faculty of Medicine 1, Charles University, Prague, Czech Republic
| | - Imre Pavo
- Eli Lilly and Company USA, LLC, Indianapolis, IN, USA
| | - Erik F Eriksen
- Department of Endocrinology, Pilestredet Park Specialist Center, Oslo, Norway; The Faculty of Dentistry, University of Oslo, Oslo, Norway
| | | | - David W Dempster
- Regional Bone Center, Helen Hayes Hospital, New York State Department of Health, West Haverstraw, NY, USA; Department of Pathology and Cell Biology, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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12
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Sinzinger F, van Kerkvoorde J, Pahr DH, Moreno R. Predicting the trabecular bone apparent stiffness tensor with spherical convolutional neural networks. Bone Rep 2022; 16:101179. [PMID: 35309107 PMCID: PMC8927924 DOI: 10.1016/j.bonr.2022.101179] [Citation(s) in RCA: 1] [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: 10/04/2021] [Revised: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 12/14/2022] Open
Abstract
The apparent stiffness tensor is relevant for characterizing trabecular bone quality. Previous studies have used morphology-stiffness relationships for estimating the apparent stiffness tensor. In this paper, we propose to train spherical convolutional neural networks (SphCNNs) to estimate this tensor. Information of the edges, trabecular thickness, and spacing are summarized in functions on the unitary sphere used as inputs for the SphCNNs. The concomitant dimensionality reduction makes it possible to train neural networks on relatively small datasets. The predicted tensors were compared to the stiffness tensors computed by using the micro-finite element method (μFE), which was considered as the gold standard, and models based on fourth-order fabric tensors. Combining edges and trabecular thickness yields significant improvements in the accuracy compared to the methods based on fourth-order fabric tensors. From the results, SphCNNs are promising for replacing the more expensive μFE stiffness estimations. Characteristic stiffness tensors are derived from trabecular bone micro-CT samples. Previous approximation methods fall short on heterogeneous data-sets. The gradient, trabecular thickness and spacing are mapped to a spherical domain. Spherical convolutional neural networks are used for the prediction. The prediction error is significantly reduced compared to the state-of-the-art.
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13
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Tice MJ, Bailey S, Sroga GE, Gallagher EJ, Vashishth D. Non‐Obese
MKR
Mouse Model of Type 2 Diabetes Reveals Skeletal Alterations in Mineralization and Material Properties. JBMR Plus 2021; 6:e10583. [PMID: 35229063 PMCID: PMC8861985 DOI: 10.1002/jbm4.10583] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/15/2021] [Accepted: 11/14/2021] [Indexed: 12/25/2022] Open
Abstract
Obesity is a common comorbidity of type 2 diabetes (T2D). Therefore, increased risk of fragility fractures in T2D is often confounded by the effects of obesity. This study was conducted to elucidate the mechanistic basis by which T2D alone leads to skeletal fragility. We hypothesized that obesity independent T2D would deteriorate bone's material quality by accumulating defects in the mineral matrix and undesired modifications in its organic matrix associated with increased oxidative stress and hyperglycemia. To test this hypothesis, we used 15‐week‐old male non‐obese mice with engineered muscle creatine kinase promoter/human dominant negative insulin growth factor 1 (IGF‐I) receptor (MKR) and FVB/N wild‐type (WT) controls (n = 12/group). MKR mice exhibit reduced insulin production and loss of glycemic control leading to diabetic hyperglycemia, verified by fasting blood glucose measurements (>250 mg/dL), without an increase in body weight. MKR mice showed a significant decrease in femoral radial geometry (cortical area, moment of inertia, cortical thickness, endosteal diameter, and periosteal diameter). Bone mineral density (BMD), as assessed by micro–computed tomography (μCT), remained unchanged; however, the quality of bone mineral was altered. In contrast to controls, MKR mice had significantly increased hydroxyapatite crystal thickness, measured by small‐angle X‐ray scattering, and elongated c‐axis length of the crystals evaluated by confocal Raman spectroscopy. There was an increase in changes in the organic matrix of MKR mice, associated with enhanced glycoxidation (carboxymethyl‐lysine [CML] and pentosidine) and overall glycation (fluorescent advanced glycation end products), both of which were associated with various measures of bone fragility. Moreover, increased CML formation positively correlated with elongated mineral crystal length, supporting the role of this negatively charged side chain to attract calcium ions, promote growth of hydroxyapatite, and build a physical link between mineral and collagen. Collectively, our results show, for the first time, changes in bone matrix in a non‐obese T2D model in which skeletal fragility is attributable to alterations in the mineral quality and undesired organic matrix modifications. © 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)
- Matthew J.L. Tice
- Department of Biomedical Engineering Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute New York NY USA
| | - Stacyann Bailey
- Department of Biomedical Engineering Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute New York NY USA
| | - Grażyna E. Sroga
- Department of Biomedical Engineering Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute New York NY USA
| | - Emily J. Gallagher
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine Icahn School of Medicine at Mount Sinai New York NY USA
| | - Deepak Vashishth
- Department of Biomedical Engineering Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute New York NY USA
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14
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Malagón-Escandón A, Hautefeuille M, Jimenez-Díaz E, Arenas-Alatorre J, Saniger JM, Badillo-Ramírez I, Vazquez N, Piñón-Zarate G, Castell-Rodríguez A. Three-Dimensional Porous Scaffolds Derived from Bovine Cancellous Bone Matrix Promote Osteoinduction, Osteoconduction, and Osteogenesis. Polymers (Basel) 2021; 13:4390. [PMID: 34960941 PMCID: PMC8705055 DOI: 10.3390/polym13244390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
The use of three-dimensional porous scaffolds derived from decellularized extracellular matrix (ECM) is increasing for functional repair and regeneration of injured bone tissue. Because these scaffolds retain their native structures and bioactive molecules, in addition to showing low immunogenicity and good biodegradability, they can promote tissue repair and regeneration. Nonetheless, imitating these features in synthetic materials represents a challenging task. Furthermore, due to the complexity of bone tissue, different processes are necessary to maintain these characteristics. We present a novel approach using decellularized ECM material derived from bovine cancellous bone by demineralization, decellularization, and hydrolysis of collagen to obtain a three-dimensional porous scaffold. This study demonstrates that the three-dimensional porous scaffold obtained from bovine bone retained its osteoconductive and osteoinductive properties and presented osteogenic potential when seeded with human Wharton's jelly mesenchymal stromal cells (hWJ-MSCs). Based on its characteristics, the scaffold described in this work potentially represents a therapeutic strategy for bone repair.
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Affiliation(s)
- Alda Malagón-Escandón
- Facultad de Medicina, UNAM, Mexico City C.P. 04510, Mexico; (A.M.-E.); (N.V.); (G.P.-Z.)
| | | | - Edgar Jimenez-Díaz
- Facultad de Ciencias, UNAM, Mexico City C.P. 04510, Mexico; (M.H.); (E.J.-D.)
| | | | - José Manuel Saniger
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), UNAM, Mexico City C.P. 04510, Mexico; (J.M.S.); (I.B.-R.)
| | - Isidro Badillo-Ramírez
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), UNAM, Mexico City C.P. 04510, Mexico; (J.M.S.); (I.B.-R.)
| | - Nadia Vazquez
- Facultad de Medicina, UNAM, Mexico City C.P. 04510, Mexico; (A.M.-E.); (N.V.); (G.P.-Z.)
| | - Gabriela Piñón-Zarate
- Facultad de Medicina, UNAM, Mexico City C.P. 04510, Mexico; (A.M.-E.); (N.V.); (G.P.-Z.)
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15
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Foessl I, Bassett JHD, Bjørnerem Å, Busse B, Calado Â, Chavassieux P, Christou M, Douni E, Fiedler IAK, Fonseca JE, Hassler E, Högler W, Kague E, Karasik D, Khashayar P, Langdahl BL, Leitch VD, Lopes P, Markozannes G, McGuigan FEA, Medina-Gomez C, Ntzani E, Oei L, Ohlsson C, Szulc P, Tobias JH, Trajanoska K, Tuzun Ş, Valjevac A, van Rietbergen B, Williams GR, Zekic T, Rivadeneira F, Obermayer-Pietsch B. Bone Phenotyping Approaches in Human, Mice and Zebrafish - Expert Overview of the EU Cost Action GEMSTONE ("GEnomics of MusculoSkeletal traits TranslatiOnal NEtwork"). Front Endocrinol (Lausanne) 2021; 12:720728. [PMID: 34925226 PMCID: PMC8672201 DOI: 10.3389/fendo.2021.720728] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/21/2021] [Indexed: 12/16/2022] Open
Abstract
A synoptic overview of scientific methods applied in bone and associated research fields across species has yet to be published. Experts from the EU Cost Action GEMSTONE ("GEnomics of MusculoSkeletal Traits translational Network") Working Group 2 present an overview of the routine techniques as well as clinical and research approaches employed to characterize bone phenotypes in humans and selected animal models (mice and zebrafish) of health and disease. The goal is consolidation of knowledge and a map for future research. This expert paper provides a comprehensive overview of state-of-the-art technologies to investigate bone properties in humans and animals - including their strengths and weaknesses. New research methodologies are outlined and future strategies are discussed to combine phenotypic with rapidly developing -omics data in order to advance musculoskeletal research and move towards "personalised medicine".
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Affiliation(s)
- Ines Foessl
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrine Lab Platform, Medical University of Graz, Graz, Austria
| | - J. H. Duncan Bassett
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Åshild Bjørnerem
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian Research Centre for Women’s Health, Oslo University Hospital, Oslo, Norway
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Ângelo Calado
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | | | - Maria Christou
- Department of Hygiene and Epidemiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Eleni Douni
- Institute for Bioinnovation, Biomedical Sciences Research Center “Alexander Fleming”, Vari, Greece
- Department of Biotechnology, Agricultural University of Athens, Athens, Greece
| | - Imke A. K. Fiedler
- Department of Osteology and Biomechanics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - João Eurico Fonseca
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Eva Hassler
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Wolfgang Högler
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Erika Kague
- The School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - David Karasik
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Patricia Khashayar
- Center for Microsystems Technology, Imec and Ghent University, Ghent, Belgium
| | - Bente L. Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Victoria D. Leitch
- Innovative Manufacturing Cooperative Research Centre, Royal Melbourne Institute of Technology, School of Engineering, Carlton, VIC, Australia
| | - Philippe Lopes
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, Medical School, University of Ioannina, Ioannina, Greece
| | | | | | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, Medical School, University of Ioannina, Ioannina, Greece
- Department of Health Services, Policy and Practice, Center for Research Synthesis in Health, School of Public Health, Brown University, Providence, RI, United States
| | - Ling Oei
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Lyon, France
| | - Jonathan H. Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, Bristol Medical School, Bristol, University of Bristol, Bristol, United Kingdom
| | - Katerina Trajanoska
- Department of Internal Medicine, Erasmus MC Rotterdam, Rotterdam, Netherlands
| | - Şansın Tuzun
- Physical Medicine & Rehabilitation Department, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Amina Valjevac
- Department of Human Physiology, School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Graham R. Williams
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Tatjana Zekic
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | | | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrine Lab Platform, Medical University of Graz, Graz, Austria
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16
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Fu Z, Huang X, Zhou P, Wu B, Cheng L, Wang X, Zhu D. Protective effects of low-magnitude high-frequency vibration on high glucose-induced osteoblast dysfunction and bone loss in diabetic rats. J Orthop Surg Res 2021; 16:650. [PMID: 34717702 PMCID: PMC8557505 DOI: 10.1186/s13018-021-02803-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/18/2021] [Indexed: 01/07/2023] Open
Abstract
Objective Low-magnitude high-frequency vibration (LMHFV) has been reported to be capable of promoting osteoblast proliferation and differentiation. Reduced osteoblast activity and impaired bone formation were related to diabetic bone loss. We investigated the potential protective effects of LMHFV on high-glucose (HG)-induced osteoblasts in this study. In addition, the assessment of LMHFV treatment for bone loss attributed to diabetes was also performed in vivo.
Method MC3T3-E1 cells induced by HG only or treated with LMHFV were treated in vitro. The experiments performed in this study included the detection of cell proliferation, migration and differentiation, as well as protein expression. Diabetic bone loss induced by streptozotocin (STZ) in rats was established. Combined with bone morphometric, microstructure, biomechanical properties and matrix composition tests, the potential of LMHFV in treating diabetes bone loss was explored. Results After the application of LMHFV, the inhibiting effects of HG on the proliferation, migration and differentiation of osteoblasts were alleviated. The GSK3β/β-catenin pathway was involved in the protective effect of LMHFV. Impaired microstructure and biomechanical properties attributed to diabetes were ameliorated by LMHFV treatment. The improvement of femur biomechanical properties might be associated with the alteration of the matrix composition by the LMHFV. Conclusion LMHFV exhibited a protective effect on osteoblasts against HG by regulating the proliferation, migration and differentiation of osteoblasts. The function of promoting bone formation and reinforcing bone strength made it possible for LMHFV to alleviate diabetic bone loss. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02803-w.
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Affiliation(s)
- Zhaoyu Fu
- Department of Orthopaedic Trauma, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xu Huang
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Pengcheng Zhou
- Department of Orthopaedic Trauma, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Bo Wu
- Department of Orthopaedic Trauma, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Long Cheng
- Department of Orthopaedic Trauma, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xinyu Wang
- Department of Orthopaedic Trauma, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Dong Zhu
- Department of Orthopaedic Trauma, The First Hospital of Jilin University, Changchun, Jilin, China.
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17
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Hoffseth K, Busse E, Jaramillo J, Simkin J, Lacey M, Sammarco MC. Age-Dependent Changes in Bone Architecture, Patterning, and Biomechanics During Skeletal Regeneration. Front Cell Dev Biol 2021; 9:749055. [PMID: 34722531 PMCID: PMC8548682 DOI: 10.3389/fcell.2021.749055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/22/2021] [Indexed: 12/21/2022] Open
Abstract
Mouse digit amputation provides a useful model of bone growth after injury, in that the injury promotes intramembranous bone formation in an adult animal. The digit tip is composed of skin, nerves, blood vessels, bones, and tendons, all of which regenerate after digit tip amputation, making it a powerful model for multi-tissue regeneration. Bone integrity relies upon a balanced remodeling between bone resorption and formation, which, when disrupted, results in changes to bone architecture and biomechanics, particularly during aging. In this study, we used recently developed techniques to evaluate bone patterning differences between young and aged regenerated bone. This analysis suggests that aged mice have altered trabecular spacing and patterning and increased mineral density of the regenerated bone. To further characterize the biomechanics of regenerated bone, we measured elasticity using a micro-computed tomography image-processing method combined with nanoindentation. This analysis suggests that the regenerated bone demonstrates decreased elasticity compared with the uninjured bone, but there is no significant difference in elasticity between aged and young regenerated bone. These data highlight distinct architectural and biomechanical differences in regenerated bone in both young and aged mice and provide a new analysis tool for the digit amputation model to aid in evaluating the outcomes for potential therapeutic treatments to promote regeneration.
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Affiliation(s)
- Kevin Hoffseth
- Department of Biological and Agricultural Engineering, Louisiana State University, Baton Rouge, LA, United States
| | - Emily Busse
- Department of Surgery, Tulane School of Medicine, New Orleans, LA, United States
| | - Josue Jaramillo
- Department of Surgery, Tulane School of Medicine, New Orleans, LA, United States
| | - Jennifer Simkin
- Department of Orthopaedic Surgery, Health Sciences Center, Louisiana State University, New Orleans, LA, United States
| | - Michelle Lacey
- Department of Mathematics, Tulane University, New Orleans, LA, United States
| | - Mimi C. Sammarco
- Department of Surgery, Tulane School of Medicine, New Orleans, LA, United States
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Yadav RN, Uniyal P, Sihota P, Kumar S, Dhiman V, Goni VG, Sahni D, Bhadada SK, Kumar N. Effect of ageing on microstructure and fracture behavior of cortical bone as determined by experiment and Extended Finite Element Method (XFEM). Med Eng Phys 2021; 93:100-112. [PMID: 34154770 DOI: 10.1016/j.medengphy.2021.05.021] [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: 10/07/2020] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
Bone fracture is a severe health concern; therefore, understanding the causes of bone fracture are crucial. This paper investigates the microstructure and fracture behaviour of cadaveric cortical bone of two different groups (Young, n= 6; Aged, n=7). The microstructure is obtained from µ-CT images, and the material parameters are measured with nanoindentation. Fracture behaviour in transverse and longitudinal orientations is investigated experimentally and numerically. The results show that the Haversian canal (HC) size increases and the osteon wall thickness (OWT) decreases significantly in the aged group, whereas a nonsignificant difference is found in tissue properties. The crack initiation (Jic) and crack growth (Jgrow) toughness of the aged group are found to be significantly lower (p<0.01) than the young group in the transverse orientation; however, for the longitudinal orientation, only the value of Jic in the aged group is found significantly lower. Further, a 4-phase XFEM (based on micro-CT image) model is developed to investigate the crack propagation behaviour in both orientations. For the transverse orientation, results show that in the aged group, the crack initially follows the cementline and then penetrates the osteon, whereas, in the young group, it propagates along the cementline. These results are in agreement with experimental results where the decrease in Jgrow is more significant than the Jic in the aged group. This study suggests that ageing leads to a larger HC and reduced OWT, which weakens the crack deflection ability and causes fragility fracture. Further, the XFEM results indicate that the presence of a small microcrack in the vicinity of a major crack tip causes an increase in the critical stress intensity factor.
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Affiliation(s)
- Ram Naresh Yadav
- Indian Institute of Technology Ropar, Rupnagar, Punjab, 140001, India
| | - Piyush Uniyal
- Indian Institute of Technology Ropar, Rupnagar, Punjab, 140001, India
| | - Praveer Sihota
- Indian Institute of Technology Ropar, Rupnagar, Punjab, 140001, India
| | - Sachin Kumar
- Indian Institute of Technology Ropar, Rupnagar, Punjab, 140001, India
| | - Vandana Dhiman
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Vijay G Goni
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Daisy Sahni
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sanjay Kumar Bhadada
- Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Navin Kumar
- Indian Institute of Technology Ropar, Rupnagar, Punjab, 140001, India.
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19
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Frank M, Reisinger AG, Pahr DH, Thurner PJ. Effects of Osteoporosis on Bone Morphometry and Material Properties of Individual Human Trabeculae in the Femoral Head. JBMR Plus 2021; 5:e10503. [PMID: 34189388 PMCID: PMC8216141 DOI: 10.1002/jbm4.10503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/30/2021] [Accepted: 04/10/2021] [Indexed: 12/02/2022] Open
Abstract
Osteoporosis is the most common bone disease and is conventionally classified as a decrease of total bone mass. Current diagnosis of osteoporosis is based on clinical risk factors and dual energy X‐ray absorptiometry (DEXA) scans, but changes in bone quantity (bone mass) and quality (trabecular structure, material properties, and tissue composition) are not distinguished. Yet, osteoporosis is known to cause a deterioration of the trabecular network, which might be related to changes at the tissue scale—the material properties. The goal of the current study was to use a previously established test method to perform a thorough characterization of the material properties of individual human trabeculae from femoral heads in cyclic tensile tests in a close to physiologic, wet environment. A previously developed rheological model was used to extract elastic, viscous, and plastic aspects of material behavior. Bone morphometry and tissue mineralization were determined with a density calibrated micro‐computed tomography (μCT) set‐up. Osteoporotic trabeculae neither showed a significantly changed material or mechanical behavior nor changes in tissue mineralization, compared with age‐matched healthy controls. However, donors with osteopenia indicated significantly reduced apparent yield strain and elastic work with respect to osteoporosis, suggesting possible initial differences at disease onset. Bone morphometry indicated a lower bone volume to total volume for osteoporotic donors, caused by a smaller trabecular number and a larger trabecular separation. A correlation of age with tissue properties and bone morphometry revealed a similar behavior as in osteoporotic bone. In the range studied, age does affect morphometry but not material properties, except for moderately increased tissue strength in healthy donors and moderately increased hardening exponent in osteoporotic donors. Taken together, the distinct changes of trabecular bone quality in the femoral head caused by osteoporosis and aging could not be linked to suspected relevant changes in material properties or tissue mineralization. © 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)
- Martin Frank
- Institute of Lightweight Design and Structural Biomechanics TU Wien Gumpendorfer Straße 7 Vienna 1060 Austria
| | - Andreas G Reisinger
- Department of Anatomy and Biomechanics, Division Biomechanics Karl Landsteiner University of Health Sciences Dr. Karl-Dorrek-Straße 30 Krems 3500 Austria
| | - Dieter H Pahr
- Institute of Lightweight Design and Structural Biomechanics TU Wien Gumpendorfer Straße 7 Vienna 1060 Austria.,Department of Anatomy and Biomechanics, Division Biomechanics Karl Landsteiner University of Health Sciences Dr. Karl-Dorrek-Straße 30 Krems 3500 Austria
| | - Philipp J Thurner
- Institute of Lightweight Design and Structural Biomechanics TU Wien Gumpendorfer Straße 7 Vienna 1060 Austria
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20
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Paschalis EP, Dempster DW, Gamsjaeger S, Rokidi S, Hassler N, Brozek W, Chan-Diehl FW, Klaushofer K, Taylor KA. Mineral and organic matrix composition at bone forming surfaces in postmenopausal women with osteoporosis treated with either teriparatide or zoledronic acid. Bone 2021; 145:115848. [PMID: 33453443 DOI: 10.1016/j.bone.2021.115848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/05/2023]
Abstract
The ability of bone to resist fracture is dependent on the composite nature of its mineral and organic matrix content. Teriparatide (TPTD) and zoledronic acid (ZOL) are approved anabolic and antiresorptive therapies, respectively, to reduce fracture risk in women with postmenopausal osteoporosis. In the SHOTZ study, postmenopausal women with osteoporosis were treated with TPTD (20 μg daily, subcutaneous) or ZOL (5 mg/year, intravenous infusion) for 24 months. Iliac crest biopsies were obtained at 6 months and again at 24 months from approximately one third of the original study cohort. To investigate the early effects of these two drugs on the quality of newly formed bone, we used vibrational spectroscopic techniques to analyze tetracycline-labelled transiliac biopsies obtained from participants at the 6-month time point. Raman spectra were acquired at forming trabecular and intra-cortical surfaces (identified by fluorescent double labels), to determine mineral, organic matrix, glycosaminoglycan, and tissue water content, as well as mineral maturity/crystallinity at three specific tissue ages (1-5, 15, and ≥25 days). Fourier transformed infrared microspectroscopy was used to determine pyridinoline/divalent collagen cross-link ratios. At 6 months, treatment with TPTD versus ZOL resulted in lower mineral and higher organic matrix content, increased tissue water content, and lower mineral/matrix, mineral maturity/crystallinity, glycosaminoglycan content, and pyridinoline/divalent enzymatic collagen cross-link ratio. Our results suggest that TPTD and ZOL have differential effects on material properties of newly formed bone at individual remodeling sites, highlighting their different mechanisms of action.
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Affiliation(s)
- Eleftherios P Paschalis
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - David W Dempster
- Regional Bone Center, Helen Hayes Hospital, New York State Department of Health, West Haverstraw, NY, USA; Department of Pathology and Cell Biology, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Sonja Gamsjaeger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Stamatia Rokidi
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Norbert Hassler
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Wolfgang Brozek
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
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21
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Gamsjaeger S, Eriksen EF, Paschalis EP. Effect of hormone replacement therapy on bone formation quality and mineralization regulation mechanisms in early postmenopausal women. Bone Rep 2021; 14:101055. [PMID: 33850974 PMCID: PMC8022851 DOI: 10.1016/j.bonr.2021.101055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 10/26/2022] Open
Abstract
Post-menopausal osteoporosis is characterized by a negative imbalance between bone formation and bone resorption resulting in a net bone loss, increasing the risk of fracture. One of the earliest interventions to protect against this was hormonal replacement therapy (HRT). Bone strength depends on both the amount and quality of bone, the latter including compositional / material and structural properties. Bone compositional / material properties are greatly dependent on both patient-, and tissue-age. Raman spectroscopy is an analytical tool ideally suited for the determination of bone compositional / material properties as a function of tissue age as it is capable of analyzing areas ~1 × 1 μm2 in tetracycline labeled bone forming areas. Using such analysis of humeri from an ovariectomized primate animal model, we reported that loss of estrogen results in alteration in the mineralization regulation mechanisms by osteoid organic matrix attributes at actively forming bone surfaces. In the present work, we used Raman microspectroscopic techniques to compare osteoid and youngest mineralized tissue composition, as well as relationships between osteoid organic matrix quality and quality attributes of the earliest mineralized tissue in paired iliac crest biopsies obtained from early postmenopausal women before and after two years of HRT therapy. Significant correlations between osteoid proteoglycans, sulfated proteoglycans, pyridinoline, and earliest mineralized tissue mineral content were observed, suggesting that in addition to changes in bone turnover rates, HRT affects the osteoid composition, mineralization regulation mechanisms, and potentially fibrillogenesis.
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Affiliation(s)
- S Gamsjaeger
- Ludwig Boltzmann Institute for Osteology, at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - E F Eriksen
- Department of Clinical Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - E P Paschalis
- Ludwig Boltzmann Institute for Osteology, at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
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22
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Unal M. Raman spectroscopic determination of bone matrix quantity and quality augments prediction of human cortical bone mechanical properties. J Biomech 2021; 119:110342. [PMID: 33706105 DOI: 10.1016/j.jbiomech.2021.110342] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/27/2020] [Accepted: 02/12/2021] [Indexed: 01/22/2023]
Abstract
Being independent contributors to bone mechanical resistance at the apparent level, quality and quantity of bone primary constituents are essential factors in better fracture risk assessment. Raman spectroscopy (RS) holds great potential for being a clinical tool with providing quality and quantity measurements of the bone mineralized matrix. Beyond mineral quality and quantity, recent years have revealed newly developed RS-derived bone compositional measurements focusing on organic matrix and water though their associations with bone mechanics have not been fully established yet. Herein, the author reported first thorough characterization study investigating associations between twenty different RS-derived measurements and mechanical properties of human cortical bone (i.e., yield and ultimate strength, elastic modulus, toughness, post-yield toughness, and post-yield strain). Forty-five rectangular human cortical beams harvested from all four anatomical quadrants of two male donors were tested under three-point bending. Raman spectra of each specimen were collected at the spectral range of 800 to 4000 cm-1. While correlations were tested among RS-derived measurements via Spearman's rank correlations, multivariate linear regression using mixed effects were used to determine the best RS-derived measurement or the combination of RS-derived measurements in predicting various mechanical properties of human cortical bone. Most of the RS-derived measurements were associated with the mechanical properties (Rm2 ranges from 8.9 to 68.3%, p < 0.05). The various linear combinations of six RS-derived measurements focusing on different aspects of bone matrix (i.e., ν1PO4/Amide I, ν1PO4/Amide III, Carbonate/ν1PO4, ~I1670/I1640, ~I3453/I2949, ~I3584/I2949) improved the prediction (Rm2 = 43.5 to 70.2%, p < 0.05). While a causal relationship still needs to be investigated, RS has a great potential to establish a robust patient-specific fracture risk prediction with the latest advances in technologies.
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Affiliation(s)
- Mustafa Unal
- Department of Mechanical Engineering, Karamanoglu Mehmetbey University, Karaman, Turkey; Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, USA.
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23
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Rokidi S, Andrade VFC, Borba V, Shane E, Cohen A, Zwerina J, Paschalis EP, Moreira CA. Bone tissue material composition is compromised in premenopausal women with Type 2 diabetes. Bone 2020; 141:115634. [PMID: 32927103 DOI: 10.1016/j.bone.2020.115634] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022]
Abstract
Type 2 diabetes mellitus (T2DM) patients are at an increased risk of fracture despite normal to high bone mineral density (BMD) values. In this cross-sectional study we establish bone compositional properties in tetracycline labeled iliac crest biopsies from premenopausal women diagnosed with T2DM (N = 26). Within group comparisons were made as a function of tissue age (TA), presence of chronic complications (CC), glycosylated haemoglobin (HbA1c) levels, and morphometric fracture (MFx). We also compared these data at actively trabecular bone forming surfaces against sex- and age-matched healthy controls (N = 32). The bone quality indices determined by Raman microspectroscopic analysis were: mineral/matrix (MM), tissue water content (nanoporosity; NanoP), mineral maturity/crystallinity (MMC), and glycosaminoglycan (GAG), pyridinoline (Pyd), N-(carboxymethyl)lysine (CML), and pentosidine (PEN) content. Within the T2DM group, at the oldest tissue, CML and PEN contents were significantly elevated in the cancellous compared to cortical compartment. The outcomes were not dependent on MFx. On the other hand, both were significantly elevated in patients with CC, as well as those with HbA1c levels > 7%. At actively forming surfaces, the cortical compartment had higher NanoP compared to cancellous. Still within the T2DM group, patients with MFx had significantly elevated MM and GAGs compared to the ones that did not. At actively forming trabecular surfaces, compared to healthy women, T2DM patients had elevated GAGs content and MMC. The results of this study indicate increased AGEs in those with poor glycation control and chronic complications. Additionally, T2DM patients had elevated MMC and decreased GAGs content compared to healthy controls. These alterations may be contributing to the T2DM inherent elevated fracture risk and suggest a role for hyperglycemia on bone quality.
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Affiliation(s)
- Stamatia Rokidi
- Ludwig Boltzmann Institute for Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Vicente F C Andrade
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil
| | - Victoria Borba
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil
| | - Elizabeth Shane
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Adi Cohen
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jochen Zwerina
- Ludwig Boltzmann Institute for Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Eleftherios P Paschalis
- Ludwig Boltzmann Institute for Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria.
| | - Carolina A Moreira
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil; Lab PRO, Bone Histomorphometry, Pro Renal Foundation, Curitiba, Brazil
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24
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Whyne CM, Ferguson D, Clement A, Rangrez M, Hardisty M. Biomechanical Properties of Metastatically Involved Osteolytic Bone. Curr Osteoporos Rep 2020; 18:705-715. [PMID: 33074529 DOI: 10.1007/s11914-020-00633-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Skeletal metastasis involves the uncoupling of physiologic bone remodeling resulting in abnormal bone turnover and radical changes in bony architecture, density, and quality. Bone strength assessment and fracture risk prediction are critical in clinical treatment decision-making. This review focuses on bone tissue and structural mechanisms altered by osteolytic metastasis and the resulting changes to its material and mechanical behavior. RECENT FINDINGS Both organic and mineral phases of bone tissue are altered by osteolytic metastatic disease, with diminished bone quality evident at multiple length-scales. The mechanical performance of bone with osteolytic lesions is influenced by a combination of tissue-level and structural changes. This review considers the effects of osteolytic metastasis on bone biomechanics demonstrating its negative impact at tissue and structural levels. Future studies need to assess the cumulative impact of cancer treatments on metastatically involved bone quality, and its utility in directing multimodal treatment planning.
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Affiliation(s)
- Cari M Whyne
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada.
- Department of Surgery, University of Toronto, Toronto, Canada.
- Biomedical Engineering, University of Toronto, Toronto, Canada.
| | - Dallis Ferguson
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
- Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Allison Clement
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Mohammedayaz Rangrez
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Michael Hardisty
- Orthopaedic Biomechanics Lab, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
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25
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Xi L, Song Y, Wu W, Qu Z, Wen J, Liao B, Tao R, Ge J, Fang D. Investigation of bone matrix composition, architecture and mechanical properties reflect structure-function relationship of cortical bone in glucocorticoid induced osteoporosis. Bone 2020; 136:115334. [PMID: 32224161 DOI: 10.1016/j.bone.2020.115334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/21/2020] [Accepted: 03/25/2020] [Indexed: 12/12/2022]
Abstract
Glucocorticoid induced osteoporosis (GIOP) is the most common negative consequence of long-term glucocorticoid treatment, leading to increased fracture risk followed by loss of mobility and high mortality risk. These biologically induced changes in bone quality at molecular level lead to changes both in bone matrix architecture and bone matrix composition. However, the quantitative details of changes in bone quality - and especially their link to reduced macroscale mechanical properties are still largely missing. In this study, a mouse model for glucocorticoid-induced osteoporosis (GIOP) was used to investigate mechanical and material alterations in bone cortex (natural nanocomposite) at different scale. By combining quantitative backscattered electron (qBSE) imaging, nanoindentation and high brilliance synchrotron X-ray nanomechanical imaging on a genetically modified mouse model of GIOP, we were able to quantify the local indentation modulus, mineralization distribution and the alterations of nanoscale structures and deformation mechanisms in the mid-diaphysis of femur, and relate them to the macroscopic mechanical changes. Our results showed clear and significant changes in terms of material quality of bone at nanoscale and microscale, which manifests itself in development of spatial heterogeneities in mineralization and indentation moduli across the bone organ, with potential implications for increased fracture risk.
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Affiliation(s)
- Li Xi
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing, China; School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK; Beamline I22, Diamond Light Source Ltd., Harwell Science and Innovation Campus, Oxfordshire, UK
| | - Yu Song
- College of Textiles, North Carolina State University, NC, USA
| | - Wenwang Wu
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, USA
| | - Zhaoliang Qu
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing, China
| | - Jiawei Wen
- Department of Mechanical Engineering, University of Moratuwa, Sri Lanka
| | - Binbin Liao
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing, China.
| | - Ran Tao
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing, China.
| | - Jingran Ge
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing, China.
| | - Daining Fang
- Institute of Advanced Structure Technology, Beijing Institute of Technology, Beijing, China; State Key Laboratory for Turbulence and Complex Systems, College of Engineering, Peking University, Beijing, China
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26
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Orduna G, Mellibovsky L, Abella E, Nogués X, Granero R, García-Giralt N, Pineda-Moncusí M, Güerri-Fernández R, Prieto-Alhambra D, Díez-Pérez A. Bone tissue quality in patients with monoclonal gammopathy of uncertain significance. J Bone Miner Metab 2020; 38:563-569. [PMID: 31974675 DOI: 10.1007/s00774-020-01084-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/06/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Monoclonal gammopathy of uncertain significance (MGUS) is highly prevalent in older adults and affects bone structure, with osteoporosis and increased risk of fractures in up to 14% of affected patients. Dual-energy X-ray absorptiometry (DXA), the standard technique for diagnosing osteoporosis, is ineffective to reveal microstructure and bone quality in this disease. MATERIALS AND METHODS We conducted a cross-sectional study of patients with MGUS, recruited consecutively from the Hematology and Internal Medicine Departments of Hospital del Mar, Barcelona, between January 2011 and January 2018. Medical records, clinical results and spinal X-ray images were collected. Bone mineral density (BMD) at hip and spine was measured by DXA and Bone Material Strength index (BMSi) by impact microindentation on the tibial mid-shaft. RESULTS Thirty-nine patients with MGUS and 65 age-matched controls without previous fractures were included. In the MGUS group, 11 (28.2%) patients had prevalent fractures, nearly half of them vertebral (n = 5, 45.45%). Compared to controls, MGUS patients had significantly lower BMSi, a mean (SD) of 70.72 (9.70) vs. 78.29 (8.70), p = 0.001, and lower spinal BMD values (0.900 [0.159] vs. 1.003 [0.168], respectively, p = 0.012), but no significant differences at femoral neck and total hip. No association was observed between BMSi and DXA. Bone remodeling markers (procollagen type-1 N propeptide, bone-alkaline phosphatase and C-terminal telopeptide of type I collagen) did not differ between the two groups. CONCLUSIONS Spinal BMD and mechanical properties of bone tissue, as measured by impact microindentation, were impaired in patients with MGUS. These changes in bone tissue mechanical resistance were independent of DXA levels.
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Affiliation(s)
- Guillermina Orduna
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Leonardo Mellibovsky
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Eugenia Abella
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Xavier Nogués
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain.
| | - Roser Granero
- Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain
| | - Natalia García-Giralt
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Marta Pineda-Moncusí
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Roberto Güerri-Fernández
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom, and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Adolfo Díez-Pérez
- Department of Internal Medicine, Musculoskeletal Research Group, Hospital del Mar-IMIM, Department of Medicine, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
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Nguyen Minh H, Du J, Raum K. Estimation of Thickness and Speed of Sound in Cortical Bone Using Multifocus Pulse-Echo Ultrasound. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:568-579. [PMID: 31647428 DOI: 10.1109/tuffc.2019.2948896] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Most bone loss during the development of osteoporosis occurs in cortical bone at the peripheral skeleton. Decreased cortical thickness (Ct.Th) and the prevalence of large pores at the tibia are associated with reduced bone strength at the hip. Ct.Th and cortical sound velocity, i.e., a surrogate marker for changes of cortical porosity (Ct.Po), are key biomarkers for the identification of patients at high fracture risk. In this study, we have developed a method using a conventional ultrasound array transducer to determine thickness (Ct.Th) and the compressional sound velocity propagating in the radial bone direction (Ct. ν11 ) using a refraction-corrected multifocus imaging approach. The method was validated in-silico on porous bone plate models using a 2-D finite-difference time-domain method and ex vivo on plate-shaped plastic reference materials and on plate-shaped cortical bovine tibia samples. Plane-wave pulse-echo measurements provided reference values to assess precision and accuracy of our method. In-silico results revealed the necessity to account for inclination-dependent transmission losses at the bone surface. Moreover, the dependence of Ct. ν11 on both porosity and pore density was observed. Ct.Th and Ct. ν11 obtained ex vivo showed a high correlation ) with reference values. The ex-vivo accuracy and precision for Ct. ν11 were 29.9 m/s and 0.94%, respectively, and those for Ct.Th were 0.04 mm and 1.09%, respectively. In conclusion, this numerical and experimental study demonstrates an accurate and precise estimation of Ct.Th and Ct. ν11 . The developed multifocus technique may have high clinical potential to improve fracture risk prediction using noninvasive and nonionizing conventional ultrasound technology with image guidance.
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Schoeb M, Hamdy NAT, Malgo F, Winter EM, Appelman-Dijkstra NM. Added Value of Impact Microindentation in the Evaluation of Bone Fragility: A Systematic Review of the Literature. Front Endocrinol (Lausanne) 2020; 11:15. [PMID: 32117052 PMCID: PMC7020781 DOI: 10.3389/fendo.2020.00015] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/09/2020] [Indexed: 12/22/2022] Open
Abstract
The current gold standard for the diagnosis of osteoporosis and the prediction of fracture risk is the measurement of bone mineral density (BMD) using dual energy x-ray absorptiometry (DXA). A low BMD is clearly associated with increased fracture risk, but BMD is not the only determinant of bone strength, particularly in secondary osteoporosis and metabolic bone disorders in which components other than BMD are affected and DXA often underestimates true fracture risk. Material properties of bone which significantly contribute to bone strength have become evaluable in vivo with the impact microindentation (IMI) technique using the OsteoProbe® device. The question arises whether this new tool is of added value in the evaluation of bone fragility. To this effect, we conducted a systematic review of all clinical studies using IMI in vivo in humans also addressing practical aspects of the technique and differences in study design, which may impact outcome. Search data generated 38 studies showing that IMI can identify patients with primary osteoporosis and fractures, patients with secondary osteoporosis due to various underlying systemic disorders, and scarce longitudinal data also show that this tool can detect changes in bone material strength index (BMSi), following bone-modifying therapy including use of corticosteroids. However, this main outcome parameter was not always concordant between studies. This systematic review also identified a number of factors that impact on BMSi outcome. These include subject- and disease-related factors such as the relationship between BMSi and age, geographical region and the presence of fractures, and technique- and operator-related factors. Taken together, findings from this systematic review confirm the added value of IMI for the evaluation and follow-up of elements of bone fragility, particularly in secondary osteoporosis. Notwithstanding, the high variability of BMSi outcome between studies calls for age-dependent reference values, and for the harmonization of study protocols. Prospective multicenter trials using standard operating procedures are required to establish the value of IMI in the prediction of future fracture risk, before this technique is introduced in routine clinical practice.
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Abstract
The main clinical tool for the diagnosis and treatment of skeletal diseases such as osteoporosis is the determination of bone mineral density by dual x-ray absorptiometry. Although this outcome contributes to the determination of bone strength, the clinical evidence to date suggests that it does not correlate strongly with fracture incidence. The main reason for this discrepancy is the fact that several other bone properties, such as material properties, are not taken into account. This short review summarizes the reasons why material properties are important in the determination of bone strength and briefly discusses some of them as well as their influence on bone’s mechanical performance.
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Affiliation(s)
- Eleftherios P Paschalis
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Heinrich Collin Strasse 30, Vienna, 1140, Austria
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Heinrich Collin Strasse 30, Vienna, 1140, Austria
| | - Markus A Hartmann
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Heinrich Collin Strasse 30, Vienna, 1140, Austria
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Unal M, Uppuganti S, Timur S, Mahadevan-Jansen A, Akkus O, Nyman JS. Assessing matrix quality by Raman spectroscopy helps predict fracture toughness of human cortical bone. Sci Rep 2019; 9:7195. [PMID: 31076574 PMCID: PMC6510799 DOI: 10.1038/s41598-019-43542-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 04/26/2019] [Indexed: 01/10/2023] Open
Abstract
Developing clinical tools that assess bone matrix quality could improve the assessment of a person's fracture risk. To determine whether Raman spectroscopy (RS) has such potential, we acquired Raman spectra from human cortical bone using microscope- and fiber optic probe-based Raman systems and tested whether correlations between RS and fracture toughness properties were statistically significant. Calculated directly from intensities at wavenumbers identified by second derivative analysis, Amide I sub-peak ratio I1670/I1640, not I1670/I1690, was negatively correlated with Kinit (N = 58; R2 = 32.4%) and J-integral (R2 = 47.4%) when assessed by Raman micro-spectroscopy. Area ratios (A1670/A1690) determined from sub-band fitting did not correlate with fracture toughness. There were fewer correlations between RS and fracture toughness when spectra were acquired by probe RS. Nonetheless, the I1670/I1640 sub-peak ratio again negatively correlated with Kinit (N = 56; R2 = 25.6%) and J-integral (R2 = 39.0%). In best-fit general linear models, I1670/I1640, age, and volumetric bone mineral density explained 50.2% (microscope) and 49.4% (probe) of the variance in Kinit. I1670/I1640 and v1PO4/Amide I (microscope) or just I1670/I1640 (probe) were negative predictors of J-integral (adjusted-R2 = 54.9% or 37.9%, respectively). While Raman-derived matrix properties appear useful to the assessment of fracture resistance of bone, the acquisition strategy to resolve the Amide I band needs to be identified.
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Affiliation(s)
- Mustafa Unal
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN, 37212, USA
| | - Sasidhar Uppuganti
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Selin Timur
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Anita Mahadevan-Jansen
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN, 37212, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37212, USA
| | - Ozan Akkus
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Orthopaedics, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Jeffry S Nyman
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN, 37212, USA.
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37212, USA.
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Fourier Transform Infrared Spectroscopy of Bone Tissue: Bone Quality Assessment in Preclinical and Clinical Applications of Osteoporosis and Fragility Fracture. Clin Rev Bone Miner Metab 2019. [DOI: 10.1007/s12018-018-9255-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Lowe T, Avcu E, Bousser E, Sellers W, Withers PJ. 3D Imaging of Indentation Damage in Bone. MATERIALS (BASEL, SWITZERLAND) 2018; 11:E2533. [PMID: 30551563 PMCID: PMC6316674 DOI: 10.3390/ma11122533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 11/27/2022]
Abstract
Bone is a complex material comprising high stiffness, but brittle, crystalline bio-apatite combined with compliant, but tough, collagen fibres. It can accommodate significant deformation, and the bone microstructure inhibits crack propagation such that micro-cracks can be quickly repaired. Catastrophic failure (bone fracture) is a major cause of morbidity, particularly in aging populations, either through a succession of small fractures or because a traumatic event is sufficiently large to overcome the individual crack blunting/shielding mechanisms. Indentation methods provide a convenient way of characterising the mechanical properties of bone. It is important to be able to visualise the interactions between the bone microstructure and the damage events in three dimensions (3D) to better understand the nature of the damage processes that occur in bone and the relevance of indentation tests in evaluating bone resilience and strength. For the first time, time-lapse laboratory X-ray computed tomography (CT) has been used to establish a time-evolving picture of bone deformation/plasticity and cracking. The sites of both crack initiation and termination as well as the interconnectivity of cracks and pores have been visualised and identified in 2D and 3D.
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Affiliation(s)
- Tristan Lowe
- Henry Moseley X-ray Imaging Facility, Henry Royce Institute, School of Materials, The University of Manchester, Manchester M13 9PL, UK.
| | - Egemen Avcu
- Henry Moseley X-ray Imaging Facility, Henry Royce Institute, School of Materials, The University of Manchester, Manchester M13 9PL, UK.
- Ford Otosan Ihsaniye Automotive Vocational School, Machine and Metal Technologies, Kocaeli University, 41680 Kocaeli, Turkey.
| | - Etienne Bousser
- Henry Moseley X-ray Imaging Facility, Henry Royce Institute, School of Materials, The University of Manchester, Manchester M13 9PL, UK.
- Engineering Physics Department, Polytechnique Montréal, Montreal H3T1J4, QC, Canada.
| | - William Sellers
- School of Earth and Environmental Sciences, The University of Manchester, Manchester M13 9PL, UK.
| | - Philip J Withers
- Henry Moseley X-ray Imaging Facility, Henry Royce Institute, School of Materials, The University of Manchester, Manchester M13 9PL, UK.
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Chang A, Easson GW, Tang SY. Clinical measurements of bone tissue mechanical behavior using reference point indentation. Clin Rev Bone Miner Metab 2018; 16:87-94. [PMID: 30983912 DOI: 10.1007/s12018-018-9249-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last thirty years, it has become increasingly clear the amount of bone (e.g. 'bone quantity') and the quality of the bone matrix (e.g. 'bone quality') both critically contribute to bone's tissue-level mechanical behavior and the subsequent ability of bone to resist fracture. Although determining the tissue-level mechanical behavior of bone through mechanical testing is relatively straightforward in the laboratory, the destructive nature of such testing is unfeasible in humans and in animal models requiring longitudinal observation. Therefore, surrogate measurements are necessary for quantifying tissue-level mechanical behavior for the pre-clinical and clinical evaluation of bone strength and fracture risk in vivo. A specific implementation of indentation known as reference point indentation (RPI) enables the mechanical testing of bone tissue without the need to excise and prepare the bone surface. However, this compromises the ability to carefully control the specimen geometry that is required to define the bone tissue material properties. Yet the versatility of such measurements in clinical populations is provocative, and to date there are a number of promising studies that have utilized this tool to discern bone pathologies and to monitor the effects of therapeutics on bone quality. Concurrently, on-going efforts continue to investigate the aspects of bone material behavior measured by RPI, and the compositional factors that contribute to these measurements. There are currently two variants, cyclic- and impact- RPI, that have been utilized in pre-clinical and clinical studies. This review surveys clinical studies that utilize RPI, with particular emphasis on the clinical instrument, as well as the endeavors to understand the fundamental mechanisms of such measurements. Ultimately, an improved awareness in the tradeoffs and limitations of in vivo RPI is critical towards the effective and successful utilization of this tool for the overall improvement of fragility determination in the clinic.
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Affiliation(s)
- Andrew Chang
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
| | - Garrett W Easson
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
| | - Simon Y Tang
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
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Bailey S, Vashishth D. Mechanical Characterization of Bone: State of the Art in Experimental Approaches-What Types of Experiments Do People Do and How Does One Interpret the Results? Curr Osteoporos Rep 2018; 16:423-433. [PMID: 29915968 PMCID: PMC8078087 DOI: 10.1007/s11914-018-0454-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The mechanical integrity of bone is determined by the direct measurement of bone mechanical properties. This article presents an overview of the current, most common, and new and upcoming experimental approaches for the mechanical characterization of bone. The key outcome variables of mechanical testing, as well as interpretations of the results in the context of bone structure and biology are also discussed. RECENT FINDINGS Quasi-static tests are the most commonly used for determining the resistance to structural failure by a single load at the organ (whole bone) level. The resistance to crack initiation or growth by fracture toughness testing and fatigue loading offers additional and more direct characterization of tissue material properties. Non-traditional indentation techniques and in situ testing are being increasingly used to probe the material properties of bone ultrastructure. Destructive ex vivo testing or clinical surrogate measures are considered to be the gold standard for estimating fracture risk. The type of mechanical test used for a particular investigation depends on the length scale of interest, where the outcome variables are influenced by the interrelationship between bone structure and composition. Advancement in the sensitivity of mechanical characterization techniques to detect changes in bone at the levels subjected to modifications by aging, disease, and/or pharmaceutical treatment is required. As such, a number of techniques are now available to aid our understanding of the factors that contribute to fracture risk.
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Affiliation(s)
- Stacyann Bailey
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY, 12180, USA
| | - Deepak Vashishth
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY, 12180, USA.
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Boughton OR, Ma S, Zhao S, Arnold M, Lewis A, Hansen U, Cobb JP, Giuliani F, Abel RL. Measuring bone stiffness using spherical indentation. PLoS One 2018; 13:e0200475. [PMID: 30001364 PMCID: PMC6042739 DOI: 10.1371/journal.pone.0200475] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/27/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives Bone material properties are a major determinant of bone health in older age, both in terms of fracture risk and implant fixation, in orthopaedics and dentistry. Bone is an anisotropic and hierarchical material so its measured material properties depend upon the scale of metric used. The scale used should reflect the clinical problem, whether it is fracture risk, a whole bone problem, or implant stability, at the millimetre-scale. Indentation, an engineering technique involving pressing a hard-tipped material into another material with a known force, may be able to assess bone stiffness at the millimetre-scale (the apparent elastic modulus). We aimed to investigate whether spherical-tip indentation could reliably measure the apparent elastic modulus of human cortical bone. Materials and methods Cortical bone samples were retrieved from the femoral necks of nineteen patients undergoing total hip replacement surgery (10 females, 9 males, mean age: 69 years). The samples underwent indentation using a 1.5 mm diameter, ruby, spherical indenter tip, with sixty indentations per patient sample, across six locations on the bone surfaces, with ten repeated indentations at each of the six locations. The samples then underwent mechanical compression testing. The repeatability of indentation measurements of elastic modulus was assessed using the co-efficient of repeatability and the correlation between the bone elastic modulus measured by indentation and compression testing was analysed by least-squares regression. Results In total, 1140 indentations in total were performed. Indentation was found to be repeatable for indentations performed at the same locations on the bone samples with a mean co-efficient of repeatability of 0.4 GigaPascals (GPa), confidence interval (C.I): 0.33–0.42 GPa. There was variation in the indentation modulus results between different locations on the bone samples (mean co-efficient of repeatability: 3.1 GPa, C.I: 2.2–3.90 GPa). No clear correlation was observed between indentation and compression values of bone elastic modulus (r = 0.33, p = 0.17). The mean apparent elastic modulus obtained by spherical indentation was 9.9 GPa, the standard deviation for each indent cycle was 0.11 GPa, and the standard deviation between locations on the same sample was 1.01 GPa. The mean compression apparent elastic modulus was 4.42 GPa, standard deviation 1.02 GPa. Discussion Spherical-tip indentation was found to be a repeatable test for measuring the elastic modulus of human cortical bone, demonstrated by a low co-efficient of repeatability in this study. It could not, however, reliably predict cortical bone elastic modulus determined by platens compression testing in this study. This may be due to indentation only probing mechanical properties at the micro-scale while platens compression testing assesses millimetre length-scale properties. Improvements to the testing technique, including the use of a larger diameter spherical indenter tip, may improve the measurement of bone stiffness at the millimetre scale and should be investigated further.
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Affiliation(s)
- Oliver R. Boughton
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, United Kingdom
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, United Kingdom
- * E-mail:
| | - Shaocheng Ma
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, United Kingdom
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Sarah Zhao
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Matthew Arnold
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Angus Lewis
- Orthopaedic Surgery Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ulrich Hansen
- The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Justin P. Cobb
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Finn Giuliani
- Centre for Advanced Structural Ceramics, Department of Mechanical Engineering and Materials, Imperial College London, South Kensington Campus, London, United Kingdom
| | - Richard L. Abel
- The MSk Lab, Imperial College London, Charing Cross Hospital, London, United Kingdom
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Reina-Romo E, Rodríguez-Vallés J, Sanz-Herrera JA. In silico dynamic characterization of the femur: Physiological versus mechanical boundary conditions. Med Eng Phys 2018; 58:S1350-4533(18)30090-0. [PMID: 29945761 DOI: 10.1016/j.medengphy.2018.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 02/06/2023]
Abstract
It is established that bone tissue adapts and responds to mechanical loading. Several studies have suggested an existence of positive influence of vibration on the bone mass maintenance. Thus, some bone regeneration therapies are based on vibration of bone tissue under circumstances of disease to stimulate its formation. Frequency of loading should be properly selected and therefore a correct characterization of the dynamic properties of this tissue may be critical for the success of such orthopedic techniques. On the other hand, many studies implement vibration techniques with in silico models. Numerical results are exclusively dependent on properties of bone tissue, i.e. geometry, density distribution and stiffness, as well as boundary conditions. In the present study, the influence of boundary conditions and material properties on the dynamic characteristics of bone tissue was explored in a human femur. Bone shape and density were directly reconstructed from computer tomographies, whereas natural frequencies and modes of vibration were obtained for different boundary conditions including physiological and mechanical ones. Results of this study show the moderate effect of material properties compared to the much substantial effect of boundary conditions. A factor of 2 in the natural frequency was obtained depending on imposed boundary conditions, highlighting the importance in the selection of appropriate conditions in the analysis of the bone organ.
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Affiliation(s)
- E Reina-Romo
- School of Engineering, University of Seville, 41092 Seville, Spain
| | | | - J A Sanz-Herrera
- School of Engineering, University of Seville, 41092 Seville, Spain.
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Mostafavinia A, Masteri Farahani R, Abdollahifar MA, Ghatrehsamani M, Ghoreishi SK, Hajihossainlou B, Chien S, Dadras S, Rezaei F, Bayat M. Evaluation of the Effects of Photobiomodulation on Partial Osteotomy in Streptozotocin-Induced Diabetes in Rats. Photomed Laser Surg 2018; 36:406-414. [PMID: 29851368 DOI: 10.1089/pho.2018.4438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE We examined the effects of photobiomodulation (PBM) on stereological parameters, and gene expression of Runt-related transcription factor 2 (RUNX2), osteocalcin, and receptor activator of nuclear factor kappa-B ligand (RANKL) in repairing tissue of tibial bone defect in streptozotocin (STZ)-induced type 1 diabetes mellitus (TIDM) in rats during catabolic response of fracture healing. BACKGROUND DATA There were conflicting results regarding the efficacy of PBM on bone healing process in healthy and diabetic animals. MATERIALS AND METHODS Forty-eight rats have been distributed into four groups: group 1 (healthy control, no TIDM and no PBM), group 2 (healthy test, no TIDM and PBM), group 3 (diabetic control, TIDM and no PBM), and group 4 (diabetic test, no TIDM and PBM). TIDM was induced in the groups 3 and 4. A partial bone defect in tibia was made in all groups. The bone defects of groups second and fourth were irradiated by a laser (890 nm, 80 Hz, 1.5 J/cm2). Thirty days after the surgery, all bone defects were extracted and were submitted to stereological examination and real-time polymerase chain reaction (RT-PCR). RESULTS PBM significantly increased volumes of total callus, total bone, bone marrow, trabecular bone, and cortical bone, and the numbers of osteocytes and osteoblasts of callus in TIDM rats compared to those of callus in diabetic control. In addition, TIDM increased RUNX2, and osteocalcin in callus of tibial bone defect compared to healthy group. PBM significantly decreased osteocalcin gene expression in TIDM rats. CONCLUSIONS PBM significantly increased many stereological parameters of bone repair in an STZ-induced TIDM during catabolic response of fracture healing. Further RT-PCR test demonstrated that bone repair was modulated in diabetic rats during catabolic response of fracture healing by significant increase in mRNA expression of RUNX2, and osteocalcin compared to healthy control rats. PBM also decreased osteocalcin mRNA expression in TIDM rats.
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Affiliation(s)
| | - Reza Masteri Farahani
- 2 Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Mohammad-Amin Abdollahifar
- 2 Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Mahdi Ghatrehsamani
- 3 Cellular and Molecular Research Center, Shahrekord University of Medical Sciences , Shahrekord, Iran
| | | | - Behnam Hajihossainlou
- 5 Department of Internal Medicine, Aroura Bay Area Medical Center , Marinette, Wisconsin
| | - Sufan Chien
- 6 Price Institute of Surgical Research, University of Louisville, and Noveratech LLC of Louisville, Kentucky; supplied in part by NIH grant DK 105692
| | - Sara Dadras
- 2 Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | | | - Mohammad Bayat
- 8 Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran
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Abstract
PURPOSE OF REVIEW While thinning of the cortices or trabeculae weakens bone, age-related changes in matrix composition also lower fracture resistance. This review summarizes how the organic matrix, mineral phase, and water compartments influence the mechanical behavior of bone, thereby identifying characteristics important to fracture risk. RECENT FINDINGS In the synthesis of the organic matrix, tropocollagen experiences various post-translational modifications that facilitate a highly organized fibril of collagen I with a preferred orientation giving bone extensibility and several toughening mechanisms. Being a ceramic, mineral is brittle but increases the strength of bone as its content within the organic matrix increases. With time, hydroxyapatite-like crystals experience carbonate substitutions, the consequence of which remains to be understood. Water participates in hydrogen bonding with organic matrix and in electrostatic attractions with mineral phase, thereby providing stability to collagen-mineral interface and ductility to bone. Clinical tools sensitive to age- and disease-related changes in matrix composition that the affect mechanical behavior of bone could potentially improve fracture risk assessment.
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Affiliation(s)
- Mustafa Unal
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN, 37232, USA
| | - Amy Creecy
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37232, USA
| | - Jeffry S Nyman
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN, 37232, USA.
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37232, USA.
- Vanderbilt Orthopedic Institute, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232, USA.
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Ojanen X, Tanska P, Malo M, Isaksson H, Väänänen S, Koistinen A, Grassi L, Magnusson S, Ribel-Madsen S, Korhonen R, Jurvelin J, Töyräs J. Tissue viscoelasticity is related to tissue composition but may not fully predict the apparent-level viscoelasticity in human trabecular bone – An experimental and finite element study. J Biomech 2017; 65:96-105. [DOI: 10.1016/j.jbiomech.2017.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/01/2017] [Accepted: 10/01/2017] [Indexed: 12/19/2022]
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Makowski AJ, Granke M, Ayala OD, Uppuganti S, Mahadevan-Jansen A, Nyman JS. Applying Full Spectrum Analysis to a Raman Spectroscopic Assessment of Fracture Toughness of Human Cortical Bone. APPLIED SPECTROSCOPY 2017; 71:2385-2394. [PMID: 28708001 PMCID: PMC5561524 DOI: 10.1177/0003702817718149] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A decline in the inherent quality of bone tissue is a † Equal contributors contributor to the age-related increase in fracture risk. Although this is well-known, the important biochemical factors of bone quality have yet to be identified using Raman spectroscopy (RS), a nondestructive, inelastic light-scattering technique. To identify potential RS predictors of fracture risk, we applied principal component analysis (PCA) to 558 Raman spectra (370-1720 cm-1) of human cortical bone acquired from 62 female and male donors (nine spectra each) spanning adulthood (age range = 21-101 years). Spectra were analyzed prior to R-curve, nonlinear fracture mechanics that delineate crack initiation (Kinit) from crack growth toughness (Kgrow). The traditional ν1phosphate peak per amide I peak (mineral-to-matrix ratio) weakly correlated with Kinit (r = 0.341, p = 0.0067) and overall crack growth toughness (J-int: r = 0.331, p = 0.0086). Sub-peak ratios of the amide I band that are related to the secondary structure of type 1 collagen did not correlate with the fracture toughness properties. In the full spectrum analysis, one principal component (PC5) correlated with all of the mechanical properties (Kinit: r = - 0.467, Kgrow: r = - 0.375, and J-int: r = - 0.428; p < 0.0067). More importantly, when known predictors of fracture toughness, namely age and/or volumetric bone mineral density (vBMD), were included in general linear models as covariates, several PCs helped explain 45.0% (PC5) to 48.5% (PC7), 31.4% (PC6), and 25.8% (PC7) of the variance in Kinit, Kgrow, and J-int, respectively. Deriving spectral features from full spectrum analysis may improve the ability of RS, a clinically viable technology, to assess fracture risk.
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Affiliation(s)
- Alexander J. Makowski
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN 37232
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN 37212
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN 37232
| | - Mathilde Granke
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN 37232
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN 37212
| | - Oscar D. Ayala
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN 37232
| | - Sasidhar Uppuganti
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN 37232
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN 37212
| | - Anita Mahadevan-Jansen
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN 37232
| | - Jeffry S. Nyman
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN 37232
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN 37212
- Vanderbilt Biophotonics Center, Vanderbilt University, Nashville, TN 37232
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Uppuganti S, Granke M, Manhard MK, Does MD, Perrien DS, Lee DH, Nyman JS. Differences in sensitivity to microstructure between cyclic- and impact-based microindentation of human cortical bone. J Orthop Res 2017; 35:1442-1452. [PMID: 27513922 PMCID: PMC5530367 DOI: 10.1002/jor.23392] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/09/2016] [Indexed: 02/04/2023]
Abstract
Unlike the known relationships between traditional mechanical properties and microstructural features of bone, the factors that influence the mechanical resistance of bone to cyclic reference point microindention (cRPI) and impact microindention (IMI) have yet to be identified. To determine whether cRPI and IMI properties depend on microstructure, we indented the tibia mid-shaft, the distal radius, and the proximal humerus from 10 elderly donors using the BioDent and OsteoProbe (neighboring sites). As the only output measure of IMI, bone material strength index (BMSi) was significantly different across all three anatomical sites being highest for the tibia mid-shaft and lowest for the proximal humerus. Total indentation distance (inverse of BMSi) was higher for the proximal humerus than for the tibia mid-shaft but was not different between other anatomical comparisons. As a possible explanation for the differences in BMSi, pore water, as determined by 1 H nuclear magnetic resonance, was lowest for the tibia and highest for the humerus. Moreover, the local intra-cortical porosity, as determined by micro-computed tomography, was negatively correlated with BMSi for both arm bones. BMSi was also positively correlated with peak bending stress of cortical bone extracted from the tibia mid-shaft. Microstructural correlations with cRPI properties were not significant for any of the bones. The one exception was that average energy dissipated during cRPI was negatively correlated with local tissue mineral density in the tibia mid-shaft. With higher indentation force and larger tip diameter than cRPI, only IMI appears to be sensitive to the underlying porosity of cortical bone. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1442-1452, 2017.
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Affiliation(s)
- Sasidhar Uppuganti
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232,Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Mathilde Granke
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232,Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Mary Kate Manhard
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232
| | - Mark D. Does
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232,Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Daniel S. Perrien
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232,Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN 37232,Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37232,Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN 37212
| | - Donald H. Lee
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Jeffry S. Nyman
- Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37232,Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN 37232,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232,Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN 37212
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Herrera S, Diez-Perez A. Clinical experience with microindentation in vivo in humans. Bone 2017; 95:175-182. [PMID: 27840302 DOI: 10.1016/j.bone.2016.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 10/31/2016] [Accepted: 11/02/2016] [Indexed: 12/28/2022]
Abstract
Densitometry and imaging techniques are currently used in clinical settings to measure bone quantity and spatial structure. Recently, Reference Point Indentation has opened the possibility of directly assessing the mechanical characteristics of cortical bone in living individuals, adding a new dimension to the assessment of bone strength. Impact microindentation was specifically developed for clinical studies and has been tested in several populations where there are discrepancies between bone density and fracture propensity, such as type 2 diabetes, atypical femoral fracture, stress fractures, glucocorticoid treatment, patients with osteopenia and fragility fractures, and individuals infected with HIV, among others. Microindentation will complement, not replace, existing bone analysis methods, particularly where bone mineral density does not fully explain fracture propensity. The available evidence provides solid proof of concept; future studies will fully define the role of microindentation for the assessment of bone health both in clinics and in research.
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Affiliation(s)
- Sabina Herrera
- Department of Internal Medicine, Hospital del Mar Institute of Medical Investigation, Autonomous University of Barcelona, Barcelona, Spain
| | - Adolfo Diez-Perez
- Department of Internal Medicine, Hospital del Mar Institute of Medical Investigation, Autonomous University of Barcelona, Barcelona, Spain.
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