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Skjødt MK, Abrahamsen B. New Insights in the Pathophysiology, Epidemiology, and Response to Treatment of Osteoporotic Vertebral Fractures. J Clin Endocrinol Metab 2023; 108:e1175-e1185. [PMID: 37186550 DOI: 10.1210/clinem/dgad256] [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: 10/28/2022] [Revised: 03/27/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
CONTEXT Vertebral fractures (VFs) make up an important but challenging group of fractures often caused by osteoporosis. Osteoporotic fractures pose unique diagnostic challenges in generally requiring imaging for diagnosis. The objective of this narrative mini-review is to provide an overview of these recent advances in our knowledge of VF pathophysiology and epidemiology with particular focus on endocrine diseases, prevention, and treatment. EVIDENCE ACQUISITION We searched PubMed on May 23, 2022, for studies of VFs in humans. Results were limited to papers available as full-text publications in English, published from 2020 and onward. This yielded 3457 citations. This was supplemented by earlier publications selected to add context to the recent findings. EVIDENCE SYNTHESIS Studies addressed VF risk in hyperthyreosis, hyperparathyroidism, acromegaly, Cushing syndrome, primary aldosteronism, and diabetes. For pharmaceutical treatment, new studies or analyses were identified for romosozumab and for weekly teriparatide. Several studies, including studies in the immediate pipeline, were intervention studies with vertebroplasty or kyphoplasty, including combination with stem cells or pharmaceuticals. CONCLUSIONS Endocrinologists should be aware of the high likelihood of osteoporotic VFs in patients with endocrine diseases. Though licensed treatments are able to substantially reduce the occurrence of VFs in patients with osteoporosis, the vast majority of recent or ongoing randomized controlled trials in the VF area focus on advanced invasive therapy of the fracture itself.
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Affiliation(s)
- Michael Kriegbaum Skjødt
- Department of Medicine 1, Holbæk Hospital, DK-4300 Holbæk, Denmark
- OPEN-Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, DK-5000 Odense, Denmark
| | - Bo Abrahamsen
- Department of Medicine 1, Holbæk Hospital, DK-4300 Holbæk, Denmark
- OPEN-Open Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, DK-5000 Odense, Denmark
- NDORMS, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford OX3 7LD, UK
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Matsugaki A, Ito M, Kobayashi Y, Matsuzaka T, Ozasa R, Ishimoto T, Takahashi H, Watanabe R, Inoue T, Yokota K, Nakashima Y, Kaito T, Okada S, Hanawa T, Matsuyama Y, Matsumoto M, Taneichi H, Nakano T. Innovative design of bone quality-targeted intervertebral spacer: accelerated functional fusion guiding oriented collagen and apatite microstructure without autologous bone graft. Spine J 2023; 23:609-620. [PMID: 36539040 DOI: 10.1016/j.spinee.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND CONTEXT Although autologous bone grafting is widely considered as an ideal source for interbody fusion, it still carries a risk of nonunion. The influence of the intervertebral device should not be overlooked. Requirements for artificial spinal devices are to join the vertebrae together and recover the original function of the spine rapidly. Ordered mineralization of apatite crystals on collagen accelerates bone functionalization during the healing process. Particularly, the stable spinal function requires the ingrowth of an ordered collagen and apatite matrix which mimics the intact intervertebral microstructure. This collagen and apatite ordering is imperative for functional bone regeneration, which has not been achieved using classical autologous grafting. PURPOSE We developed an intervertebral body device to achieve high stability between the host bone and synthesized bone by controlling the ordered collagen and apatite microstructure. STUDY DESIGN This was an in vivo animal study. METHODS Intervertebral spacers with a through-pore grooved surface structure, referred to as a honeycomb tree structure, were produced using metal 3D printing. These spacers were implanted into normal sheep at the L2-L3 or L4-L5 disc levels. As a control group, grafting autologous bone was embedded. The mechanical integrity of the spacer/bone interface was evaluated through push-out tests. RESULTS The spacer with honeycomb tree structure induced anisotropic trabecular bone growth with textured collagen and apatite orientation in the through-pore and groove directions. The push-out load of the spacer was significantly higher than that of the conventional autologous graft spacer. Moreover, the load was significantly correlated with the anisotropic texture of the newly formed bone matrix. CONCLUSIONS The developed intervertebral spacer guided the regenerated bone matrix orientation of collagen and apatite, resulting in greater strength at the spacer/host bone interface than that obtained using a conventional gold-standard autologous bone graft. CLINICAL SIGNIFICANCE Our results provide a foundation for designing future spacers for interbody fusion in human.
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Affiliation(s)
- Aira Matsugaki
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Anisotropic Design and Additive Manufacturing Research Center, Osaka University, 2-1 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Manabu Ito
- Department of Spine and Spinal Cord Disorders, National Hospital Organization, Hokkaido Medical Center,5-7-1-1, Yamanote, Nishi-ku, Sapporo, Hokkaido, 063-0005, Japan
| | - Yoshiya Kobayashi
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Tadaaki Matsuzaka
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Ryosuke Ozasa
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Anisotropic Design and Additive Manufacturing Research Center, Osaka University, 2-1 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Takuya Ishimoto
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Anisotropic Design and Additive Manufacturing Research Center, Osaka University, 2-1 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Hiroyuki Takahashi
- Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Ryota Watanabe
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Takayuki Inoue
- Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Katsuhiko Yokota
- Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Yoshio Nakashima
- Teijin Nakashima Medical Co., Ltd., 688-1 Joto-Kitagata, Higashi-ku, Okayama, 709-0625, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan
| | - Takao Hanawa
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takayoshi Nakano
- Division of Materials and Manufacturing Science, Graduate School of Engineering, Osaka University, 2-1, Yamada-Oka, Suita, Osaka, 565-0871, Japan; Anisotropic Design and Additive Manufacturing Research Center, Osaka University, 2-1 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
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Li C, Ma C, Zhuo X, Li L, Li B, Li S, Lu WW. Focal osteoporosis defect is associated with vertebral compression fracture prevalence in a bone mineral density-independent manner. JOR Spine 2022; 5:e1195. [PMID: 35386753 PMCID: PMC8966878 DOI: 10.1002/jsp2.1195] [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: 06/30/2021] [Revised: 12/19/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Focal osteoporosis defect has shown a high association with the bone fragility and osteoporotic fracture prevalence. However, no routine computed tomography (CT)‐based vertebral focal osteoporosis defect measurement and its association with vertebral compression fracture (VCF) were discussed yet. This study aimed to develop a routine CT‐based measurement method for focal osteoporosis defect quantification, and to assess its association with the VCF prevalence. Materials and Methods A total of 205 cases who underwent routine CT scanning, were retrospectively reviewed and enrolled into either the VCF or the control group. The focal bone mineral content loss (focal BMC loss), measured as the cumulated demineralization within bone void space, was proposed for focal osteoporosis defect quantification. Its scan‐rescan reproducibility and its correlation with trabecular bone mineral density (BMD) and apparent microarchitecture parameters were evaluated. The association between focal BMC loss and the prevalence of VCF was studied by logistic regression. Results The measurement of focal BMC loss showed high reproducibility (RMSSD = 0.011 mm, LSC = 0.030 mm, ICC = 0.97), and good correlation with focal bone volume fraction (r = 0.79, P < 0.001), trabecular bone separation (r = 0.76, P < 0.001), but poor correlation with trabecular BMD (r = 0.37, P < 0.001). The focal BMC loss was significantly higher in the fracture group than the control (1.03 ± 0.13 vs. 0.93 ± 0.11 mm; P < 0.001), and was associated with prevalent VCF (1.87, 95% CI = 1.31–2.65, P < 0.001) independent of trabecular BMD level. Discussion As a surrogate measure of focal osteoporosis defect, focal BMC Loss independently associated with the VCF prevalence. It suggests that focal osteoporosis defect is a common manifestation that positively contributed to compression fracture risk and can be quantified with routine CT using focal BMC Loss.
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Affiliation(s)
- Chentian Li
- Department of Orthopedics and Taumatology Zhujiang Hospital, Southern Medical University Guangzhou Guangdong China.,Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China
| | - Chi Ma
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China
| | - Xianglong Zhuo
- Department of Orthopaedics Liuzhou Worker's Hospital, Guangxi Medical University Liuzhou Guangxi China
| | - Li Li
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,Department of Orthopaedics Liuzhou Worker's Hospital, Guangxi Medical University Liuzhou Guangxi China
| | - Bing Li
- Department of Orthopaedics Liuzhou Worker's Hospital, Guangxi Medical University Liuzhou Guangxi China
| | - Songjian Li
- Department of Orthopedics and Taumatology Zhujiang Hospital, Southern Medical University Guangzhou Guangdong China
| | - William W Lu
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,SIAT & Shenzhen Institutes of Advanced Technology Chinese Academy of Science Shenzhen Guangdong China
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