Bisphosphonates, Bone and Joint Pain

Psychosocial Outcomes of Pain and Pain Management in Adults with Osteogenesis Imperfecta: A Qualitative Study

Osteogenesis imperfecta (OI) is a genetic disorder characterized by bone fragility and fractures, short stature, dental abnormalities, hearing loss, scoliosis, and chronic pain. Despite a growing literature on the functional outcomes of OI, limited research has explicitly examined the psychosocial outcomes of pain within OI. Adults with OI (N = 15) were interviewed to understand pain-related experiences through a thematic analysis of semi-structured interview data. Research team members, genetic research experts, and OI clinicians developed an interview guide focused on topics related to pain and mental health challenges. Participants' transcripts were coded by two independent coders; codes were then merged across coders and quotation outputs were subsequently abstracted (paraphrased then thematically classified) to identify common themes. Themes related to pain management variability regarding pain type, pain risk management and accessibility, pain outcomes (e.g., behavior, cognitive, affective), and pain exacerbating factors (e.g., individual, contextual) were identified. Participants reported chronic and acute pain, and despite the inaccessibility and stigmatization of pain medications (e.g., opioids), pharmacological treatments were the most common pain management approach. Participants reported negative pain outcomes, such as limited daily functioning and activity participation, fear, anger, anxiety, depression, and difficulty concentrating. Lastly, participants suggested that lack of physician and community knowledge on chronic pain in OI indirectly exacerbates both subjective pain intensity and outcomes. Although limited by a small, nondiverse sample, the current study provides valuable exploration of the unique pain experiences of adults with OI that may have implications for proactive management, treatment development, and clinician training.

Intervention effects of telenursing based on M-O-A model in empty-nest older adult individuals with chronic diseases: a randomized controlled trial

Aim

This study aims to verify the effectiveness of M-O-A telenursing intervention model in improving the health status and quality of life of the empty-nest older adult individuals with chronic diseases by a randomized comparative trial.

Methods

M-O-A telenursing intervention model was constructed based on the needs of the participants. The control group (N = 39) received routine nursing, the experimental group (N = 39) received M-O-A telenursing intervention in addition to routine nursing. After 12 weeks of intervention, the intervention effects of being a participant in the two groups were evaluated. SPSS 26.0 was used for data analysis.

Results

After 12 weeks of intervention, for the experimental group, each dimension of quality of life based on EQ-5D-3L became better, especially for "pain/discomfort," "anxiety/depression," "HRQoL" and "EQ-VAS" (all p < 0.05) and each dimension of quality of life based on SF-36 became better too, especially for "GH," "BP," "RE," "MH," "VT," "SF," "PCS," "MCS," "SF-36" (all p < 0.05). In addition, there was a statistical downward trend in blood pressure, blood glucose, weight, BMI, fat rate, nap duration, number of nocturnal awakenings, light sleep rate and a statistical upward trend in water rate, basal metabolic rate, nighttime sleep duration, deep sleep rate, rapid eye movement sleep rate, especially at the end of intervention (all p < 0.05). While for the control group, there was no statistical improvement in all these aspects.

Conclusion

The M-O-A telenursing model could effectively regulate quality of life and health condition of the empty-nest older adult individuals with chronic diseases, making it worthy of further promotion and application.

Expression of semaphorin-3A in the joint and role in osteoarthritis

Osteoarthritis (OA) is characterised by the deterioration of cartilage in the joints and pain. We hypothesise that semaphorin-3A (sema-3A), a chemorepellent for sensory nerves, plays a role in joint degradation and pain. We used the mechanical joint loading (MJL) model of OA to investigate sema-3A expression in the joint and examine its association with the development of OA and pain. We also analyse its effect on chondrocyte differentiation using the ATDC5 cell line. We demonstrate that sema-3A is present in most tissues in the healthy joint and its expression increases in highly innervated tissues, such as cruciate ligaments, synovial lining and subchondral bone, in loaded compared to nonloaded control joints. In contrast, sema-3A expression in cartilage was decreased in the severe OA induced by the application of high loads. There was a significant increase in circulating sema-3A, 6 weeks after MJL compared to the nonloaded mice. mRNA for sema-3A and its receptor Plexin A1 were upregulated in the dorsal root ganglia of mice submitted to MJL. These increases were supressed by zoledronate, an inhibitor of bone pain. Sema-3A was expressed at all stages of Chondrocyte maturation and, when added exogenously, stimulated expression of markers of chondrocyte differentiation. This indicates that sema-3A could affect joint tissues distinctively during the development of OA. In highly innervated joint tissues, sema-3A could control innervation and/or induce pain-associated neuronal changes. In cartilage, sema-3A could favour its degeneration by modifying chondrocyte differentiation.

Review of the Mechanism of Action and Use of Bisphosphonates in Horses

Bisphosphonates are a group of drugs that can reduce bone resorption by incorporating into the crystal structure of exposed hydroxyapatite where they are taken up by osteoclasts. Bisphosphonates have several other mechanisms of action including reducing pain and inflammation and altering macrophage function. There are two types of bisphosphonates - nitrogenous and non-nitrogenous, the latter of which is used in horses. This article provides a literature-based review of the proposed mechanisms of action and therapeutic uses of bisphosphonates including a brief review of bone response to disease. A review of the literature available in horses including safety data and current rules and regulations is also provided.

How Has Molecular Biology Enhanced Our Undertaking of axSpA and Its Management

PURPOSE

This review aims at investigating pathophysiological mechanisms in spondyloarthritis (SpA). Analysis of genetic factors, immunological pathways, and abnormalities of bone metabolism lay the foundations for a better understanding of development of the axial clinical manifestations in patients, allowing physician to choose the most appropriate therapeutic strategy in a more targeted manner.

RECENT FINDINGS

In addition to the contribution of MHC system, findings emerged about the role of non-HLA genes (as ERAP1 and 2, whose inhibition could represent a new therapeutic approach) and of epigenetic mechanisms that regulate the expression of genes involved in SpA pathogenesis. Increasing evidence of bone metabolism abnormalities secondary to the activation of immunological pathways suggests the development of various bone anomalies that are present in axSpA patients. SpA are a group of inflammatory diseases with a multifactorial origin, whose pathogenesis is linked to the genetic predisposition, the action of environmental risk factors, and the activation of immune response. It is now well known how bone metabolism leads to long-term structural damage via increased bone turnover, bone loss and osteoporosis, osteitis, erosions, osteosclerosis, and osteoproliferation. These effects can exist in the same patient over time or even simultaneously. Evidence suggests a cross relationship among innate immunity, autoimmunity, and bone remodeling in SpA, making treatment approach a challenge for rheumatologists. Specifically, treatment targets are consistently increasing as new drugs are upcoming. Both biological and targeted synthetic drugs are promising in terms of their efficacy and safety profile in patients affected by SpA.

Study on the Relationship between the Use of Bisphosphonates for Antiosteoporosis and Vertebral Re-Fracture after Vertebroplasty

Objective. To explore the effect of bisphosphonates after vertebroplasty in patients with osteoporotic vertebral compression fractures (OVCF), and to analyze the relationship between the use of bisphosphonates and vertebral refracture. Methods. A total of 150 patients with OVCF were selected from the pain department of our hospital from January 2018 to May 2020. All patients received vertebroplasty after admission, and were divided into the surgery group (62 cases) and combined with the bisphosphonates group (combined group, 88 cases) according to whether patients had used bisphosphonates after surgery. Before surgery, 1 month, 3 months, 6 months, and 1 year after surgery, visual analogue scale (VAS), Oswestry disability index (ODI), vertebral body and femoral neck bone mineral density (BMD), and Cobb Angle were collected, and the differences among groups were compared to analyze the treatment effect. After the follow-up, patients were divided into two groups according to whether vertebral refracture occurred during the follow-up period. Clinical characteristics, general information, and surgical indicators of patients in the two groups were collected, and related factors of postoperative vertebral refracture were analyzed. Results. There were no significant differences in preoperative VAS score, ODI index, BMD value, and Cobb angle between the two groups $\left(P>0.05\right)$ . At 12 months after surgery, VAS score, ODI index, and Cobb angle decreased, while BMD value increased in both groups. The VAS score, ODI index, and Cobb angle in the combined group were lower than those in the operation group, while the BMD value was higher than that in the operation group, and the difference was significant $\left(P<0.05\right)$ . The results of multivariate regression analysis showed that in BMD, no postoperative antiosteoporosis treatment, bone cement leakage, and poor cement diffusion were independent risk factors for vertebral refracture after vertebroplasty in patients with vertebral compression fractures. Conclusion. In order to avoid recurrent fractures in OVCF patients, attention should be paid to BMD, whether patients take antiosteoporosis drugs, whether bone cement permeation occurs and the diffusion of bone cement, etc. The above factors are the main influencing factors leading to recurrent fractures after PKP and PVP in the clinic.

Mice Lacking Wnt9a or Wnt4 Are Prone to Develop Spontaneous Osteoarthritis With Age and Display Alteration in Either the Trabecular or Cortical Bone Compartment

Osteoarthritis (OA) is a common degenerative disease of the joint, with a complex multifactorial not yet fully understood etiology. Over the past years, the Wnt signaling pathway has been implicated in osteoarthritis. In a recent genomewide association study (GWAS), the chromosomal location on chromosome 1, linked to the Wnt3a-Wnt9a gene locus, was identified as the most significant locus associated with a thumb osteoarthritis endophenotype. Previously, it was shown that WNT9a is involved in maintaining synovial cell identity in the elbow joint during embryogenesis. Here, we report that the conditional loss of Wnt9a in the Prx1-Cre expressing limb mesenchyme or Prg4-CreER expressing cells predispositions the mice to develop spontaneous OA-like changes with age. In addition, the trabecular bone volume is altered in these mice. Similarly, mice with a conditional loss of Wnt4 in the limb mesenchyme are also more prone to develop spontaneously OA-like joint alterations with age. These mice display additional alterations in their cortical bone. The combined loss of Wnt9a and Wnt4 increased the likelihood of the mice developing osteoarthritis-like changes and enhanced disease severity in the affected mice. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

The Role of Extracellular Vesicles in Osteoporosis: A Scoping Review

As an insidious metabolic bone disease, osteoporosis plagues the world, with high incidence rates. Patients with osteoporosis are prone to falls and becoming disabled, and their cone fractures and hip fractures are very serious, so the diagnosis and treatment of osteoporosis is very urgent. Extracellular vesicles (EVs) are particles secreted from cells to the outside of the cell and they are wrapped in a bilayer of phospholipids. According to the size of the particles, they can be divided into three categories, namely exosomes, microvesicles, and apoptotic bodies. The diameter of exosomes is 30–150 nm, the diameter of microvesicles is 100–1000 nm, and the diameter of apoptotic bodies is about 50–5000 nm. EVs play an important role in various biological process and diseases including osteoporosis. In this review, the role of EVs in osteoporosis is systematically reviewed and some insights for the prevention and treatment of osteoporosis are provided.