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Effects of type 2 diabetes on the viscoelastic behavior of human trabecular bone. Med Eng Phys 2022; 104:103810. [DOI: 10.1016/j.medengphy.2022.103810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 04/17/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022]
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Yadav RN, Sihota P, Uniyal P, Neradi D, Bose JC, Dhiman V, Karn S, Sharma S, Aggarwal S, Goni VG, Kumar S, Kumar Bhadada S, Kumar N. Prediction of mechanical properties of trabecular bone in patients with type 2 diabetes using damage based finite element method. J Biomech 2021; 123:110495. [PMID: 34004396 DOI: 10.1016/j.jbiomech.2021.110495] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 03/24/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
Type-2 diabetic (T2D) and osteoporosis (OP) suffered patients are more prone to fragile fracture though the nature of alteration in areal bone mineral density (aBMD) in these two cases are completely different. Therefore, it becomes crucial to compare the effect of T2D and OP on alteration in mechanical and structural properties of femoral trabecular bone. This study investigated the effect of T2D, OP, and osteopenia on bone structural and mechanical properties using micro-CT, nanoindentation and compression test. Further, a nanoscale finite element model (FEM) was developed to predict the cause of alteration in mechanical properties. Finally, a damage-based FEM was proposed to predict the pathological related alteration of bone's mechanical response. The obtained results demonstrated that the T2D group had lower volume fraction (-18.25%, p = 0.023), young's modulus (-23.47%, p = 0.124), apparent modulus (-37.15%, p = 0.02), and toughness (-40%, p = 0.001) than the osteoporosis group. The damage-based FE results were found in good agreement with the compression experiment results for all three pathological conditions. Also, nanoscale FEM results demonstrated that the elastic and failure properties of mineralised collagen fibril decreases with increase in crystal size. This study reveals that T2D patients are more prone to fragile fracture in comparison to OP and osteopenia patients. Also, the proposed damage-based FEM can help to predict the risk of fragility fracture for different pathological conditions.
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Affiliation(s)
- Ram Naresh Yadav
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab 140001, India
| | - Praveer Sihota
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab 140001, India
| | - Piyush Uniyal
- Center for Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab 140001, India
| | - Deepak Neradi
- Department of OrthopedicsPost Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jagadeesh Chandra Bose
- Department of Internal MedicinePost Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vandana Dhiman
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shailesh Karn
- Department of OrthopedicsPost Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sidhartha Sharma
- Department of OrthopedicsPost Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sameer Aggarwal
- Department of OrthopedicsPost Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vijay G Goni
- Department of OrthopedicsPost Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sachin Kumar
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab 140001, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Navin Kumar
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab 140001, India.
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Schoenhof R, Munz A, Yuan A, ElAyouti A, Boesmueller H, Blumenstock G, Reinert S, Hoefert S. Microarchitecture of medication-related osteonecrosis of the jaw (MRONJ); a retrospective micro-CT and morphometric analysis. J Craniomaxillofac Surg 2021; 49:508-517. [PMID: 33707134 DOI: 10.1016/j.jcms.2021.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/13/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive (AR) drugs such as bisphosphonates (BP) and denosumab (Dmab). Although several risk factors are described, the etiology of MRONJ is still not fully elucidated. Bone-strengthening is the primary aim of antiresorptive therapy; however, overly increased bone mass and microcrack accumulation are also discussed in MRONJ etiologies. The aim of this study is to evaluate the microarchitecture of jaw bones with micro-computed tomography (micro-CT) in AR-treated patients with or without MRONJ. Human jaw bone samples of AR-treated patients were separated into 11 groups by AR treatment bisphosphonate (BP), denosumab (Dmab), both (M) and control groups. Subgroups were divided according to the clinical localization as AR-exposed vital jaw bone (BPexp, Dmabexp, Mexp), osteonecrosis-margin of a sequestrum (BPOmar, DmabOmar, MOmar) and osteonecrosis-sequestrum (BPOseq, DmabOseq, MOseq). Healthy jaw bone (CHB) and osteoporotic jaw bone (COP) represent control groups. Samples underwent retrospective micro-CT and morphometric analysis in representative units by bone volume fraction (BV/TV), bone surface density (BS/BV), trabecular thickness (Tr.Th.), trabecular number (Tr.N.), trabecular space (Tr.Sp.), Euler characteristic for bone connectivity, bone mineral density (BMD) and tissue mineral density (TMD). A total of 141 samples from 78 patients were analyzed. BV/TV of Mexp group (mean: 0.46 ± 0.27) was significantly higher than in the COP group (mean: 0.14 ± 0.05; p = 0.0053). Tr.Th. differed significantly between the BPexp group (mean: 0.32 ± 0.15) and the Mexp group (mean: 0.57 ± 0.20; p = 0.0452) as well as between the BPOseq group (mean: 0.25 ± 0.10) and the MOseq group (mean: 0.39 ± 0.18; p = 0.0417). Signs of trabecular thickening and unorganized trabecular microarchitecture from AR-exposed- to sequestrum groups, were analyzed in 3D reconstructions. However, BS/BV, Tr.N., and Tr.Sp. showed no significant differences. Euler characteristic of the BPOseq group (median: 7.46) doubled compared to that of the BPexp group (median: 14.97; p = 0.0064). Mineralization parameters BMD and TMD were similar in all groups. Findings show evidence of enhanced bone mass and suspect microarchitecture in some AR-treated jaw bone compared to osteoporotic jaw bone. Despite increased bone mass, some MRONJ samples showed decreased trabecular connectivity by Euler characteristic compared to AR-treated jaw bone. These samples may indicate extensive ossification and ineffective bone mass with superficially higher bone mass without existing or even reduced mechanical stability, indicated by connectivity loss. This result might also suggest a high risk to microcrack accumulation. At some point, possibly some kind of over-ossification could lead to under-nourishment and microarchitectural weakness, creating instability, subsequently increasing vulnerability to MRONJ.
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Affiliation(s)
- Rouven Schoenhof
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tuebingen, Germany
| | - Adelheid Munz
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tuebingen, Germany
| | - Anna Yuan
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tuebingen, Germany
| | - Ashraf ElAyouti
- Department of Conservative Dentistry and Periodontology, University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tuebingen, Germany
| | - Hans Boesmueller
- Institute of Pathology, Liebermeisterstrasse 8, 72076, Tuebingen, Germany
| | - Gunnar Blumenstock
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tuebingen, Silcherstrasse 5, 72076, Tuebingen, Germany
| | - Siegmar Reinert
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tuebingen, Germany
| | - Sebastian Hoefert
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstrasse 2-8, 72076, Tuebingen, Germany.
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Koç O, Tüz HH, Ocak M, Bilecenoğlu B, Fırat A, Kaymaz FF. Can the Combination of Simvastatin and Melatonin Create a Synergistic Effect on Bone Regeneration? J Oral Maxillofac Surg 2021; 79:1672-1682. [PMID: 33524327 DOI: 10.1016/j.joms.2020.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The present study evaluated the potential bone regeneration capacity of combining melatonin and simvastatin, with a goal of producing more osteogenic bone substitutes. MATERIALS AND METHODS A total of 48 male Wistar rats were randomly divided into 4 groups. The following were administered into critical-sized calvarial defects of the rats: Group I-human allograft; Group II-human allograft + 10 mg melatonin; Group III-human allograft + 0.1 mg simvastatin; and Group IV-human allograft + 10 mg melatonin + 0.1 mg simvastatin. Histopathologic, histomorphometric, and microcomputed tomographic evaluations were performed postprocedurally at 4 and 8 weeks. A P value < .05 was considered significant for all evaluations. RESULTS Groups II and III had significantly superior regeneration compared to Group I at weeks 4 and 8. Group III had significantly superior regeneration compared to Group II, particularly in week 4. Group IV had significantly superior regeneration compared to all groups at week 8. CONCLUSIONS The local administration of melatonin and simvastatin resulted in increased new bone mass and quality of bone microstructure than was seen in the control group. Simvastatin shortened the defect regeneration time more effectively than melatonin did. The combined use of melatonin and simvastatin provided a synergic effect on bone regeneration, particularly in the late phase of healing.
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Affiliation(s)
- Onur Koç
- Doctor, Department of Oral and Maxillofacial Surgery, Hacettepe University, Faculty of Dentistry, Ankara, Turkey.
| | - Hıfzı Hakan Tüz
- Professor, Department of Oral and Maxillofacial Surgery, Hacettepe University, Faculty of Dentistry, Ankara, Turkey
| | - Mert Ocak
- Assistant Professor, Department of Anatomy, Ankara University, Faculty of Dentistry, Ankara, Turkey
| | - Burak Bilecenoğlu
- Professor of Anatomy, Department of Anatomy, Ankara Medipol University, Faculty of Medicine, Ankara, Turkey
| | - Ayşegül Fırat
- Associate Professor, Department of Anatomy, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Figen Fevziye Kaymaz
- Professor, Department of Histology and Embryology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Sharma DK, Sawyer RK, Robertson TS, Stamenkov R, Solomon LB, Atkins GJ, Clifton PM, Morris HA, Anderson PH. Elevated Serum 25-Hydroxyvitamin D Levels Are Associated with Improved Bone Formation and Micro-Structural Measures in Elderly Hip Fracture Patients. J Clin Med 2019; 8:jcm8111988. [PMID: 31731695 PMCID: PMC6912246 DOI: 10.3390/jcm8111988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/17/2022] Open
Abstract
Vitamin D, along with calcium, is generally considered necessary for bone health and reduction of fractures. However, he effects of improving vitamin D status have not always been observed to improve bone mineral density (BMD). We have investigated whether varying vitamin D status in humans, as measured by serum 25(OH)D levels, relate to micro-structural and histomorphetric measures of bone quality and quantity, rather than density. Intertrochanteric trabecular bone biopsies and serum samples were collected from patients undergoing hip arthroplasty (65 females, 38 males, mean age 84.8 ± 8.3 years) at Royal Adelaide Hospital. Estimated GFR, serum ionized calcium, alkaline phosphatase, albumin, supplement and medication intake prior to surgery were taken from patient case records. Serum 25(OH)D, 1,25(OH)2D, and parathyroid hormone (PTH) levels were measured by immunoassays. Trabecular bone structural indices were determined by high-resolution micro-CT. Mean wall thickness (MWT) was measured on toluidine blue-stained histological sections. Bone mRNA levels for vitamin D metabolising enzymes CYP27B1 and CYP24A1 were measured by qRT-PCR. While serum 25(OH)D levels did not associate with bone volume/tissue volume (BV/TV%), serum 25(OH)D levels were strongly and independently associated with MWT (r = 0.81 p < 0.0001) with values significantly greater in patients with higher serum 25(OH)D levels. Furthermore, serum 25(OH)D levels were negatively associated with Bone Surface/Bone Volume (BS/BV) (r = −0.206, p < 0.05) and together with bone CYP27B1 and CYP24A1 mRNA accounted for 10% of the variability of BS/BV (p = 0.001). These data demonstrate that serum 25(OH)D is an independent positive predictor of micro-structural and bone formation measures and may be dependent, in part, on its metabolism within the bone.
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Affiliation(s)
- Deepti K. Sharma
- Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia (R.K.S.); (G.J.A.); (P.M.C.)
| | - Rebecca K. Sawyer
- Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia (R.K.S.); (G.J.A.); (P.M.C.)
| | - Thomas S. Robertson
- Royal Adelaide Hospital, Adelaide 5001, Australia (R.S.); (L.B.S.)
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide 5001, Australia
| | - Roumen Stamenkov
- Royal Adelaide Hospital, Adelaide 5001, Australia (R.S.); (L.B.S.)
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide 5001, Australia
| | - Lucian B. Solomon
- Royal Adelaide Hospital, Adelaide 5001, Australia (R.S.); (L.B.S.)
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide 5001, Australia
| | - Gerald J. Atkins
- Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia (R.K.S.); (G.J.A.); (P.M.C.)
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide 5001, Australia
| | - Peter M. Clifton
- Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia (R.K.S.); (G.J.A.); (P.M.C.)
| | - Howard A. Morris
- Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia (R.K.S.); (G.J.A.); (P.M.C.)
| | - Paul H. Anderson
- Health and Biomedical Innovation, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide 5001, Australia (R.K.S.); (G.J.A.); (P.M.C.)
- Correspondence:
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