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Hwang KT, Kook I, Lee JH, Oh CW, Sohn OJ, Kim JW, Park KC. Outcomes of Angular Stable Locking System in Femoral Diaphyseal Fractures of Elderly Patients: A Multicenter Comparative Study. Clin Orthop Surg 2023; 15:349-357. [PMID: 37274487 PMCID: PMC10232304 DOI: 10.4055/cios22215] [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: 06/28/2022] [Revised: 09/27/2022] [Accepted: 11/08/2022] [Indexed: 06/06/2023] Open
Abstract
Background The angular stable locking system (ASLS) was developed to provide additional stability to the distal interlocking screw of the intramedullary (IM) nail. Effects of ASLS on the treatment of femoral diaphyseal fractures in the elderly remain unknown. The aim of this study was to compare radiological outcomes of IM nailing using ASLS screws to IM nails with conventional interlocking screws in elderly patients with femoral shaft fractures. Methods A multicenter retrospective review of 129 patients (average age, 73.5 years; 98 women and 31 men) aged 65 years or older who underwent IM nail fixation for femoral diaphyseal fractures (AO/Orthopaedic Trauma Association [OTA] classification 32) was conducted. Demographic information of patients, fracture site (subtrochanteric or shaft), fracture type (traumatic or atypical), and AO/OTA fracture classification were investigated. Reduction status was evaluated by postoperative plain radiography. Presence of union and time to union were evaluated through serial plain radiograph follow-up. Reoperation due to nonunion or implant failure was also evaluated. Results ASLS was used in 65 patients (50.3%). A total of 118 patients (91.5%) achieved union without additional surgery and the mean union time was 31.8 ± 13.0 weeks. In terms of reduction status, angulation was greater in the group using ASLS. There were no statistically significant differences of union rate, time to union, and reoperation rate according to the use of ASLS (p > 0.05). There was no difference in the outcomes according to the use of ASLS even when the analysis was divided in terms of fracture site or fracture type (p > 0.05). In further subgroup analysis, only the traumatic subtrochanteric area group showed statistically significantly shorter time to union when ASLS was used (p = 0.038). Conclusions In geriatric patients with femoral diaphyseal fractures, the use of ASLS was not considered to have a significant effect on fracture healing. Fracture healing seemed to be more affected by surgical techniques such as minimizing the gap and fracture characteristics such as atypical femoral fractures, rather than implants.
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Affiliation(s)
- Kyu Tae Hwang
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, Korea
| | - Incheol Kook
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, Korea
| | - Jae-Ho Lee
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Oog-Jin Sohn
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Chul Park
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Korea
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2
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Tao K, Li M, Ling J, Tu Y. Prevalence and correlative factors of hyperhomocysteinemia in elderly patients with femoral neck fracture: A cross-sectional study. J Clin Lab Anal 2022; 36:e24563. [PMID: 35712847 PMCID: PMC9279943 DOI: 10.1002/jcla.24563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Aims The occurrence of hyperhomocysteinemia (HHcy) in elderly patients with femoral neck fracture (FNF) draws little attention from surgeons preoperatively. The aim of our study was to determine the prevalence and correlative factors of HHcy in elderly patients (≥65 years) with FNF prior to surgery. Methods We retrospectively investigated 286 elderly FNF patients aged 65–98 years admitted to our institution from September 2020 to September 2021. Categorical variables were compared using the Chi‐squared test, and continuous variables were compared using the Mann–Whitney U test. Univariable and multivariable logistic regression were used to determine the associations of variables with the odds of HHcy. Results Among the 286 elderly FNF patients, the prevalence of HHcy was 30.77% and the mean Hcy level was 14.52 ± 10.49 μmol/L. The mean Hcy level and the prevalence of HHcy in male patients were significantly higher than that in female patients (16.41 ± 9.58 μmol/L vs. 14.00 ± 10.69 μmol/L, p = 0.002; 43.55% vs. 27.23%, p = 0.014). Multivariate analysis indicated that being male patient (OR 2.187, 95% CI 1.187–4.028, p = 0.012), hypertension (OR 1.993, 95% CI 1.141–3.479, p = 0.015), and low HDL‐C (OR 2.979, 95% CI 1.353–6.558, p = 0.007) were significant correlative factors of HHcy among elderly FNF patients. Conclusions This study found a high prevalence of HHcy in elderly FNF patients, with being male patient, hypertension, and low levels of HDL‐C as the significant correlative factors after adjusting for age and other covariables. However, further large‐scale studies in wider regions are warranted to confirm these findings. Hyperhomocysteinemia (HHcy), which have been associated with increased cardiovascular, cerebrovascular, and thromboembolic diseases in elderly patients, are frequently neglected by orthopedic surgeons in their clinical practices. Using the descriptive statistical analysis and logistic regression model, we found a high prevalence (30.77%) of HHcy among elderly patients with femoral neck fracture (FNF), with being male patient, hypertension, and low levels of HDL‐C as the significant correlates after adjusting for age and other covariables. The current findings may help to the preoperative assessment and optimization of patient with FNF.
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Affiliation(s)
- Kun Tao
- Department of Orthopedic Surgery, Ningbo No.6 Hospital, Ningbo City, China
| | - Ming Li
- Department of Orthopedic Surgery, Ningbo No.6 Hospital, Ningbo City, China
| | - Jing Ling
- Department of Orthopedic Surgery, Ningbo No.6 Hospital, Ningbo City, China
| | - Yiji Tu
- Department of Orthopedic Surgery, Ningbo No.6 Hospital, Ningbo City, China
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3
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Mazza E, Ferro Y, Pujia R, Maurotti S, Geirola N, Gazzaruso C, Romeo S, Pujia A, Montalcini T. Bending Resistance at Hip and Fractures Risk in Postmenopausal Women Independent of Bone Mineral Density. J Clin Densitom 2022; 25:198-207. [PMID: 34465538 DOI: 10.1016/j.jocd.2021.08.001] [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: 06/03/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Abstract
Several studies suggest that aging loss of bone mass is not necessarily associated with reduced mechanical proprieties as bending resistance. Since postmenopausal women with fracture and without osteoporosis might have an impairment in the bending mechanisms at hip, our aim was to assess if women with and without fractures differ in the femoral parameters of resistance to bending, independent of the bone loss. In this cross-sectional study we enrolled 192 postmenopausal women who underwent X-ray absorptiometry scan to measure bone mineral density as well as cross-sectional geometry parameters at the hip (Hip structure analysis). Among women with osteoporosis, a higher odds ratio for fracture was found in the first tertile of NN-Dmax, a parameter linked to the resistance to bending forces in a cross-section (tertile I, OR = 6.7, p = 0.03; CI 1.19-38.01; reference tertile III). We also found a significantly higher risk for major fracture in the first tertile of NN-Dmax (tertile I, OR = 6.0, p = 0.02; CI 1.26-28.4; reference tertile III). Among women without osteoporosis, a significantly higher odds ratio for fracture was found in the first tertile of IT-CSA, a parameter of resistance to axial load (tertile I, OR = 7.2, p = 0.002; CI 2.04-25.9; reference tertile III). We also found a significantly higher risk for major fracture in the first tertile of IT-CSA (OR = 18.4, p = 0.001; CI 1.52-221.8; tertile III reference). We demonstrate that some hip structural parameters are independently associated to the fracture risk in postmenopausal women.
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Affiliation(s)
- Elisa Mazza
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy
| | - Yvelise Ferro
- Department of Health Science, University Magna Grecia, Catanzaro, Italy
| | - Roberta Pujia
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy
| | - Samantha Maurotti
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy
| | - Nadia Geirola
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy
| | - Carmine Gazzaruso
- Institute "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy.; Department of Biomedical Science for Health, University of Milan, Milano, Italy
| | - Stefano Romeo
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy.; Department of Molecular and Clinical Medicine, Sahlgrenska Center for Cardiovascolar and Metabolic Research, University of Gothenburg, Göteborg, Sweden
| | - Arturo Pujia
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy.; Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Grecia, Catanzaro, Italy
| | - Tiziana Montalcini
- Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Grecia, Catanzaro, Italy.; Department of Clinical and Experimental Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy..
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von Kroge S, Stürznickel J, Bechler U, Stockhausen KE, Eissele J, Hubert J, Amling M, Beil FT, Busse B, Rolvien T. Impaired bone quality in the superolateral femoral neck occurs independent of hip geometry and bone mineral density. Acta Biomater 2022; 141:233-243. [PMID: 34999261 DOI: 10.1016/j.actbio.2022.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 11/01/2022]
Abstract
Skeletal adaptation is substantially influenced by mechanical loads. Osteocytes and their lacuno-canalicular network have been identified as a key player in load sensation and bone quality regulation. In the femoral neck, one of the most common fracture sites, a complex loading pattern with lower habitual loading in the superolateral neck and higher compressive stresses in the inferomedial neck is present. Variations in the femoral neck-shaft angle (NSA), i.e., coxa vara or coxa valga, provide the opportunity to examine the influence of loading patterns on bone quality. We obtained femoral neck specimens of 28 osteoarthritic human subjects with coxa vara, coxa norma and coxa valga during total hip arthroplasty. Bone mineral density (BMD) was assessed preoperatively by dual energy X-ray absorptiometry (DXA). Cortical and trabecular microstructure and three-dimensional osteocyte lacunar characteristics were assessed in the superolateral and inferomedial neck using ex vivo high resolution micro-computed tomography. Additionally, BMD distribution and osteocyte lacunar characteristics were analyzed by quantitative backscattered electron imaging (qBEI). All groups presented thicker inferomedial than superolateral cortices. Furthermore, the superolateral site exhibited a lower osteocyte lacunar density along with lower lacunar sphericity than the inferomedial site, independent of NSA. Importantly, BMD and corresponding T-scores correlated with microstructural parameters at the inferomedial but not superolateral neck. In conclusion, we provide micromorphological evidence for fracture vulnerability of the superolateral neck, which is independent of NSA and BMD. The presented bone qualitative data provide an explanation why DXA may be insufficient to predict a substantial proportion of femoral neck fractures. STATEMENT OF SIGNIFICANCE: The femoral neck, one of the most common fracture sites, is subject to a complex loading pattern. Site-specific differences (i.e., superolateral vs. inferomedial) in bone quality influence fracture risk, but it is unclear how this relates to hip geometry and bone mineral density (BMD) measurements in vivo. Here, we examine femoral neck specimens using a variety of high-resolution imaging techniques and demonstrate impaired bone quality in the superolateral compared to the inferomedial neck. Specifically, we found impaired cortical and trabecular microarchitecture, mineralization, and osteocyte properties, regardless of neck-shaft angle. Since BMD correlated with bone quality of the inferomedial but not the superolateral neck, our results illustrate why bone densitometry may not predict a substantial proportion of femoral neck fractures.
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Saad RK, Ghezzawi M, Habli D, Alami RS, Chakhtoura M. Fracture risk following bariatric surgery: a systematic review and meta-analysis. Osteoporos Int 2022; 33:511-526. [PMID: 34988627 DOI: 10.1007/s00198-021-06206-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/08/2021] [Indexed: 12/14/2022]
Abstract
Bariatric surgery may negatively impact bone health. We aimed to compare fracture risk following bariatric surgery by type (malabsorptive, restrictive), or to non-surgical weight loss, or to controls with obesity. We systematically searched four databases from inception until October 2020. We included observational and interventional studies on adults. We screened articles and abstracted data in duplicate and independently and assessed the risk of bias. We conducted random-effects model meta-analyses (Review Manager v5.3), to calculate the relative risk of any or site-specific fracture (CRD42019128536). We identified four trials of unclear-to-high risk of bias and 15 observational studies of fair-to-good quality. Data on fracture risk following bariatric surgery compared to medical weight loss is scarce and limited by the small number of participants. In observational studies, at a mean/median post-operative follow-up > 2 years, the relative risk of any fracture was 45% (p < 0.001) and 61% (p = 0.04) higher following malabsorptive procedures compared to obese controls and restrictive procedures, respectively, with moderate to high heterogeneity. Site-specific relative fracture risk (hip and wrist) was one- to two-folds higher post malabsorptive procedures compared to obese controls or restrictive procedures. The risks of any and of site-specific fracture were not increased following restrictive procedures compared to obese controls. Fracture risk seems to increase following malabsorptive bariatric surgeries, at a mean/median follow-up > 2 years. The risk is not increased with restrictive surgeries. The available evidence has several limitations. A prospective and rigorous long-term follow-up of patients following bariatric surgery is needed for a better assessment of their fracture risk with aging.
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Affiliation(s)
- R K Saad
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Ghezzawi
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - D Habli
- Department of Clinical Nutrition, American University of Beirut Medical Center, Beirut, Lebanon
| | - R S Alami
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Chakhtoura
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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6
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Hong N, Burm SW, Treece G, Ye Kim J, Hwan Kim M, Lee S, Shin S, Rhee Y. Protective effect of bisphosphonate on the cortical bone at key locations of the femur in aromatase inhibitor-associated bone loss: A three-dimensional cortical bone mapping study. J Bone Oncol 2022; 32:100409. [PMID: 35024328 PMCID: PMC8728402 DOI: 10.1016/j.jbo.2021.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 12/02/2022] Open
Abstract
Aromatase inhibitor use was associated with cortical bone loss in the hip. Bisphosphonate protected hip cortical bone against aromatase inhibitor use. The effect was prominent at the superior femoral neck and greater trochanter.
Aromatase inhibitor treatment in breast cancer is associated with accelerated bone loss and an increased risk of fracture. Bisphosphonates (BPs) are the mainstay treatment of aromatase inhibitor-associated bone loss (AIBL), which might improve femoral bone at key locations prone to fracture. To test this hypothesis, we performed three-dimensional cortical bone mapping based on quantitative computed tomography (QCT) scans in postmenopausal women with early breast cancer who were receiving aromatase inhibitors. Data of subjects who had both baseline and at least one follow-up QCT at Severance Hospital (South Korea) between 2005 and 2015 were analyzed (BP users, n = 93; BP non-users, n = 203). After exclusion of BP users with low medication persistence (proportion of days covered: <50%), BP users and non-users were 1:1 matched (n = 54 for each group) in terms of age, lumbar spine volumetric bone mineral density (LSvBMD), femoral neck areal BMD (FNaBMD), and total hip areal BMD (THaBMD). During a median follow-up of 2.1 years, BP use attenuated bone loss in LSvBMD (+7.2% vs. −3.8%, p < 0.001), FNaBMD (+1.3% vs. −2.7%, p < 0.001), and THaBMD (-0.3% vs. −2.5%, p = 0.024). BP had a protective effect on cortical parameters of femoral bone: estimated cortical thickness (CTh) (+3.3% vs. + 0.1%, p = 0.007) and cortical mass surface density (CMSD, cortical mass per unit surface area was calculated by multiplying cortical BMD with CTh) (+3.4% vs. −0.3%, p < 0.001). CMSD increased by up to 15% at key locations such as the superior part of the femoral neck and greater trochanter. BP prevented the thinning of average CTh of the femoral neck (-1.4% vs. −6.1%, p < 0.001), particularly at the superior anterior quadrant of femoral neck (absolute difference: +12.8% point vs. non-users). Compared to BP non-users, BP users had improved cross-sectional moment of inertia (+4.4% vs. −0.7%, p = 0.001) and less increase in buckling ratio (+1.3% vs. + 7.5%, p < 0.001). In summary, BP use prevented cortical bone deficits observed in AIBL at key locations of the proximal femur.
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Affiliation(s)
- Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Seung Won Burm
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Graham Treece
- Department of Engineering, University of Cambridge, Trumpington St, Cambridge CB2 1PZ, UK
| | - Jee Ye Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Min Hwan Kim
- Division of Oncology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Seunghyun Lee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Sungjae Shin
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
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7
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Adrados M, Wang K, Deng Y, Bozzo J, Messina T, Stevens A, Moore A, Morris J, O'Connor MI. A Simple Physical Therapy Algorithm Is Successful in Decreasing Skilled Nursing Facility Length of Stay and Increasing Cost Savings After Hip Fracture With No Increase in Adverse Events. Geriatr Orthop Surg Rehabil 2021; 12:2151459321998615. [PMID: 33815865 PMCID: PMC7995299 DOI: 10.1177/2151459321998615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction: Shorter length of stays (LOS) at a Skilled Nursing Facility (SNF) after hip fracture surgery would be expected to lead to costs savings for the healthcare system. Evidence also suggests that shorter SNF stays also leads to improved 30-day outcomes, thus compounding this value proposition. Our Integrated Fragility Hip Fracture Program created a simple algorithm at discharge to provide each post-operative hip fracture patient with an expected SNF LOS. We studied whether this intervention produced a shorter SNF LOS and other observable short-term outcomes. Methods: We retrospectively reviewed all original Medicare hip fracture patients treated with operative fixation who were admitted to our hospital in 2015, 2017 and 2018. We selected patients who were discharged to a single SNF following hospitalization, and excluded patients with incomplete records. The algorithm for the expected LOS recommendation was based on the degree of assistance the patient needed for ambulation: 7 days (“0-person assist”), 14 days (“1-person assist”), or 21 days (“2-person assist”). We compare the SNF LOS of our hip fracture patient population between those discharged to a program participant, those SNF that agreed to this algorithm, and those discharged to a non-program participant SNF. Results: We identified 246 patients meeting our selection criteria. 69 were discharged to a program participant SNF. Patients discharged to a participant SNF had similar baseline demographics and ASA distributions to those discharged to a non-participant provider. There was a statistically significant difference in length of stay between the groups, with program participant patients spending an average of 23 days at the SNF while the control group spent an average of 31 days. (p < 0.001). Program participant discharges were also associated with additional cost savings. There was no significant difference in ED visits within 90 days of discharge. Discussion: SNF LOS for geriatric hip fractures can be decreased with implementation of a simple physical therapy driven algorithm based on the patient’s ambulatory independence at hospital discharge. Conclusion: This is a simple, yet completely unique program that seems to have increased the value of healthcare provided.
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Affiliation(s)
- Murillo Adrados
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Kaicheng Wang
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Janis Bozzo
- ITS Analytic Strategy, Yale New Haven Health System, New Haven, CT, USA
| | | | - Amie Stevens
- Grimes Center, Yale New Haven Health System, New Haven, CT, USA
| | - Anne Moore
- Yale New Haven Hospital, New Haven, CT, USA
| | - Jensa Morris
- Hospitalist Service, Yale New Haven Hospital, New Haven, CT, USA
| | - Mary I O'Connor
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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8
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Naot D, Watson M, Choi AJ, Musson DS, Callon KE, Zhu M, Gao R, Caughey W, Pitto RP, Munro JT, Horne A, Gamble GD, Dalbeth N, Reid IR, Cornish J. The effect of age on the microarchitecture and profile of gene expression in femoral head and neck bone from patients with osteoarthritis. Bone Rep 2020; 13:100287. [PMID: 32551338 PMCID: PMC7292911 DOI: 10.1016/j.bonr.2020.100287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 01/03/2023] Open
Abstract
Ageing of the skeleton is characterised by decreased bone mineral density, reduced strength, and increased risk of fracture. Although it is known that these changes are determined by the activities of bone cells through the processes of bone modelling and remodelling, details of the molecular mechanisms that underlie age-related changes in bone are still missing. Here, we analysed age-related changes in bone microarchitecture along with global gene expression in samples obtained from patients with osteoarthritis (OA). We hypothesised that changes would be evident in both microarchitecture and gene expression and aimed to identify novel molecular mechanisms that underlie ageing processes in bone. Samples of femoral head and neck were obtained from patients undergoing hip arthroplasty for OA, who were either ≤60 years or ≥70 years of age. Bone microarchitecture was analysed in cores of trabecular bone from the femoral head (17 from the younger group and 18 from the older), and cortical bone from the femoral neck (25 younger/22 older), using a Skyscan 1172 microCT scanner (Bruker). Gene expression was compared between the two age groups in 20 trabecular samples from each group, and 10 cortical samples from each group, using Clariom S Human microarrays (ThermoFisher Scientific). We found no significant changes between the two age groups in indices of trabecular or cortical bone microarchitecture. Gene expression analysis identified seven genes that had higher expression in the older group, including the transcription factor EGR1 and the glucose transporter SLC2A3 (GLUT3), and 21 differentially expressed genes in cortical bone samples (P<0.05, fold change>2). However, none of the comparisons of gene expression had false discovery rate-adjusted P<0.1. In contrast to our working hypothesis, we found only minor differences in gene expression and no differences in bone microarchitecture between the two age-groups. It is possible that pathological processes related to OA provide protection against age-related changes in bone. Our study suggests that in patients with OA, the bone properties measured here in femoral head and neck do not deteriorate significantly from the sixth to the eighth decade of life.
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Affiliation(s)
- Dorit Naot
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Maureen Watson
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Ally J. Choi
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - David S. Musson
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Karen E. Callon
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Mark Zhu
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Ryan Gao
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - William Caughey
- Middlemore Hospital, Counties Manukau District Health Board, Auckland 1062, New Zealand
| | - Rocco P. Pitto
- Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Jacob T. Munro
- Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Anne Horne
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Gregory D. Gamble
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Ian R. Reid
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Jillian Cornish
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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9
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Wang Q, Tang T, Cooper D, Eltit F, Fratzl P, Guy P, Wang R. Globular structure of the hypermineralized tissue in human femoral neck. J Struct Biol 2020; 212:107606. [PMID: 32905849 DOI: 10.1016/j.jsb.2020.107606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/15/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
Bone becomes more fragile with ageing. Among many structural changes, a thin layer of highly mineralized and brittle tissue covers part of the external surface of the thin femoral neck cortex in older people and has been proposed to increase hip fragility. However, there have been very limited reports on this hypermineralized tissue in the femoral neck, especially on its ultrastructure. Such information is critical to understanding both the mineralization process and its contributions to hip fracture. Here, we use multiple advanced techniques to characterize the ultrastructure of the hypermineralized tissue in the neck across various length scales. Synchrotron radiation micro-CT found larger but less densely distributed cellular lacunae in hypermineralized tissue than in lamellar bone. When examined under FIB-SEM, the hypermineralized tissue was mainly composed of mineral globules with sizes varying from submicron to a few microns. Nano-sized channels were present within the mineral globules and oriented with the surrounding organic matrix. Transmission electron microscopy showed the apatite inside globules were poorly crystalline, while those at the boundaries between the globules had well-defined lattice structure with crystallinity similar to the apatite mineral in lamellar bone. No preferred mineral orientation was observed both inside each globule and at the boundaries. Collectively, we conclude based on these new observations that the hypermineralized tissue is non-lamellar and has less organized mineral, which may contribute to the high brittleness of the tissue.
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Affiliation(s)
- Qiong Wang
- Department of Materials Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Tengteng Tang
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
| | - David Cooper
- Department of Anatomy, Physiology and Pharmacology, University of Saskatchewan, Saskatoon, Canada
| | - Felipe Eltit
- Vancouver Prostate Centre, Vancouver, Canada; Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter Fratzl
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
| | - Pierre Guy
- Centre for Hip Health and Mobility, Vancouver, BC, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Rizhi Wang
- Department of Materials Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada; School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada.
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10
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Zhang V, Koa B, Borja AJ, Padmanhabhan S, Bhattaru A, Raynor WY, Rojulpote C, Seraj SM, Werner TJ, Rajapakse C, Alavi A, Revheim ME. Diagnosis and Monitoring of Osteoporosis with Total-Body 18F-Sodium Fluoride-PET/CT. PET Clin 2020; 15:487-496. [PMID: 32768370 DOI: 10.1016/j.cpet.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In recent years, 18F-Sodium Fluoride (NaF)-PET/CT has seen its role in the detection and management of osteoporosis increase. This article reviews the extent of this application in the literature, its efficacy compared with other comparable imaging tools, and how total-body PET/CT combined with global disease assessment can revolutionize measurement of total osteoporotic disease activity. NaF-PET/CT eventually can be the modality of choice for metabolic bone disorders, especially with these advances in technology and computation.
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Affiliation(s)
- Vincent Zhang
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin Koa
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sayuri Padmanhabhan
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Abhijit Bhattaru
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Chaitanya Rojulpote
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | | | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Chamith Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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11
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Schileo E, Pitocchi J, Falcinelli C, Taddei F. Cortical bone mapping improves finite element strain prediction accuracy at the proximal femur. Bone 2020; 136:115348. [PMID: 32240847 DOI: 10.1016/j.bone.2020.115348] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
Despite evidence of the biomechanical role of cortical bone, current state of the art finite element models of the proximal femur built from clinical CT data lack a subject-specific representation of the bone cortex. Our main research hypothesis is that the subject-specific modelling of cortical bone layer from CT images, through a deconvolution procedure known as Cortical Bone Mapping (CBM, validated for cortical thickness and density estimates) can improve the accuracy of CT-based FE models of the proximal femur, currently limited by partial volume artefacts. Our secondary hypothesis is that a careful choice of cortical-specific density-elasticity relationship may improve model accuracy. We therefore: (i) implemented a procedure to include subject-specific CBM estimates of both cortical thickness and density in CT-based FE models. (ii) defined alternative models that included CBM estimates and featured a cortical-specific or an independently optimised density-elasticity relationship. (iii) tested our hypotheses in terms of elastic strain estimates and failure load and location prediction, by comparing with a published cohort of 14 femurs, where strain and strength in stance and fall loading configuration were experimentally measured, and estimated through reference FE models that did not explicitly model the cortical compartment. Our findings support the main hypothesis: an explicit modelling of the proximal femur cortical bone layer including CBM estimates of cortical bone thickness and density increased the FE strains prediction, mostly by reducing peak errors (average error reduced by 30%, maximum error and 95th percentile of error distribution halved) and especially when focusing on the femoral neck locations (all error metrics at least halved). We instead rejected the secondary hypothesis: changes in cortical density-elasticity relationship could not improve validation performances. From these improved baseline strain estimates, further work is needed to achieve accurate strength predictions, as models incorporating cortical thickness and density produced worse estimates of failure load and equivalent estimates of failure location when compared to reference models. In summary, we recommend including local estimates of cortical thickness and density in FE models to estimate bone strains in physiological conditions, and especially when designing exercise studies to promote bone strength.
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Affiliation(s)
- Enrico Schileo
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Jonathan Pitocchi
- Materialise N.V., Heverlee, Belgium; Multiscale in Mechanical and Biological Engineering (M2BE), University of Zaragoza, Zaragoza, Spain; Biomechanics Section, KU Leuven, Leuven, Belgium
| | | | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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12
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Maranesi E, Riccardi GR, Lattanzio F, Di Rosa M, Luzi R, Casoni E, Rinaldi N, Baldoni R, Di Donna V, Bevilacqua R. Randomised controlled trial assessing the effect of a technology-assisted gait and balance training on mobility in older people after hip fracture: study protocol. BMJ Open 2020; 10:e035508. [PMID: 32546491 PMCID: PMC7299027 DOI: 10.1136/bmjopen-2019-035508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Deficits in balance and walking ability are relevant risk factors for falls during ageing. Moreover, falls are a risk factor for future falls, strongly associated with adverse health outcomes, such as fear of falling or fractures, particularly, hip fracture. For this reason, the development of prevention tools and innovative rehabilitation strategies is one of the main objectives in geriatrics. Effective interventions to promote hip recovery after hip fracture are characterised by intensive and repetitive movements. One treatment approach is to increase the number of steps during the rehabilitation sessions and to improve the balance and the endurance of the patients in the use of technological devices. METHODS AND ANALYSIS This randomised controlled trial aimed to evaluate an innovative rehabilitation treatment of elderly patients with hip fractures. A total of 195 patients with hip fractures will be recruited and randomly divided into three groups: traditional rehabilitation programme, traditional rehabilitation programme plus TYMO system and traditional rehabilitation programme plus Walker View. Assessments will be performed at baseline, at the end of treatment, at 6 months, and at 1 and 2 years after the end of the treatment. Only subjects hospitalised 4 weeks prior to the beginning of the study will be taken into consideration. Twenty treatment sessions will be conducted, divided into three training sessions per week, for 7 weeks. The technological intervention group will carry out 30 min sessions of traditional therapy and 20 min of treatment with a technological device. The control group will perform traditional therapy sessions, each lasting 50 min. The primary outcomes are risk of falling, gait performance and fear of falling. ETHICS AND DISSEMINATION The study was approved by the Istituto di Ricerca e Cura a Carattere Scientifica, Istituto Nazionale Ricovero e Cura Anziani Ethics Committee, with identification code number 19 014. Trial results will be submitted for publication in journals and conferences. TRIAL REGISTRATION NUMBER NCT04095338.
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Affiliation(s)
| | | | | | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA, Ancona, Italy
| | | | - Elisa Casoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
| | - Nadia Rinaldi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Fermo, Italy
| | - Renato Baldoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
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13
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Postoperative Pressure Ulcers After Geriatric Hip Fracture Surgery Are Predicted by Defined Preoperative Comorbidities and Postoperative Complications. J Am Acad Orthop Surg 2020; 28:342-351. [PMID: 31567615 DOI: 10.5435/jaaos-d-19-00104] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The current study sought to determine the factors predictive of postoperative pressure ulcer development by analyzing extensive multicenter outcomes data from the 2016 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. METHODS The 2016 NSQIP Participant Use File and Hip Fracture Procedure Targeted file were used to identify the risk factors for the development of postoperative pressure ulcers after hip fracture surgery in a geriatric cohort. Multivariate regressions were performed to identify preoperative comorbidities and postoperative complications that are risk factors for developing postoperative pressure ulcers. RESULTS Of 8,871 geriatric hip fracture patients included in the study cohort, 457 (5.15%) developed pressure ulcers. Multivariate regressions identified the following preoperative risk factors for developing a postoperative pressure ulcer (in order of decreasing relative risk): preoperative sepsis, elevated platelet count, insulin-dependent diabetes, and preexisting pressure ulcer. Multivariate regressions also identified the following postoperative complications as risk factors for developing a postoperative pressure ulcer: postoperative sepsis, postoperative pneumonia, urinary tract infection, and postoperative delirium. DISCUSSION The identified preoperative factors and postoperative complications should help guide quality improvement programs.
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14
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Andreasen CM, Bakalova LP, Brüel A, Hauge EM, Kiil BJ, Delaisse JM, Kersh ME, Thomsen JS, Andersen TL. The generation of enlarged eroded pores upon existing intracortical canals is a major contributor to endocortical trabecularization. Bone 2020; 130:115127. [PMID: 31689525 DOI: 10.1016/j.bone.2019.115127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 02/04/2023]
Abstract
The gradual conversion of cortical bone into trabecular bone on the endocortical surface contributes substantially to thinning of the cortical bone. The purpose of the present study was to characterize the intracortical canals (3D) and pores (2D) in human fibular bone, to identify the intracortical remodeling events leading to this endocortical trabecularization. The analysis was conducted in fibular diaphyseal bone specimens obtained from 20 patients (6 women and 14 men, age range 41-75 years). μCT revealed that endosteal bone had a higher cortical porosity (p< 0.05) and canals with a larger diameter (p< 0.05) than periosteal bone, while the canal spacing and number were similar in the endosteal and periosteal half. Histological analysis showed that the endosteal half versus the periosteal half: (i) had a higher likelihood of being non-quiescent type 2 pores (i.e. remodeling of existing pores) than other pore types (OR = 1.6, p< 0.01); (ii) that the non-quiescent type 2 pores contributed to a higher porosity (p< 0.001); and that (iii) amongst these pores especially eroded type 2 pores contributed to the elevated cortical porosity (p< 0.001). In conclusion, we propose that endocortical trabecularization results from the accumulation of eroded cavities upon existing intracortical canals, favored by delayed initiation of bone formation.
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Affiliation(s)
- Christina Møller Andreasen
- Department of Orthopedic Surgery & Traumatology, Odense University Hospital, Odense, Denmark; Clinical Cell Biology, Research Unit of Pathology, Department of Clinical Research, University of Southern Denmark and Department of Pathology, Odense University Hospital, Odense, Denmark; Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
| | - Lydia Peteva Bakalova
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, IL, USA.
| | - Annemarie Brüel
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.
| | - Ellen Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Birgitte Jul Kiil
- Department of Plastic Surgery, Aarhus University Hospital, Aarhus, Denmark.
| | - Jean-Marie Delaisse
- Clinical Cell Biology, Research Unit of Pathology, Department of Clinical Research, University of Southern Denmark and Department of Pathology, Odense University Hospital, Odense, Denmark; Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark; Clinical Cell Biology, Vejle Hospital - Lillebælt Hospital, University of Southern Denmark, Vejle, Denmark.
| | - Mariana Elizabeth Kersh
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, IL, USA.
| | | | - Thomas Levin Andersen
- Clinical Cell Biology, Research Unit of Pathology, Department of Clinical Research, University of Southern Denmark and Department of Pathology, Odense University Hospital, Odense, Denmark; Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark; Clinical Cell Biology, Vejle Hospital - Lillebælt Hospital, University of Southern Denmark, Vejle, Denmark; Department of Forensic Medicine, Aarhus University, Aarhus, Denmark.
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15
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Mant M, de la Cova C, Ives R, Brickley MB. Perimortem fracture manifestations and mortality after hip fracture in a documented skeletal series. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 27:56-65. [PMID: 31586732 DOI: 10.1016/j.ijpp.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/03/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Unhealed hip fractures are underrepresented in the archaeological record, suggesting that better identification criteria are required. This paper evaluates whether a sample of documented perimortem hip fractures displayed classic perimortem features and which features may facilitate better identification of such fractures in the archaeological record. MATERIALS Ten individuals from the Robert J. Terry Anatomical Skeletal Collection with documented hip fractures and intervals of survival. METHODS We observed the skeletal remains macroscopically and with a Keyence VHX-2000 digital microscope at a range of 5x to 100x magnification. RESULTS 90% of the individuals and 64% of the fragments had identifiable perimortem features; hinging was the most consistent feature. Eburnation was found in two individuals who died 13 days after sustaining a hip fracture. CONCLUSIONS This study underscores the importance of examining fracture margins for evidence of hinging. Eburnation may be added to the list of potential perimortem fracture identification criteria. SIGNIFICANCE Identifying perimortem trauma unequivocally remains challenging. Using collections with documented perimortem fractures aids in determining which criteria are most likely to appear in archaeological human bone. LIMITATIONS The fracture location patterning (70% intertrochanteric) may be the result of sample selection. SUGGESTIONS FOR FUTURE RESEARCH Further intensive comparative investigation with the Hamann-Todd Collection would elucidate patterns further.
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Affiliation(s)
- Madeleine Mant
- Memorial University, Department of Archaeology, St. John's, Newfoundland and Labrador, A1B 3R6, Canada; McMaster University, Department of Anthropology, Hamilton, Ontario, L8S 4L9, Canada.
| | - Carlina de la Cova
- University of South Carolina, Department of Anthropology, Columbia, South Carolina, 29208, USA.
| | - Rachel Ives
- Natural History Museum, Department of Earth Sciences, Cromwell Road, SW7 5BD, London, United Kingdom.
| | - Megan B Brickley
- McMaster University, Department of Anthropology, Hamilton, Ontario, L8S 4L9, Canada.
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16
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Liu Z, Zhang J, He K, Zhang Y, Zhang Y. Optimized clinical practice for superaged patients with hip fracture: significance of damage control and enhanced recovery program. BURNS & TRAUMA 2019; 7:21. [PMID: 31410362 PMCID: PMC6686476 DOI: 10.1186/s41038-019-0159-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/06/2019] [Indexed: 11/24/2022]
Abstract
With the advent of global aging, the incidence, mortality, and medical costs of hip fracture among aged patients are increasing annually. The number of controlled clinical studies and health economics analyses that conform to evidence-based medicine principles is growing day by day. However, unfortunately, no specific recommendations regarding the procedures for the treatment of hip fracture are available. Meanwhile, the existence of both traditional treatment systems and new treatment theories means that most doctors confront difficult choices in their daily practice. These factors make the therapeutic approach for aged patients, especially among superaged patients with hip fracture, extremely challenging. This study focuses on superaged patients (> 80 years as defined by the World Health Organization) with hip fracture and includes their preoperative pathological condition; therapeutic decision-making in terms of the benefit and risk ratio, damage control theory, and enhanced recovery after surgery were also investigated. These patients were discussed specifically by combining the current treatment strategies from several experts and the results of a meta-analysis published recently. The study presents some new ideas and approaches currently recognized in the field, such as preoperative assessment, surgical planning, safety consideration, complication intervention, and enhanced recovery implementation, and further presents some clear interpretations regarding misunderstandings in clinical practice. Finally, optimized treatment according to damage control principles and enhanced recovery after surgery during the perioperative period among superaged hip fracture patients is defined.
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Affiliation(s)
- Zaiyang Liu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037 China
| | - Jun Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037 China
| | - Kaiqi He
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037 China
| | - Yumei Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037 China
| | - Yuan Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, 400037 China
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17
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Tang T, Wagermaier W, Schuetz R, Wang Q, Eltit F, Fratzl P, Wang R. Hypermineralization in the femoral neck of the elderly. Acta Biomater 2019; 89:330-342. [PMID: 30872111 DOI: 10.1016/j.actbio.2019.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 01/04/2023]
Abstract
Hip fragility depends on the decline in bone mass as well as changes in bone microstructure and the properties of bone mineral and organic matrix. Although it is well-established that low bone mass or osteoporosis is a key factor in hip fracture risk, it is striking to observe that 92% of 24 patients who have sustained an intracapsular hip fracture showed hypermineralization at the superior-anterior quadrant, a critical region associated with increased hip fracture risk. In-depth material studies on a total of 12 human cadaver femurs revealed increased degree of mineralization in the hypermineralized tissue: calcium weight percentage as measured by quantitative backscattered electron imaging increased by approximately 15% compared with lamellar bone; mineral-to-matrix ratio obtained by Raman microspectroscopy imaging also increased. Immunohistochemistry revealed localized type II collagen in the hypermineralized region, implying its cartilaginous nature. At the ultrastructural level, X-ray scattering revealed significantly smaller (on average 2.3 nm thick and 15.6 nm long) and less ordered bone minerals in the hypermineralized tissue. Finally, the hypermineralized tissue was more brittle than lamellar bone under hydrated state - cracks propagated easily in the hypermineralized region but stopped at the lamellar boundary. This study demonstrates that hypermineralization of femoral neck cortical bone is a source of bone fragility which is worth considering in future fracture risk assessment when the origin of hip fracture is unclear based on current evaluation standards. STATEMENT OF SIGNIFICANCE: Hypermineralization of femoral cortical bone in older adults might occur in many more hip fracture cases than presently known. Yet, this tissue remains largely unknown to the orthopedic community possibly due to coarse resolution of clinical imaging. The current study showed the hypermineralized tissue had reduced fracture resistance which could be attributed to the material changes in mineral content, organic matrix, and mineral platelets properties. It thus could be a source for fracture initiation. Consequently, we believe hypermineralization of femoral neck cortical bone should be considered in hip fragility assessment, especially when low bone mass cannot be identified as a primary contributor to hip fracture.
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Affiliation(s)
- Tengteng Tang
- Department of Materials Engineering, University of British Columbia, Vancouver, BC, Canada; Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany; Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Wolfgang Wagermaier
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
| | - Roman Schuetz
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany
| | - Qiong Wang
- Department of Materials Engineering, University of British Columbia, Vancouver, BC, Canada; School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Felipe Eltit
- Department of Materials Engineering, University of British Columbia, Vancouver, BC, Canada; School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Peter Fratzl
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Potsdam, Germany.
| | - Rizhi Wang
- Department of Materials Engineering, University of British Columbia, Vancouver, BC, Canada; School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada.
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18
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Khoo BCC, Brown K, Lewis JR, Perilli E, Prince RL. Ageing Effects on 3-Dimensional Femoral Neck Cross-Sectional Asymmetry: Implications for Age-Related Bone Fragility in Falling. J Clin Densitom 2019; 22:153-161. [PMID: 30205985 DOI: 10.1016/j.jocd.2018.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/01/2018] [Indexed: 01/27/2023]
Abstract
This paper explores the effects of aging on femoral neck (FN) anatomy in a study of women aged 20-90years in relation to implications for FN fracture propensity in buckling. Five hundred and four participants were scanned by Quantitative Computed Tomography and analyzed using Quantitative Computed Tomography Pro BIT (Mindways). FN cross-section was split through geometric center into superior and inferior sectors. Bone mass, structural measurements, and bone mineral density were analyzed. Buckling ratio was calculated as ratio of buckling radius to cortical thickness. Between 2nd decade and 8th decade, age-related integral bone mass reduction in superior sector was substantially larger than in inferior sector (33% compared to 21%), especially in cortical bone superiorly compared to inferiorly (53% vs 21%; p < 0.001), principally due to reduction in cortical thickness, averaged cortical thickness (56%) with little difference in density. Superior and inferior sector trabecular bone mineral density reduction was similar at 41% and 43% respectively. Differential cortical bone loss in superior sector resulted in a 59% inferior displacement (δ) of center-of-mass from geometric center. Differences in δ and averaged cortical thickness with age accounted for a 151% increase in mean superior buckling ratio from 9 to 23. Analysis confirms significant progressive age-related superior cortical bone loss as the major age effect on FN structure with relative preservation of inferior cortex probably related to maintenance of inferior sector by regular loading as a result of standing and walking. Computation of buckling ratio may allow prediction of fracture propensity in a sideways fall.
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Affiliation(s)
- B C C Khoo
- Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; University of Western Australia, Medical School, Nedlands, WA, Australia
| | - K Brown
- Mindways Software, Austin, TX, USA
| | - J R Lewis
- University of Western Australia, Medical School, Nedlands, WA, Australia; Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - E Perilli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, Australia
| | - R L Prince
- University of Western Australia, Medical School, Nedlands, WA, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
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19
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Skedros JG, Doutré MS. Collagen fiber orientation pattern, osteon morphology and distribution, and presence of laminar histology do not distinguish torsion from bending in bat and pigeon wing bones. J Anat 2019; 234:748-763. [PMID: 30924933 DOI: 10.1111/joa.12981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2019] [Indexed: 12/17/2022] Open
Abstract
Bone can adapt to its habitual load history at various levels of its hierarchical structural and material organization. However, it is unclear how strongly a bone's structural characteristics (e.g. cross-sectional shape) are linked to microstructural characteristics (e.g. distributions of osteons and their vascular canals) or ultrastructural characteristics [e.g. patterns of predominant collagen fiber orientation (CFO)]. We compared the cross-sectional geometry, microstructure and ultrastructure of pigeon (Columba livia domestica) humeri, and third metacarpals (B3M) and humeri of a large bat (Pteropus poliocephalus). The pigeon humerus is habitually torsionally loaded, and has unremodeled ('primary') bone with vessels (secondary osteons are absent) and high 'laminarity' because a large majority of these vessels course circularly with respect to the bone's external surface. In vivo data show that the bat humerus is also habitually torsionally loaded; this contrasts with habitual single-plane bending of the B3M, where in vivo data show that it oscillates back and forth in the same direction. In contrast to pigeon humeri where laminar bone is present, the primary tissue of these bat bones is largely avascular, but secondary osteons are present and are usually in the deeper cortex. Nevertheless, the load history of humeri of both species is prevalent/predominant torsion, producing diffusely distributed shear stresses throughout the cross-section. We tested the hypothesis that despite microstructural/osteonal differences in these pigeon and bat bones, they will have similar characteristics at the ultrastructural level that adapt each bone for its load history. We postulate that predominant CFO is this characteristic. However, even though data reported in prior studies of bones of non-flying mammals suggest that CFO would show regional variations in accordance with the habitual 'tension regions' and 'compression regions' in the direction of unidirectional habitual bending, we hypothesized that alternating directions of bending within the same plane would obviate these regional/site-specific adaptations in the B3M. Similarly, but for other reasons, we did not expect regional variations in CFO in the habitually torsionally loaded bat and pigeon humeri because uniformly oblique-to-transverse CFO is the adaptation expected for the diffusely distributed shear stresses produced by torsion/multidirectional loads. We analyzed transverse sections from mid-diaphyses of adult bones for CFO, secondary osteon characteristics (size, shape and population density), cortical thickness in quadrants of the cortex, and additional measures of cross-sectional geometry, including the degree of circular shape that can help distinguish habitual torsion from bending. Results showed the expected lack of regional CFO differences in quasi-circular shaped, and torsionally loaded, pigeon and bat humeri. As expected, the B3M also lacked CFO variations between the opposing cortices along the plane of bending, and the quasi-elliptical cross-sectional shape and regional microstructural/osteonal variations expected for bending were not found. These findings in the B3M show that uniformity in CFO does not always reflect habitual torsional loads. Osteon morphology and distribution, and presence of laminar histology also do not distinguish torsion from bending in these bat and pigeon wing bones.
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Affiliation(s)
- John G Skedros
- Bone and Joint Research Laboratory, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA.,Department of Orthopaedic Surgery, The University of Utah, Salt Lake City, UT, USA
| | - Madison S Doutré
- Bone and Joint Research Laboratory, George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
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20
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Power J, Loveridge N, Kröger H, Parker M, Reeve J. Femoral neck cortical bone in female and male hip fracture cases: Differential contrasts in cortical width and sub-periosteal porosity in 112 cases and controls. Bone 2018; 114:81-89. [PMID: 29807138 DOI: 10.1016/j.bone.2018.05.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/17/2018] [Accepted: 05/24/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To quantitate differences between cases of hip fracture and controls in cortical width around the mid-femoral neck in men and women. METHODS Over 5 years, 64 (14 male) participants over age 55 (mean 79) years, who had never taken bone-active drugs and suffered intra-capsular hip fracture treated by arthroplasty, donated their routinely discarded distal intra-capsular femoral neck bone for histomorphometry. After embedding, complete femoral neck cross sections from the cut surface near the narrowest part of the neck were stained with von Kossa and cortical width was measured radially every 5 degrees of arc. Control material (n = 48, 25 male) was available through consented post mortems prior to the year 2000. Cortical widths were averaged for circumferential octants, each representing 45 degrees of arc. Divergence of individual cortical widths from their means was also examined. RESULTS Because sections were required to have a complete cortex, sampling was biased towards cases with sub-capital versus trans-cervical fractures. Compared to sex- and age matched controls, male cases showed larger relative differences in cortical widths than female cases. Unexpectedly, cortical widths in female but not male cases also showed marked over-representation of extremely narrow (<0.1 mm) cortical widths, located mainly posteriorly. The numbers of these very narrow cortical widths observed per subject retrospectively predicted female fracture status in logistic regression independently of mean cortical width values. Together with mean cortical width differences, the numbers of measured cortical widths <0.1 mm (out of 72 measured) raised the sensitivity of predicting fracture status in women from 48 to 80% at 80% specificity. In almost all cases, very narrow cortical widths were identified in regions enclosing a cortical pore roofed on its endosteal surface by thin structural bone defined a priori as trabecular. CONCLUSIONS Cortical widths <0.1 mm probably reflect zones where endosteal cortex has been trabecularised through expansion of an un-refilled sub-endosteal canal close to the periosteum. Persistent cortical defects occurring near the periosteal surface, where mechanical loading exerts its greatest stresses, are likely to result in extremes of localized concentrations of stress during a fall, unknown in young normal fallers. Such defects have the potential to help explain the excess of hip fractures among elderly women. Prevention of sub-periosteal tunnelling by osteoclasts might explain in part the additional benefits, beyond an increase in bone density, of treatments that reduce excessive bone resorption or else stimulate new bone formation on previously resorbed surfaces.
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Affiliation(s)
- Jon Power
- Department of Biological Sciences, University of Chester, Chester CH1 4BJ, UK
| | - Nigel Loveridge
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Box 180, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Handsurgery, Kuopio University Hospital, P.O.BOX 100, FIN-70029 KYS Kuopio, Finland
| | - Martyn Parker
- Trauma and Orthopaedics, Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough PE3 9GZ, UK
| | - Jonathan Reeve
- NIHR Biomedical Research Centre, Institute of Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK.
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Tang T, Cripton PA, Guy P, McKay HA, Wang R. Clinical hip fracture is accompanied by compression induced failure in the superior cortex of the femoral neck. Bone 2018; 108:121-131. [PMID: 29277713 DOI: 10.1016/j.bone.2017.12.020] [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] [Received: 09/11/2017] [Revised: 11/22/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
Hip fractures pose a major health problem throughout the world due to their devastating impact. Current theories for why these injuries are so prevalent in the elderly point to an increased propensity to fall and decreases in bone mass with ageing. However, the fracture mechanisms, particularly the stress and strain conditions leading to bone failure at the hip remain unclear. Here, we directly examined the cortical bone from clinical intra-capsular hip fractures at a microscopic level, and found strong evidence of compression induced failure in the superior cortex. A total of 143 sections obtained from 24 femoral neck samples that were retrieved from 24 fracturing patients at surgery were examined using laser scanning confocal microscopy (LSCM) after fluorescein staining. The stained microcracks showed significantly higher density in the superior cortex than in the inferior cortex, indicating a greater magnitude of strain in the superior femoral neck during the failure-associated deformation and fracture process. The predominant stress state for each section was reconstructed based on the unique correlation between the microcrack pattern and the stress state. Specifically, we found clear evidence of longitudinal compression and buckling as the primary failure mechanisms in the superior cortex. These findings demonstrate the importance of microcrack analysis in studying clinical hip fractures, and point to the central role of the superior cortex failure as an important aspect of the failure initiation in clinical intra-capsular hip fractures.
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Affiliation(s)
- Tengteng Tang
- Department of Materials Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Peter A Cripton
- Department of Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada; International Collaboration On Repair Discoveries, Vancouver, BC, Canada
| | - Pierre Guy
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Heather A McKay
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Rizhi Wang
- Department of Materials Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada.
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Abstract
OBJECTIVES Mortality in elderly patients after the surgical treatment of hip fractures remains high. Although individual clinical risk factors have been widely studied, there has been limited research on prediction models in this population. The purpose of this study was to develop a prediction model for in-hospital mortality after hip fracture surgery and to evaluate the performance of this model. METHODS Using the National Inpatient Sample database from 2012 to 2013, we collected data on 535,475 patients older than 50 years who had hip fracture surgery. Patient characteristics, surgery-specific factors, and Elixhauser comorbidities were used as candidate variables. The patients were randomly divided into training and testing cohorts. The Lasso (least absolute shrinkage and selection operator) method was used to select predictor variables, and points were assigned to each variable based on its coefficient. RESULTS We identified 8 essential predictors (age, timing of surgery, male sex, congestive heart failure, pulmonary circulation disease, renal failure, weight loss, and fluid and electrolyte disorders) for mortality, with a maximum prediction score of 20. The model's area under the curve was 0.74, and the Hosmer-Lemeshow test P value was 0.59 on the testing set. With the application of cutoff values (scores 0-5, 6-9, and 10-20), the observed in-hospital postoperative mortality was 0.6%, 2.5%, and 7.5%, respectively. CONCLUSIONS We built a simple prediction model with 8 essential clinical factors that predict in-hospital mortality after hip fracture surgery. This model may assist in counseling patients and families and measuring hospital quality of care. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Bonnheim N, Gramling H, Ries M, Shukla S, Iliescu B, Pruitt L. Fatigue fracture of a cemented Omnifit CoCr femoral stem: implant and failure analysis. Arthroplast Today 2017; 3:234-238. [PMID: 29204487 PMCID: PMC5712028 DOI: 10.1016/j.artd.2017.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/07/2017] [Accepted: 06/10/2017] [Indexed: 11/20/2022] Open
Abstract
A cemented, cast CoCr alloy, Omnifit Plus femoral stem was retrieved following mid-stem fracture after 24 years in vivo. The patient was an active 55-year-old male with a high body mass index (31.3) and no traumatic incidents before stem fracture. Fractographic and fatigue-based failure analyses were performed to illuminate the etiology of fracture and retrospectively predict the device lifetime. The fracture surfaces show evidence of a coarse grain microstructure, intergranular fracture, and regions of porosity. The failure analysis suggests that stems with similar metallurgical characteristics, biomechanical environments, and in vivo durations may be abutting their functioning lifetimes, raising the possibility of an increased revision burden.
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Affiliation(s)
- Noah Bonnheim
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Hannah Gramling
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | | | | | - Beatrice Iliescu
- Thayer School of Engineering at Dartmouth College, Hanover, NH, USA
| | - Lisa Pruitt
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
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24
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Piemontese M, Almeida M, Robling AG, Kim HN, Xiong J, Thostenson JD, Weinstein RS, Manolagas SC, O'Brien CA, Jilka RL. Old age causes de novo intracortical bone remodeling and porosity in mice. JCI Insight 2017; 2:93771. [PMID: 28878136 DOI: 10.1172/jci.insight.93771] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 08/03/2017] [Indexed: 01/08/2023] Open
Abstract
Decreased cortical thickness and increased cortical porosity are the key anatomic changes responsible for osteoporotic fractures in elderly women and men. The cellular basis of these changes is unbalanced endosteal and intracortical osteonal remodeling by the osteoclasts and osteoblasts that comprise the basic multicellular units (BMUs). Like humans, mice lose cortical bone with age, but unlike humans, this loss occurs in the face of sex steroid sufficiency. Mice are therefore an ideal model to dissect age-specific osteoporotic mechanisms. Nevertheless, lack of evidence for endosteal or intracortical remodeling in mice has raised questions about their translational relevance. We show herein that administration of the antiosteoclastogenic cytokine osteoprotegerin to Swiss Webster mice ablated not only osteoclasts, but also endosteal bone formation, demonstrating the occurrence of BMU-based endosteal remodeling. Femoral cortical thickness decreased in aged male and female C57BL/6J mice, as well as F1 hybrids of C57BL/6J and BALB/cBy mice. This decrease was greater in C57BL/6J mice, indicating a genetic influence. Moreover, endosteal remodeling became unbalanced because of increased osteoclast and decreased osteoblast numbers. The porosity of the femoral cortex increased with age but was much higher in females of both strains. Notably, the increased cortical porosity resulted from de novo intracortical remodeling by osteon-like structures. Age-dependent cortical bone loss was associated with increased osteocyte DNA damage, cellular senescence, the senescence-associated secretory phenotype, and increased levels of RANKL. The demonstration of unbalanced endosteal and intracortical remodeling in old mice validates the relevance of this animal model to involutional osteoporosis in humans.
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Affiliation(s)
- Marilina Piemontese
- Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Maria Almeida
- Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Alexander G Robling
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ha-Neui Kim
- Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Jinhu Xiong
- Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Jeff D Thostenson
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Robert S Weinstein
- Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Stavros C Manolagas
- Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Charles A O'Brien
- Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Robert L Jilka
- Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
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Souza RD, Javaheri B, Collinson R, Chenu C, Shefelbine S, Lee P, Pitsillides A. Prolonging disuse in aged mice amplifies cortical but not trabecular bones' response to mechanical loading. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2017; 17:218-225. [PMID: 28860424 PMCID: PMC5601267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Short-term neurectomy-induced disuse (SN) has been shown to restore load responses in aged mice. We examined whether this restoration was further enhanced in both cortical and trabecular bone by simply extending the SN. METHODS Following load:strain calibration, tibiae in female C57BL/J6 mice at 8, 14 and 20 weeks and 18 months (n=8/group) were loaded and bone changes measured. Effects of long-term SN examined in twenty-six 18 months-old mice, neurectomised for 5 or 100 days with/without subsequent loading. Cortical and trabecular responses were measured histomorphometrically or by micro-computed tomography. RESULTS Loading increased new cortical bone formation, elevating cross-sectional area in 8, 14 and 20 week-old (p ⟨0.05), but not 18 month-old aged mice. Histomorphometry showed that short-term SN reinstated load-responses in aged mice, with significant 33% and 117% increases in bone accrual at 47% and 37%, but not 27% of tibia length. Cortical responses to loading was heightened and widespread, now evident at all locations, following prolonged SN (108, 167 and 98% at 47, 37 and 27% of tibial length, respectively). In contrast, loading failed to modify trabecular bone mass or architecture. CONCLUSIONS Mechanoadaptation become deficient with ageing and prolonging disuse amplifies this response in cortical but not trabecular bone.
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Affiliation(s)
- R. De Souza
- Universidade Federal de Mato Grosso (UFMT) · Departamento de Clínica, Cuiabá, Brazil
| | - B. Javaheri
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London NW1 0TU, United Kingdom,Corresponding author: Dr Behzad Javaheri, Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London, NW1 0TU, UK E-mail:
| | - R.S. Collinson
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London NW1 0TU, United Kingdom
| | - C. Chenu
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London NW1 0TU, United Kingdom
| | - S.J. Shefelbine
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA
| | - P.D. Lee
- Manchester X-Ray Imaging Facility, University of Manchester, Manchester, UK
| | - A.A. Pitsillides
- Skeletal Biology Group, Comparative Biomedical Sciences, Royal Veterinary College, Royal College Street, London NW1 0TU, United Kingdom
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26
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Wang L, Khoo BCC, Cheng XG, Brown K, Lewis JR, Su YB, Guo Z, Li K, Prince RL. Differences in femoral neck structure between elderly Caucasian and Chinese populations: a cross-sectional study of Perth-Beijing cohorts. Arch Osteoporos 2017; 12:72. [PMID: 28812206 DOI: 10.1007/s11657-017-0366-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/31/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Structural skeletal differences of the femoral neck of older Beijing-Chinese and Perth-Caucasian women were compared; adjusting for frame size-related differences, Beijing-Chinese have lower periosteal width; however, indices of internal bone distribution suggest that Beijing-Chinese may exhibit increased resistance to fracture that may relate to the reduced hip fracture incidence. INTRODUCTION Ethnic differences in skeletal structure may relate to differences in hip fracture risk in Chinese and Caucasian populations. 2D mass, size, and structural biomechanics were compared in the two populations. METHODS Quantitative computed tomography-derived geometric variables were compared in age-matched community-derived female populations, 196 Beijing-Chinese 76.5 ± 4.8 (mean ± SD) years and 237 Perth-Caucasians 77.1 ± 5.0 years. These included scanned area (A), periosteal width (W), bone mineral content (BMC), aBMD, bone cross-sectional area (bCSA), section modulus (Z) and buckling ratio (BR). Assumption-free measures included sigma (σ), related to the distribution of bone in the scanned image previously identified as a predictor of hip fracture, and delta (δ), the center-of-mass displacement from the geometric center. RESULTS Compared to Beijing-Chinese, Perth-Caucasians were heavier (Beijing-Chinese 58.7 ± 11.8; Perth-Caucasians 66.1 ± 11.0 kg), taller (154.9 ± 16.7 vs 158.9 ± 6.0 cm), and had higher BMC, A, and W. After adjustment for frame size, BMC was not significantly different but W remained higher in Perth-Caucasians. Differences in variables aBMD, Z, BR, and σ favored higher resistance to failure with Beijing-Chinese before and after adjustment for frame size. δ was similar in both populations; bCSA was higher in Beijing-Chinese before adjustment for frame size but not after. CONCLUSIONS Bone mass differences in two populations were related to frame size differences. However, femoral neck width remained smaller in Beijing-Chinese suggesting effects of local genetic and environmental factors. In Beijing-Chinese participants compared to Perth-Caucasians, internal bone distribution suggests increased resistance to deformation if exposed to same force that may, in-part, relate to reduced incidence of hip fracture in Beijing-Chinese.
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Affiliation(s)
- L Wang
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - B C C Khoo
- Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia.,School of Physics, University of Western Australia, Nedlands, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA, Australia
| | - X G Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - K Brown
- Mindways Software, Austin, TX, USA
| | - J R Lewis
- School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA, Australia.,Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Y B Su
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - Z Guo
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - K Li
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - R L Prince
- School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA, Australia. .,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
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Yu A, Carballido-Gamio J, Wang L, Lang TF, Su Y, Wu X, Wang M, Wei J, Yi C, Cheng X. Spatial Differences in the Distribution of Bone Between Femoral Neck and Trochanteric Fractures. J Bone Miner Res 2017; 32:1672-1680. [PMID: 28407298 PMCID: PMC5550343 DOI: 10.1002/jbmr.3150] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/21/2017] [Accepted: 04/10/2017] [Indexed: 01/08/2023]
Abstract
There is little knowledge about the spatial distribution differences in volumetric bone mineral density and cortical bone structure at the proximal femur between femoral neck fractures and trochanteric fractures. In this case-control study, a total of 93 women with fragility hip fractures, 72 with femoral neck fractures (mean ± SD age: 70.6 ± 12.7 years) and 21 with trochanteric fractures (75.6 ± 9.3 years), and 50 control subjects (63.7 ± 7.0 years) were included for the comparisons. Differences in the spatial distributions of volumetric bone mineral density, cortical bone thickness, cortical volumetric bone mineral density, and volumetric bone mineral density in a layer adjacent to the endosteal surface were investigated using voxel-based morphometry (VBM) and surface-based statistical parametric mapping (SPM). We compared these spatial distributions between controls and both types of fracture, and between the two types of fracture. Using VBM, we found spatially heterogeneous volumetric bone mineral density differences between control subjects and subjects with hip fracture that varied by fracture type. Interestingly, femoral neck fracture subjects, but not subjects with trochanteric fracture, showed significantly lower volumetric bone mineral density in the superior aspect of the femoral neck compared with controls. Using surface-based SPM, we found that compared with controls, both fracture types showed thinner cortices in regions in agreement with the type of fracture. Most outcomes of cortical and endocortical volumetric bone mineral density comparisons were consistent with VBM results. Our results suggest: 1) that the spatial distribution of trabecular volumetric bone mineral density might play a significant role in hip fracture; 2) that focal cortical bone thinning might be more relevant in femoral neck fractures; and 3) that areas of reduced cortical and endocortical volumetric bone mineral density might be more relevant for trochanteric fractures in Chinese women. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Aihong Yu
- Department of Radiology, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | | | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Thomas F Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Xinbao Wu
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Manyi Wang
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Jie Wei
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Chen Yi
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
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28
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Gräsel M, Glüer CC, Barkmann R. Characterization of a new ultrasound device designed for measuring cortical porosity at the human tibia: A phantom study. ULTRASONICS 2017; 76:183-191. [PMID: 28107676 DOI: 10.1016/j.ultras.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/30/2016] [Accepted: 01/02/2017] [Indexed: 06/06/2023]
Abstract
Quantitative ultrasound (QUS) measurements of trabecular bone are a useful tool for the assessment of osteoporotic fracture risk. However, cortical bone properties (e.g. porosity) have an impact on bone strength as well and thus current research is focused on QUS assessment of cortical bone properties. Simulation studies of ultrasound propagation through cortical bone indicate that anisotropy, calculated from the ratio of the velocities in axial and tangential directions, is correlated with porosity. However, this relationship is affected by error sources, specifically bone surface curvature and variability of probe positioning. With the aim of in vivo estimation of cortical porosity a new ultrasound device was developed, which sequentially measures velocities in 3 different directions (axial=0° and ±37.5°) using the axial transmission method. Measurements on planar porosity phantoms (0-25%) were performed to confirm the results of the afore mentioned simulation studies. Additionally, measurements on cylindrical phantoms without pores (min. radius=34mm for strongest curvature) were performed to estimate the influence of surface curvature on velocity measurements (the tibia bone surface is fairly flat but may show surface curvature in some patients). The velocities in the axial and ±37.5° directions were used to calculate an anisotropy index. The velocities measured on the porosity phantoms showed a decrease by -6.3±0.2m/s and -10.1±0.2m/s per percent increase in porosity in axial and ±37.5° directions, respectively. Surface curvature had an effect on the velocities measured in ±37.5° directions which could be minimized by a correction algorithm resulting in an error of 5m/s. The anisotropy index could be used to estimate porosity with an accuracy error of 1.5%. These results indicate that an estimation of porosity using velocity measurements in different directions might be feasible, even in bones with curved surface. These results obtained on phantom material indicate that the approach tested may be suited for porosity measurements on human tibia bone.
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Affiliation(s)
- M Gräsel
- Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Am Botanischen Garten 14, 24118 Kiel, Germany.
| | - C-C Glüer
- Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Am Botanischen Garten 14, 24118 Kiel, Germany.
| | - R Barkmann
- Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Am Botanischen Garten 14, 24118 Kiel, Germany.
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Role of cortical bone in hip fracture. BONEKEY REPORTS 2017; 6:867. [PMID: 28277562 DOI: 10.1038/bonekey.2016.82] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/03/2016] [Indexed: 12/23/2022]
Abstract
In this review, I consider the varied mechanisms in cortical bone that help preserve its integrity and how they deteriorate with aging. Aging affects cortical bone in two ways: extrinsically through its effects on the individual that modify its mechanical loading experience and 'milieu interieur'; and intrinsically through the prolonged cycle of remodelling and renewal extending to an estimated 20 years in the proximal femur. Healthy femoral cortex incorporates multiple mechanisms that help prevent fracture. These have been described at multiple length scales from the individual bone mineral crystal to the scale of the femur itself and appear to operate hierarchically. Each cortical bone fracture begins as a sub-microscopic crack that enlarges under mechanical load, for example, that imposed by a fall. In these conditions, a crack will enlarge explosively unless the cortical bone is intrinsically tough (the opposite of brittle). Toughness leads to microscopic crack deflection and bridging and may be increased by adequate regulation of both mineral crystal size and the heterogeneity of mineral and matrix phases. The role of osteocytes in optimising toughness is beginning to be worked out; but many osteocytes die in situ without triggering bone renewal over a 20-year cycle, with potential for increasing brittleness. Furthermore, the superolateral cortex of the proximal femur thins progressively during life, so increasing the risk of buckling during a fall. Besides preserving or increasing hip BMD, pharmaceutical treatments have class-specific effects on the toughness of cortical bone, although dietary and exercise-based interventions show early promise.
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Evidence for Altered Canonical Wnt Signaling in the Trabecular Bone of Elderly Postmenopausal Women with Fragility Femoral Fracture. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8169614. [PMID: 27999816 PMCID: PMC5143692 DOI: 10.1155/2016/8169614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/07/2016] [Accepted: 10/30/2016] [Indexed: 01/07/2023]
Abstract
Wnt signaling, a major regulator of bone formation and homeostasis, might be involved in the bone loss of osteoporotic patients and the consequent impaired response to fracture. Therefore we analyzed Wnt-related, osteogenic, and adipogenic genes in bone tissue of elderly postmenopausal women undergoing hip replacement for either femoral fracture or osteoarthritis. Bone specimens derived from the intertrochanteric region of the femurs of 25 women with fracture (F) and 29 with osteoarthritis without fracture (OA) were analyzed. Specific miRNAs were analyzed in bone and in matched blood samples. RUNX2, BGP, and OPG showed lower expression in F than in OA samples, while OSX, OPN, BSP, and RANKL were not different. Inhibitory genes of Wnt pathway were lower in F versus OA. β-Catenin protein levels were higher in F versus OA, whereas its cotranscriptional regulator (Lef1) was lower in F group. miR-204, which targets RUNX2, and miR-130a, which inhibits PPARγ, were lower and higher, respectively, in F versus OA serum samples. The present study showed an inefficient Wnt signal transduction in F group despite higher β-catenin protein levels, consistent with the expected overall postfracture systemic activation towards osteogenesis. This transcriptional inefficiency could contribute to the osteoporotic bone fragility.
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Riedel C, Zimmermann EA, Zustin J, Niecke M, Amling M, Grynpas M, Busse B. The incorporation of fluoride and strontium in hydroxyapatite affects the composition, structure, and mechanical properties of human cortical bone. J Biomed Mater Res A 2016; 105:433-442. [DOI: 10.1002/jbm.a.35917] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/06/2016] [Accepted: 09/27/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Christoph Riedel
- Department of Osteology and Biomechanics; University Medical Center Hamburg-Eppendorf; Lottestrasse 55A Hamburg 22529 Germany
| | - Elizabeth A. Zimmermann
- Department of Osteology and Biomechanics; University Medical Center Hamburg-Eppendorf; Lottestrasse 55A Hamburg 22529 Germany
| | - Jozef Zustin
- Department of Pathology; University Medical Center Hamburg-Eppendorf; Martinistrasse 52 Hamburg 20246 Germany
| | - Manfred Niecke
- Institute of Experimental Physics, University of Hamburg; Luruper Chaussee 149 Hamburg 22761 Germany
| | - Michael Amling
- Department of Osteology and Biomechanics; University Medical Center Hamburg-Eppendorf; Lottestrasse 55A Hamburg 22529 Germany
| | - Marc Grynpas
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital; 25 Orde Street Toronto Ontario M5T 3H7 Canada
| | - Björn Busse
- Department of Osteology and Biomechanics; University Medical Center Hamburg-Eppendorf; Lottestrasse 55A Hamburg 22529 Germany
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Cosman F, Dempster DW, Nieves JW, Zhou H, Zion M, Roimisher C, Houle Y, Lindsay R, Bostrom M. Effect of Teriparatide on Bone Formation in the Human Femoral Neck. J Clin Endocrinol Metab 2016; 101:1498-505. [PMID: 26900640 PMCID: PMC4880158 DOI: 10.1210/jc.2015-3698] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/18/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Teriparatide (TPTD) improves bone mass and microstructure resulting in reduced risk of vertebral and nonvertebral fractures. However, hip bone mineral density improvements are modest and there are no data confirming that TPTD reduces hip fracture risk. To study the effects of TPTD on the proximal femur, we performed a double-blind trial of TPTD vs placebo (PBO) in patients with osteoarthritis from whom femoral neck (FN) samples were obtained at total hip replacement (THR) surgery. METHODS Participants were randomly assigned to receive TPTD or PBO for an average of 40 days before THR. Double tetracycline labeling was initiated 21 days prior to THR to allow histomorphometric assessment of bone formation. During the THR, an intact sample of the FN was procured, fixed, and sectioned transversely. Serum levels of bone turnover markers were measured at baseline and during the THR. Standard histomorphometric parameters were measured and calculated on four bone envelopes (cancellous, endocortical, intracortical, and periosteal). The primary outcome measure was bone formation rate/bone surface (BFR/BS). RESULTS Forty individuals were enrolled (25 women, mean age, 71.5 ± 8.0 y and 15 men, mean age, 68.9 ± 7.7 y). In cancellous and endocortical envelopes, BFR/BS was 100% higher in the TPTD vs PBO group (P < .05). Bone turnover markers measured at the time of THR correlated with BFR/BS. CONCLUSIONS TPTD stimulates bone formation rapidly in cancellous and endocortical envelopes of the FN. Our findings provide a mechanistic basis for TPTD-mediated improvement in FN bone mass and ultimately hip strength. This study is the first demonstration of the effect of any osteoporosis medication on osteoblast activity in the human proximal femur.
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Affiliation(s)
- Felicia Cosman
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - David W Dempster
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Jeri W Nieves
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Hua Zhou
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Marsha Zion
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Catherine Roimisher
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Yvonne Houle
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Robert Lindsay
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
| | - Mathias Bostrom
- Regional Bone Center, Helen Hayes Hospital (F.C., D.W.D., J.W.N., H.Z., M.Z., C.R., R.L.), West Haverstraw, New York 10993; Department of Medicine (F.C., R.L.), Department of Pathology (D.W.D.), and Department of Epidemiology (J.W.N.), Columbia University, New York, New York 10032; and Department of Orthopedics (Y.H., M.B.), Hospital for Special Surgery, New York, New York 10021
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Duarte Sosa D, Vilaplana L, Güerri R, Nogués X, Wang-Fagerland M, Diez-Perez A, F Eriksen E. Are the High Hip Fracture Rates Among Norwegian Women Explained by Impaired Bone Material Properties? J Bone Miner Res 2015; 30:1784-9. [PMID: 25900016 DOI: 10.1002/jbmr.2537] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/08/2015] [Accepted: 04/16/2015] [Indexed: 12/20/2022]
Abstract
Hip fracture rates in Norway rank among the highest in the world, more than double that of Spanish women. Previous studies were unable to demonstrate significant differences between the two populations with respect to bone mass or calcium metabolism. In order to test whether the difference in fracture propensity between both populations could be explained by differences in bone material quality we assessed bone material strength using microindentation in 42 Norwegian and 46 Spanish women with normal BMD values, without clinical or morphometric vertebral fractures, no clinical or laboratory signs of secondary osteoporosis, and without use of drugs with known influence on bone metabolism. Bone material properties were assessed by microindentation of the thick cortex of the mid tibia following local anesthesia of the area using the Osteoprobe device (Active Life Scientific, Santa Barbara, CA, USA). Indentation distance was standardized against a calibration phantom of methylmethacrylate and results, as percentage of this reference value, expressed as bone material strength index units (BMSi). We found that the bone material properties reflected in the BMSi value of Norwegian women was significantly inferior when compared to Spanish women (77 ± 7.1 versus 80.7 ± 7.8, p < 0.001). Total hip BMD was significantly higher in Norwegian women (1.218 g/cm(2) versus 0.938 g/cm(2) , p < 0.001) but regression analysis revealed that indentation values did not vary with BMD r(2) = 0.03 or age r(2) = 0.04. In conclusion Norwegian women show impaired bone material properties, higher bone mass, and were taller than Spanish women. The increased height will increase the impact on bone after falls, and impaired bone material properties may further enhance the risk fracture after such falls. These ethnic differences in bone material properties may partly explain the higher propensity for fracture in Norwegian women.
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Affiliation(s)
| | - Laila Vilaplana
- Hospital del Mar-Medical Research Institute (IMIM), Autonomous University of Barcelona, Barcelona, Spain
| | - Roberto Güerri
- Hospital del Mar-Medical Research Institute (IMIM), Autonomous University of Barcelona, Barcelona, Spain
| | - Xavier Nogués
- Hospital del Mar-Medical Research Institute (IMIM), Autonomous University of Barcelona, Barcelona, Spain
| | - Morten Wang-Fagerland
- Department of Biostatistics, Epidemiology, and Health Economics, Oslo University Hospital, Oslo, Norway
| | - Adolfo Diez-Perez
- Hospital del Mar-Medical Research Institute (IMIM), Autonomous University of Barcelona, Barcelona, Spain
| | - Erik F Eriksen
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
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Pritchard ZJ, Cary RL, Yang C, Novack DV, Voor MJ, Sankar U. Inhibition of CaMKK2 reverses age-associated decline in bone mass. Bone 2015; 75:120-7. [PMID: 25724145 PMCID: PMC4737584 DOI: 10.1016/j.bone.2015.01.021] [Citation(s) in RCA: 18] [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: 11/13/2014] [Revised: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 02/07/2023]
Abstract
Decline in bone formation is a major contributing factor to the loss of bone mass associated with aging. We previously showed that the genetic ablation of the tissue-restricted and multifunctional Ca(2+)/calmodulin (CaM)-dependent protein kinase kinase 2 (CaMKK2) stimulates trabecular bone mass accrual, mainly by promoting anabolic pathways and inhibiting catabolic pathways of bone remodeling. In this study, we investigated whether inhibition of this kinase using its selective cell-permeable inhibitor STO-609 will stimulate bone formation in 32 week old male WT mice and reverse age-associated of decline in bone volume and strength. Tri-weekly intraperitoneal injections of saline or STO-609 (10 μM) were performed for six weeks followed by metabolic labeling with calcein and alizarin red. New bone formation was assessed by dynamic histomorphometry whereas micro-computed tomography was employed to measure trabecular bone volume, microarchitecture and femoral mid-shaft geometry. Cortical and trabecular bone biomechanical properties were assessed using three-point bending and punch compression methods respectively. Our results reveal that as they progress from 12 to 32 weeks of age, WT mice sustain a significant decline in trabecular bone volume, microarchitecture and strength as well as cortical bone strength. However, treatment of the 32 week old WT mice with STO-609 stimulated apposition of new bone and completely reversed the age-associated decrease in bone volume, quality, as well as trabecular and cortical bone strength. We also observed that regardless of age, male Camkk2(-/-) mice possessed significantly elevated trabecular bone volume, microarchitecture and compressive strength as well as cortical bone strength compared to age-matched WT mice, implying that the chronic loss of this kinase attenuates age-associated decline in bone mass. Further, whereas STO-609 treatment and/or the absence of CaMKK2 significantly enhanced the femoral mid-shaft geometry, the mid-shaft cortical wall thickness and material bending stress remained similar among the cohorts, implying that regardless of treatment, the material properties of the bone remain similar. Thus, our cumulative results provide evidence for the pharmacological inhibition of CaMKK2 as a bone anabolic strategy in combating age-associated osteoporosis.
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Affiliation(s)
- Zachary J Pritchard
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Rachel L Cary
- James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
| | - Chang Yang
- Department of Medicine and Pathology, Washington University School of Medicine, St. Louis, MO, USA
| | - Deborah V Novack
- Department of Medicine and Pathology, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael J Voor
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY, USA; Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, KY, USA.
| | - Uma Sankar
- Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY, USA; James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA; Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA.
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