1
|
Ali A, Huszti E, Noordin S, Ali U, Sale JEM. Examining treatment targets and equity in bone-active medication use within secondary fracture prevention: a systematic review and meta-analysis. Osteoporos Int 2024:10.1007/s00198-024-07078-5. [PMID: 38740589 DOI: 10.1007/s00198-024-07078-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/27/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE This systematic review seeks to evaluate the proportion of fragility fracture patients screened in secondary fracture prevention programs who were indicated for pharmacological treatment, received prescriptions for bone-active medications, and initiated the prescribed medication. Additionally, the study aims to analyze equity in pharmacological treatment by examining equity-related variables including age, sex, gender, race, education, income, and geographic location. METHODS We conducted a systematic review to ascertain the proportion of fragility fracture patients indicated for treatment who received prescriptions and/or initiated bone-active medication through secondary fracture prevention programs. We also examined treatment indications reported in studies and eligibility criteria to confirm patients who were eligible for treatment. To compute the pooled proportions for medication prescription and initiation, we carried out a single group proportional meta-analysis. We also extracted the proportions of patients who received a prescription and/or began treatment based on age, sex, race, education, socioeconomic status, location, and chronic conditions. RESULTS This review included 122 studies covering 114 programs. The pooled prescription rate was 77%, and the estimated medication initiation rate was 71%. Subgroup analysis revealed no significant difference in treatment initiation between the Fracture Liaison Service and other programs. Across all studies, age, sex, and socioeconomic status were the only equity variables reported in relation to treatment outcomes. CONCLUSION Our systematic review emphasizes the need for standardized reporting guidelines in post-fracture interventions. Moreover, considering equity stratifiers in the analysis of health outcomes will help address inequities and improve the overall quality and reach of secondary fracture prevention programs.
Collapse
Affiliation(s)
- Anum Ali
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada.
| | - Ella Huszti
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Shahryar Noordin
- Department of Surgery, Aga Khan University, National Stadium Rd, P.O. Box 3500, Karachi City, Sindh, Pakistan
| | - Usman Ali
- Department of Surgery, Aga Khan University, National Stadium Rd, P.O. Box 3500, Karachi City, Sindh, Pakistan
| | - Joanna E M Sale
- Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, 5th Floor - 149 College Street, Toronto, ON, M5B 1W8, Canada
| |
Collapse
|
2
|
Liao S, Xu Y, Liu J, Jiang L, Dai G, Wang Y. Risk factors for nonunion of osteoporotic vertebral compression fracture: a case‒control study. BMC Musculoskelet Disord 2024; 25:295. [PMID: 38627756 PMCID: PMC11020417 DOI: 10.1186/s12891-024-07386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Early assessment of the risk of nonunion in osteoporotic vertebral compression fracture (OVCF) is beneficial to early clinical decision making. However, a comprehensive understanding of the risk factors for OVCF nonunion is lacking. METHODS We conducted a case-control study to investigate risk factors for OVCF nonunion. Patients who underwent surgery for nonunited OVCFs between January 2011 and December 2021 were eligible for inclusion as cases. Patients with successful OVCF healing confirmed by MRI over the same period were identified as controls. Patient demographics, comorbidities, and fasting blood test data were extracted for analysis. RESULTS A total of 201 patients with nonunited OVCFs and 1044 controls were included to evaluate the risk factors for nonunited OVCFs. There were statistically significant differences in sex, age, number of patients with hypertension, number of patients on bed rest after OVCF and T-score of BMD between the two groups. Logistic regression showed that female patients had a higher risk of OVCF nonunion than male patients and that smoking, drinking, diabetes, and hypertension were risk factors for nonunion of OVCFs, while bed rest and spinal support were protective factors against nonunion of OVCFs. We also found that age, BMD, FBG, and β-CTX were positively correlated with nonunited OVCFs, and that HGB and 1,25-(OH)2VitD3 level were negatively correlated with nonunited OVCFs. CONCLUSION Smoking, drinking, diabetes and hypertension were risk factors for nonunion of OVCFs, while bed rest and spinal support were protective factors against nonunion of OVCFs. Age, BMD, FBG and β-CTX were positively correlated with nonunited OVCFs, while HGB and 1,25-(OH)2VitD3 level were negatively correlated with nonunited OVCFs. Based on the results of our study, we suggest that bed rest or spinal support for at least 3 consecutive weeks is necessary to reduce the risk of OVCFs nonunion.
Collapse
Affiliation(s)
- Shichuan Liao
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, No. 132 West First Section First Ring Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Yan Xu
- Experiment Teaching Center for Preclinical Medicine, Chengdu Medical College, No. 783, Xindu Avenue, Xindu District, Chengdu, Sichuan Province, China
| | - Jing Liu
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, No. 132 West First Section First Ring Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Ling Jiang
- College Hospital, Sichuan Agricultural University-Chengdu Campus, No. 211 Huiming Road, Wenjiang district, Chengdu, Sichuan Province, China
| | - Guogang Dai
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, No. 132 West First Section First Ring Road, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Yi Wang
- Cervicodynia/Omalgia/Lumbago/Sciatica Department 2, Sichuan Province Orthopedic Hospital, No. 132 West First Section First Ring Road, Wuhou District, Chengdu, 610041, Sichuan Province, China.
| |
Collapse
|
3
|
Zhang R, Ni Z, Wei M, Cui Y, Zhou H, Di D, Wang Q. Composite dietary antioxidant intake and osteoporosis likelihood in premenopausal and postmenopausal women: a population-based study in the United States. Menopause 2023; 30:529-538. [PMID: 36944153 DOI: 10.1097/gme.0000000000002173] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Osteoporosis is a skeletal disease characterized by low bone mass, reduced bone strength, and increased fracture risk. We aimed to investigate the association between combined dietary antioxidant intake and the likelihood of osteoporosis in premenopausal and postmenopausal women, based on data from the National Health and Nutrition Examination Survey. METHODS Nutrient intake data were obtained using two 24-hour recalls. Composite dietary antioxidant index (CDAI), which refers to the intake amounts of β-carotene, vitamin A, vitamin C, vitamin E, selenium, zinc, copper, and iron, was then constructed. Prevalent osteoporosis was defined according to bone mineral density T scores of ≤ -2.5 and self-reports. Multiple logistic and Poisson regression models were used for association analyses. RESULTS A total of 3,418 participants (1,157 premenopausal and 2,261 postmenopausal women) 40 years or older were included, 776 (22.70%) of whom had prevalent osteoporosis. In terms of individual nutrients, postmenopausal women in the highest CDAI quartiles for dietary β-carotene, vitamin A, vitamin C, and iron intakes had a low likelihood of osteoporosis. Regarding the CDAI-osteoporosis association, postmenopausal women in the highest quartile were less likely to have osteoporosis (OR Q3 vs Q1 , 0.64; 95% CI, 0.43-0.96; OR Q4 vs Q1 , 0.56; 95% CI, 0.35-0.89; P for trend = 0.013), after controlling for covariates. CONCLUSIONS CDAI was negatively associated with the likelihood of osteoporosis in postmenopausal women. Our findings suggest that the combined intake of antioxidant nutrients can help reduce the likelihood of osteoporosis in women.
Collapse
Affiliation(s)
- Ruyi Zhang
- From the MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zemin Ni
- Women and Children Medical Center for Jiang-an District, Wuhan, China
| | - Muhong Wei
- From the MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuan Cui
- From the MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haolong Zhou
- From the MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dongsheng Di
- From the MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Wang
- From the MOE Key Lab of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
4
|
Liu W, Chen W, Hu M, Wang G, Hu Y, He Q, Xu Y, Tan J, Wang H, Huo L. Bioinformatics analysis combined with molecular dynamics simulation validation to elucidate the potential molecular mechanisms of Jianshen Decoction for treatment of osteoporotic fracture. Medicine (Baltimore) 2023; 102:e33610. [PMID: 37083798 PMCID: PMC10118375 DOI: 10.1097/md.0000000000033610] [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: 02/07/2023] [Accepted: 04/03/2023] [Indexed: 04/22/2023] Open
Abstract
Osteoporotic fracture (OPF) is a prevalent skeletal disease in the middle-aged and elderly. In clinical practice, Jianshen Decoction (JSD) has been used to treat OPFs. However, the specific effective components and mechanisms of JSD on OPF have not been explored. Therefore, this study used bioinformatics analysis combined with molecular dynamics simulation validation to explore the molecular mechanism of JSD treatment of OPF. Public databases (TCMSP, Batman TCM) were used to find the effective active components and corresponding target proteins of JSD (screening conditions: OB ≥ 30%, drug-likeness ≥ 0.18, half-life ≥ 4). Differentially expressed genes (DEGs) related to OPF lesions were obtained based on the gene expression omnibus database (screening conditions: adjust P value < .01, | log2 FC | ≥ 1.0). The BisoGenet plug-in and the CytoNCA plug-in of Cytoscape were used to derive the potential core target proteins of JSD in the treatment of OPF. The JSD active ingredient target interaction network and the JSD-OPF target protein core network were constructed using the Cytoscape software. In addition, the R language Bioconductor package and clusterProfiler package were used to perform gene ontology (GO)/Kyoto Encylopedia Of Genes And Genome (KEGG) enrichment analysis on core genes to explain the biological functions and signal pathways of core proteins. Finally, molecular docking and molecular dynamics simulations were carried out through PyMOL, AutoDockTools 1.5.6, Vina, LeDock, Discovery Studio (DS) 2019, and other software to verify the binding ability of drug active ingredients and core target proteins. A total of 245 targets and 70 active components were identified. Through protein-protein interaction (PPI) network construction, 39 core targets were selected for further research. GO/KEGG enrichment analysis showed that the DNA-binding transcription factor binding, RNA polymerase II-specific DNA-binding transcription factor binding, MAPK signaling pathway, and ErbB signaling pathway were mainly involved. The results of molecular docking and molecular dynamics simulations supported the good interaction between MYC protein and Quercetin/Stigmasterol. In this study, bioinformatics, molecular docking, and molecular dynamics simulations were used for the first time to clarify the active components, molecular targets, and key biological pathways of JSD in the treatment of OPF, providing a theoretical basis for further research.
Collapse
Affiliation(s)
- Weinian Liu
- Guangzhou Orthopedic Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Weijian Chen
- The Fifth Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Mengting Hu
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Guangwei Wang
- Guangzhou Orthopedic Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- The Third Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yuanhao Hu
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Qi He
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yidong Xu
- Guangzhou Orthopedic Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jun Tan
- Guangzhou Orthopedic Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial People’s Hospital’s Nanhai Hospital, Foshan, Guangdong, China
| | - Haibin Wang
- Department of Orthopaedics of the First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Liwei Huo
- Guangzhou Orthopedic Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| |
Collapse
|
5
|
Olarte CM, López AM, Tihanyi Feldman J, Libos Zabala A, Morales DC, Patiño AF, Pesantez RF, Salavarrieta JE, Sanint V. Impact of a Secondary Prevention Program for Fragility Fractures at the Orthogeriatric Clinical Care Center at the Fundación Santa Fe de Bogotá, 2014-2020. Geriatr Orthop Surg Rehabil 2022; 13:21514593221118182. [PMID: 35983317 PMCID: PMC9379958 DOI: 10.1177/21514593221118182] [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: 05/05/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction The presence of a fragility fracture increases the risk of new fractures. The timely and prompt initiation of treatment for osteoporosis can reduce the incidence of new fractures, for which adherence to management is a determining factor. The main objective of the study was to characterize the secondary prevention program for fragility hip fractures in patients older than 65 years, determine adherence to treatment and its effect on the appearance of new fractures in the established follow-up period. Materials and Methods A descriptive retrospective cohort study was carried out. Patients older than 65 years with a fragility hip fracture treated by an Orthogeriatric Clinical Care Center between May 2014 and April 2020 who completed a one-year follow-up were included. Results A final sample of 290 patients was obtained (226 women and 64 men) with an average age of 82.27 years. It was found that 84.5% of patients received indications to start osteoporotic management prior to hospital discharge and only 35.2% started the treatment in the first 6 postoperative months. 16.6% (n = 48) of patients presented a new fracture, with no significant difference between those who started their osteoporosis treatment in a timely manner. Out of the 48 patients, 5 patients (10.4%) met therapeutic failure criteria. Discussion Most patients (84.5%) received indications for starting osteoporotic treatment before hospital discharge, nevertheless 35.2% started it during the first 6 postoperative months. 16.6% of patients presented a new fracture during follow up, of which only five met therapeutic failure criteria. Conclusions No significant differences were found between the presence of new fractures and early initiation of osteoporotic management. However, literature shows that prompt and timely osteoporotic treatment reduces the incidence of new fractures, thus measures must be implemented to strengthen the adherence and surveillance of patients to the indicated treatment.
Collapse
Affiliation(s)
- Carlos M Olarte
- Orthopaedics, Hospital Universitario Fundacion Santa Fe de Bogotá, Bogotá, Colombia
| | - Ana M López
- Geriatrics, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Andrés Libos Zabala
- Orthopaedics, Hospital Universitario Fundacion Santa Fe de Bogotá, Bogotá, Colombia
| | - Diana C Morales
- Geriatrics, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Aldo F Patiño
- Geriatrics, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Rodrigo F Pesantez
- Orthopaedics, Hospital Universitario Fundacion Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Valentina Sanint
- Geriatrics, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| |
Collapse
|
6
|
Lv H, Zhang X, Wang J, Hou Z, Wang H, Li C, Wang W, Chen W, Zhang Y. Short-term effects of COVID-19 on the risk of traumatic fractures in China cities. Sci Rep 2022; 12:6528. [PMID: 35444225 PMCID: PMC9020760 DOI: 10.1038/s41598-022-10531-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/08/2022] [Indexed: 12/21/2022] Open
Abstract
This study aimed to investigate the association between COVID-19 and fracture risk and provide a targeted reference for the world through China’s experience. A nationally representative sample of COVID-19 prevalence areas selected using stratified random sampling was retrospectively analyzed. Age, sex, fracture site, mechanism of injury, and concurrent fractures of traumatic fracture patients in selected hospitals were collected from 10 January to 10 July 2020. The epidemiologic characteristics of traumatic fractures and the association between COVID-19 and fracture risk were explored using descriptive epidemiological methods and a distributed lag nonlinear model. A total of 67,249 patients (52.3% males, 49.4 ± 19.4 years old) with 68,989 fractures were included. The highest proportion of fractures were in the tibia and fibula (14.9%), followed by the femur (13.6%) and ulna and radius (12.5%). Low-energy fractures accounted for 23.3%. With the increase in newly confirmed COVID-19 cases, fracture risk decreased for children, young and middle-aged adults, elderly men, high-energy fractures, and residents in regions with < 1000 cumulative confirmed COVID-19 cases. Fracture risk decreased sharply in all residents except elderly women, for low-energy fractures, and in regions with > 1000 cumulative confirmed COVID-19 cases when newly confirmed COVID-19 cases increased in China. Primary (home) prevention measures are emphasized to prevent traumatic fractures.
Collapse
Affiliation(s)
- Hongzhi Lv
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Xiaolin Zhang
- Department of Epidemiology and Statistics, Hebei Medical University, Shijiazhuang, 050017, China
| | - Juan Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Haicheng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Chao Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Wenjuan Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China. .,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China. .,NHC Key Laboratory of Intelligent Orthopaedic Equipment, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, China.
| |
Collapse
|
7
|
Malekpour K, Hazrati A, Zahar M, Markov A, Zekiy AO, Navashenaq JG, Roshangar L, Ahmadi M. The Potential Use of Mesenchymal Stem Cells and Their Derived Exosomes for Orthopedic Diseases Treatment. Stem Cell Rev Rep 2022; 18:933-951. [PMID: 34169411 PMCID: PMC8224994 DOI: 10.1007/s12015-021-10185-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 02/06/2023]
Abstract
Musculoskeletal disorders (MSDs) are conditions that can affect muscles, bones, and joints. These disorders are very painful and severely limit patients' mobility and are more common in the elderly. MSCs are multipotent stem cells isolated from embryonic (such as the umbilical cord) and mature sources (such as adipose tissue and bone marrow). These cells can differentiate into various cells such as osteoblasts, adipocytes, chondrocytes, NP-like cells, Etc. Due to MSC characteristics such as immunomodulatory properties, ability to migrate to the site of injury, recruitment of cells involved in repair, production of growth factors, and large amount production of extracellular vesicles, these cells have been used in many regenerative-related medicine studies. Also, MSCs produce different types of EVs, such as exosomes, to the extracellular environment. Exosomes reflect MSCs' characteristics and do not have cell therapy-associated problems because they are cell-free. These vesicles carry proteins, nucleic acids, and lipids to the host cell and change their function. This review focuses on MSCs and MSCs exosomes' role in repairing dense connective tissues such as tendons, cartilage, invertebrate disc, bone fracture, and osteoporosis treatment.
Collapse
Affiliation(s)
- Kosar Malekpour
- Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Hazrati
- Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Marziah Zahar
- Social Security Centre of Excellence, School of Business Management, College of Business, Universiti Utara Malaysia, Sintok Kedah, Malaysia
| | | | - Angelina Olegovna Zekiy
- Department of Prosthetic Dentistry, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Leila Roshangar
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Ahmadi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
8
|
Mandatori D, Penolazzi L, Pelusi L, Lambertini E, Michelucci F, Porreca A, Cerritelli P, Pipino C, Di Iorio A, Bruni D, Di Nicola M, Buda R, Piva R, Pandolfi A. Three-Dimensional Co-Culture System of Human Osteoblasts and Osteoclast Precursors from Osteoporotic Patients as an Innovative Model to Study the Role of Nutrients: Focus on Vitamin K2. Nutrients 2021; 13:nu13082823. [PMID: 34444982 PMCID: PMC8399348 DOI: 10.3390/nu13082823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/03/2021] [Accepted: 08/14/2021] [Indexed: 01/03/2023] Open
Abstract
Several natural compounds, such as vitamin K2, have been highlighted for their positive effects on bone metabolism. It has been proposed that skeletal disorders, such as osteoporosis, may benefit from vitamin K2-based therapies or its regular intake. However, further studies are needed to better clarify the effects of vitamin K2 in bone disorders. To this aim, we developed in vitro a three-dimensional (3D) cell culture system one step closer to the bone microenvironment based on co-culturing osteoblasts and osteoclasts precursors obtained from bone specimens and peripheral blood of the same osteoporotic patient, respectively. Such a 3-D co-culture system was more informative than the traditional 2-D cell cultures when responsiveness to vitamin K2 was analyzed, paving the way for data interpretation on single patients. Following this approach, the anabolic effects of vitamin K2 on the osteoblast counterpart were found to be correlated with bone turnover markers measured in osteoporotic patients’ sera. Overall, our data suggest that co-cultured osteoblasts and osteoclast precursors from the same osteoporotic patient may be suitable to generate an in vitro 3-D experimental model that potentially reflects the individual’s bone metabolism and may be useful to predict personal responsiveness to nutraceutical or drug molecules designed to positively affect bone health.
Collapse
Affiliation(s)
- Domitilla Mandatori
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy; (D.M.); (L.P.); (A.P.); (C.P.); (M.D.N.)
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy
| | - Letizia Penolazzi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (L.P.); (E.L.)
| | - Letizia Pelusi
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy; (D.M.); (L.P.); (A.P.); (C.P.); (M.D.N.)
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy
| | - Elisabetta Lambertini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (L.P.); (E.L.)
| | - Francesca Michelucci
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy; (F.M.); (P.C.); (A.D.I.); (D.B.); (R.B.)
| | - Annamaria Porreca
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy; (D.M.); (L.P.); (A.P.); (C.P.); (M.D.N.)
| | - Pietro Cerritelli
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy; (F.M.); (P.C.); (A.D.I.); (D.B.); (R.B.)
| | - Caterina Pipino
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy; (D.M.); (L.P.); (A.P.); (C.P.); (M.D.N.)
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy
| | - Angelo Di Iorio
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy; (F.M.); (P.C.); (A.D.I.); (D.B.); (R.B.)
| | - Danilo Bruni
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy; (F.M.); (P.C.); (A.D.I.); (D.B.); (R.B.)
| | - Marta Di Nicola
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy; (D.M.); (L.P.); (A.P.); (C.P.); (M.D.N.)
| | - Roberto Buda
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy; (F.M.); (P.C.); (A.D.I.); (D.B.); (R.B.)
| | - Roberta Piva
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (L.P.); (E.L.)
- Correspondence: (R.P.); (A.P.); Tel.: +39-0532-974405 (R.P.); +39-0871-541425 (A.P.)
| | - Assunta Pandolfi
- Department of Medical, Oral and Biotechnological Sciences, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy; (D.M.); (L.P.); (A.P.); (C.P.); (M.D.N.)
- Center for Advanced Studies and Technology (C.A.S.T.), University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy
- Correspondence: (R.P.); (A.P.); Tel.: +39-0532-974405 (R.P.); +39-0871-541425 (A.P.)
| |
Collapse
|
9
|
Jingui Shenqi Pills Regulate Bone-Fat Balance in Murine Ovariectomy-Induced Osteoporosis with Kidney Yang Deficiency. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:1517596. [PMID: 32963560 PMCID: PMC7492893 DOI: 10.1155/2020/1517596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 08/16/2020] [Accepted: 08/27/2020] [Indexed: 11/23/2022]
Abstract
Jingui Shenqi Pills (JGSQP) have been a staple of traditional Chinese medicine for thousands of years, used primarily as a treatment for kidney yang deficiency (KYD). In vitro analyses of JGSQP revealed strong induction of osteogenic differentiation and inhibition of adipogenic differentiation in bone-marrow-derived mesenchymal stem/stromal cells. However, the mechanisms by which JGSQP regulate the bone-fat balance in murine ovariectomy-induced osteoporosis with KYD have not been reported. Materials and Methods. Two-month-old female C57BL/6 mice were divided randomly into three groups: those receiving a sham operation (Sham); those undergoing bilateral ovariectomy and selection of KYD syndrome (Model); and those subjected to both bilateral ovariectomy and KYD syndrome selection for 8 weeks, followed by JGSQP treatment for 4 weeks (JGSQP). In the Sham and Model groups, mice were given the same dose of distilled water orally for 4 weeks. Animals from all three groups were euthanised at the 12th week. Vertebral microarchitecture and histomorphology were examined by micro-CT and H&E staining, respectively. In addition, we examined the mRNA expression of Akt, Wnt10b, Osterix (Osx), Fndc5, PPARγ, and Fabp4, as well as the protein of AKT, phosphorylation-AKT (p-AKT), BMP2, COL1A1, and FNDC5. Results. JGSQP treatment improved bone microarchitecture and mitigated histomorphological damage relative to the Model group. The osteoblast number (Ob.N/BS) and area (Ob.S/BS) were increased, whereas adipocyte number (adipocyte/tissue area) and area (adipocyte area/tissue area) were decreased in the JGSQP group. JGSQP treatment reduced the mRNA expression of Akt and adipogenesis-related genes (Fndc5, PPARγ, and Fabp4) while promoting osteogenesis-related genes (Wnt10b and Osx) mRNA expression. Additionally, the expression of p-AKT, BMP2, and COL1A1 proteins was increased and FNDC5 protein expression was decreased after JGSQP treatment. Conclusions. JGSQP treatment reversed murine ovariectomy-induced osteoporosis with KYD by controlling bone-fat balance via AKT pathway.
Collapse
|
10
|
Wong CC, Liao JH, Sheu SY, Lin PY, Chen CH, Kuo TF. Novel transplant of combined platelet-rich fibrin Releasate and bone marrow stem cells prevent bone loss in Ovariectomized osteoporotic mice. BMC Musculoskelet Disord 2020; 21:527. [PMID: 32770974 PMCID: PMC7415181 DOI: 10.1186/s12891-020-03549-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/30/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Osteoporosis is a metabolic bone disorder characterized by deterioration in the quantity and quality of bone tissue, with a consequent increase susceptibility to fracture. METHODS In this study, we sought to determine the efficacy of platelet-rich fibrin releasates (PRFr) in augmenting the therapeutic effects of stem cell-based therapy in treating osteoporotic bone disorder. An osteoporosis mouse model was established through bilateral ovariectomy on 12-week-old female ICR (Institute of Cancer Research) mice. Eight weeks postoperatively, the ovariectomized (OVX) mice were left untreated (control) or injected with PRFr, bone marrow stem cells (BMSCs), or the combination of BMSCs and PRFr. Two different injection (single versus quadruple) dosages were tested to investigate the accumulative effects of BMSCS and PRFr on bone quality. Eight weeks after injection, the changes in tibial microstructural profiles included the percentage of bone volume versus total tissue volume (BV/TV, %), bone mineral density (BMD, g/cm3), trabecular number (Tb.N, number/mm), and trabecular separation (Tb.Sp, mm) and bony histology were analyzed. RESULTS Postmenopausal osteoporosis model was successfully established in OVX mice, evidenced by reduced BMD, decreased BV/TV, lower Tb.N but increased Tb.Sp. Eight weeks after injection, there was no significant change to BMD and bone trabeculae could be detected in mice that received single-injection regimen. In contrast, in mice which received 4 doses of combined PRFr and BMSCs, the BMD, BV/TV, and TB.N increased, and the TB.Sp decreased significantly compared to untreated OVX mice. Moreover, the histological analysis showed the trabecular spacing become narrower in OVX-mice treated with quadruple injection of BMSCs and combined PRFr and BMSCs than untreated control. CONCLUSION The systemic administration of combined BMSCs and PRFr protected against OVX-induced bone mass loss in mice. Moreover, the improvement of bony profile scores in quadruple-injection group is better than the single-injection group, probably through the increase in effect size of cells and growth factors. Our data also revealed the combination therapy of BMSCs and PRFr has better effect in enhancing osteogenesis, which may provide insight for the development of a novel therapeutic strategy in osteoporosis treatment.
Collapse
Affiliation(s)
- Chin-Chean Wong
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan.,Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan.,Research Center of Biomedical Devices, Taipei Medical University, Taipei, 11031, Taiwan.,International Ph.D. Program for Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan.,Non-invasive Cancer Therapy Research Institute of Taiwan, Taipei, 10489, Taiwan
| | - Jeng-Hao Liao
- School of Veterinary Medicine, National Taiwan University, Taipei, 10617, Taiwan
| | - Shi-Yuan Sheu
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, 84001, Taiwan. .,Department of Chinese Medicine, E-Da Cancer Hospital, Kaohsiung, 84001, Taiwan.
| | - Po-Yu Lin
- School of Veterinary Medicine, National Taiwan University, Taipei, 10617, Taiwan
| | - Chih-Hwa Chen
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan.,Research Center of Biomedical Devices, Taipei Medical University, Taipei, 11031, Taiwan.,School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan
| | - Tzong-Fu Kuo
- School of Veterinary Medicine, National Taiwan University, Taipei, 10617, Taiwan. .,Department of Post-Baccalaureate Veterinary Medicine, Asia University, Taichung, 41354, Taiwan.
| |
Collapse
|
11
|
Lv H, Zhang Q, Yin Y, Zhu Y, Wang J, Hou Z, Zhang Y, Chen W. Epidemiologic characteristics of traumatic fractures during the outbreak of coronavirus disease 2019 (COVID-19) in China: A retrospective & comparative multi-center study. Injury 2020; 51:1698-1704. [PMID: 32563519 PMCID: PMC7295526 DOI: 10.1016/j.injury.2020.06.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Amid the outbreak of coronavirus disease 2019 (COVID-19), effective measures have been taken in China to suggest people wearing masks and staying at home. The majority of the people stayed at home, which had an obvious impact on the occurrence of traumatic fractures. This study aimed to describe the epidemiologic characteristics of traumatic fractures during the COVID-19, and provide reference for targeted control measures for the whole world by proposing China's experiences. METHODS This was a retrospective & comparative multi-center study with data obtained from 11 hospitals in five provinces of China. Patients were enrolled into this study, who sustained fractures from 20 January to 19 February 2020 and the same period in 2019 (based on Chinese lunar calendar). All patients were divided into two groups: epidemic group (admitted in 2020) and control group (admitted in 2019). The data of patients' demographics (age and gender), injury related data (fracture type, fractured site, osteoporosis fracture, concurrent fractures, injury mechanism, places where fracture occurred, ISS score, Gustilo-Anderson Classification for open fracture), mortality and treatment modality were compared between the two groups. RESULTS A total of 2,489 patients with 2,590 fractures were included. In the epidemic group, there were 865 patients, including 483 (55.8%) males and 382 (44.2%) females with an average age of 53.1 ± 23.1 years (range, 1 to 105). In the control group, there were 1,624 patients, including 876 (53.9%) males and 748 (46.1%) females with an average age of 51.2 ± 21.5 years (range, 1 to 98). Patients in the epidemic group was significantly older than those in the control group (t=-2.046, P = 0.045). For epidemic group, the mostly commonly involved age group was elderly patients, whereas it was middle-aged adults for the control group (χ2 = 14.642, P = 0.002). For epidemic group, a total of 576 (66.6%) patients had their fracture occurring at home, while in the control group there was 183 (11.3%). The proportion rates of low energy injuries (79.1%, 684/865), osteoporotic fractures (32.5%, 294/906) and closed fractures (94.5%, 817/865) in the epidemic group were significantly higher when compared to the control group, respectively (34.4%, 559/1624; 26.9%, 453/1684; 91.9%, 1,493/1692; all P<0.05). The proportion rates of Gustilo-Anderson classification (5.5%, 16/865), concurrent fractures (2.3%, 20/865), and injury severity score (15.6 ± 6.7) in epidemic group were significantly lower than those in the control group, respectively (52.8%, 199/1624; 3.9%, 63/1624; 20.1 ± 8.7; all P<0.05). No positive case with COVID-19 was diagnosed in the epidemic group. The mortality rate in the epidemic group (0.46%) was similar with that in the control group (0.43%). CONCLUSIONS Our findings confirmed the importance of the measures to restrict people's movement and wear masks in the prevention of the spread of COVID-19. The epidemiological characteristics of traumatic fractures amid the epidemic changes dramatically, and more attempts should be focused on the prevention of low energy injuries of elderly population.
Collapse
Affiliation(s)
- Hongzhi Lv
- Editorial department, the Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, PR China
| | - Qi Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University
| | - Yingchao Yin
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University
| | - Yanbin Zhu
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University
| | - Juan Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University
| | - Zhiyong Hou
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University,Corresponding authors
| | - Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University,Corresponding authors
| |
Collapse
|
12
|
Bisphosphonates for Secondary Prevention of Osteoporotic Fractures: A Bayesian Network Meta-Analysis of Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2594149. [PMID: 31828096 PMCID: PMC6885847 DOI: 10.1155/2019/2594149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/01/2019] [Indexed: 12/11/2022]
Abstract
Purpose To investigate the comparative efficacies of the five most commonly used bisphosphonates for the secondary prevention of osteoporotic fractures in a Bayesian network meta-analysis. Methods Five databases and the reference lists of all acquired articles from inception to July 2017 were searched. A Bayesian random-effects model was employed, and vertebral, hip and nonvertebral nonhip fractures were assessed by odds ratios (ORs) and 95%credible intervals. Furthermore, with respect to each endpoint, rank probabilities for each bisphosphonate were evaluated using the surface under the cumulative ranking curve (SUCRA) value. Results Thirteen eligible studies were identified involving 11,822 patients with osteoporotic fractures. Overall in the pairwise meta-analyses, bisphosphonate use significantly reduced the risk of new vertebral, hip, and nonvertebral nonhip fractures, with ORs and 95% confidence intervals of 0.56 (0.49–0.64), 0.69 (0.48–0.98), and 0.82 (0.70–0.97), respectively. In network meta-analyses, significant differences were found between placebo and any one of the five bisphosphonates for new vertebral fractures. The rank probability plot and the SUCRA calculation results suggested that alendronate was the best intervention (14.6%) for secondary prevention of vertebral fractures, followed by zoledronate (15.3%) and etidronate (22.1%). In terms of the incidence of new hip fractures, alendronate was associated with the lowest incidence (18.5%), followed by zoledronate (43.1%) and risedronate (52.5%). However, zoledronate ranked lowest (16.6%) regarding the incidence of new nonvertebral nonhip fractures, followed by risedronate (23.8%) and alendronate (44.1%). Conclusions Bisphosphonates show significant efficacy for secondary prevention of new vertebral fractures, and alendronate is most likely to be successful at secondary prevention of vertebral and hip fractures compared with the other four bisphosphonates.
Collapse
|
13
|
Stem cells in Osteoporosis: From Biology to New Therapeutic Approaches. Stem Cells Int 2019; 2019:1730978. [PMID: 31281368 PMCID: PMC6589256 DOI: 10.1155/2019/1730978] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 12/11/2022] Open
Abstract
Osteoporosis is a systemic disease that affects the skeleton, causing reduction of bone density and mass, resulting in destruction of bone microstructure and increased risk of bone fractures. Since osteoporosis is a disease affecting the elderly and the aging of the world's population is constantly increasing, it is expected that the incidence of osteoporosis and its financial burden on the insurance systems will increase continuously and there is a need for more understanding this condition in order to prevent and/or treat it. At present, available drug therapy for osteoporosis primarily targets the inhibition of bone resorption and agents that promote bone mineralization, designed to slow disease progression. Safe and predictable pharmaceutical means to increase bone formation have been elusive. Stem cell therapy of osteoporosis, as a therapeutic strategy, offers the promise of an increase in osteoblast differentiation and thus reversing the shift towards bone resorption in osteoporosis. This review is focused on the current views regarding the implication of the stem cells in the cellular and physiologic mechanisms of osteoporosis and discusses data obtained from stem cell-based therapies of osteoporosis in experimental animal models and the possibility of their future application in clinical trials.
Collapse
|
14
|
Discrimination of vertebral fragility fracture with lumbar spine bone mineral density measured by quantitative computed tomography. J Orthop Translat 2018; 16:33-39. [PMID: 30723679 PMCID: PMC6350047 DOI: 10.1016/j.jot.2018.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 01/22/2023] Open
Abstract
Background/Objective This study is a case–control study to explore risk and protective factors, including clinical data and bone mineral density (BMD), affecting vertebral body fragility fracture in elderly men and postmenopausal women. In addition, we investigate the effectiveness of lumbar spine BMD by quantitative computed tomography (QCT) in discriminating vertebral fragility fracture. Methods In this case–control study, 52 males and 198 females with vertebral fragility fracture were compared with sex- and age-matched healthy controls to analyse the risk factors that may affect vertebral fragility fracture. The L1–L3 vertebral BMDs were measured by QCT. The difference in risk factors between fracture cases and controls were analysed using student t test and Mann–Whitney U test. The correlation between BMD, age, height and weight were analysed using univariate analysis. Multiple logistic regression analysis was used to study statistically significant indexes. The receiver operating characteristic curve was used to calculate the cut-off values for positive and negative predictive values of BMD for vertebral fracture discrimination. Results In males, body weight and BMD were significantly different between the fracture group and the control group, whereas BMD was only weakly correlated with age (r = −0.234). In females, only BMD was significantly different between the fracture and control groups. BMD was weakly correlated with height (r = 0.133) and weight (r = 0.120) and was moderately correlated with age (r = −0.387). There was no correlation between BMD and the remaining variables in this study. In both men and women, the BMD (p = 0.000) was the independent protective factor against vertebral fracture. The cut-off values of vertebral BMD for fractures were 64.16 mg/cm3 for males and 55.58 mg/cm3 for females. QCT-measured BMD has a high positive predictive value and negative predictive value for discriminating vertebral fragility fracture across a range of BMD values. Conclusion This study suggests that BMD is closely related to vertebral fragility fracture and that QCT is an effective technique to accurately discriminate vertebral fragility fracture. The translational potential of this article The spine BMD measured by QCT is closely related to fracture, which may allow clinicians to more accurately discriminate which individuals are likely to experience vertebral fragility fracture.
Collapse
|
15
|
Zhang X, Zhao G, Zhang Y, Wang J, Wang Y, Cheng L, Sun M, Rui Y. Activation of JNK signaling in osteoblasts is inversely correlated with collagen synthesis in age-related osteoporosis. Biochem Biophys Res Commun 2018; 504:771-776. [PMID: 30217450 DOI: 10.1016/j.bbrc.2018.08.094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/13/2018] [Indexed: 12/15/2022]
Abstract
The age-related reduction in the function of osteoblasts plays a central role in the pathogenesis of bone loss and osteoporosis. Collagen synthesis is a primary function of differentiated osteoblasts, however, the mechanisms for age-related changes in collagen synthesis in human osteoblasts remain elusive. We use Gene Ontology (GO) analysis and Gene Set Enrichment Analysis (GSEA) analysis to exploit the transcriptional profiles of osteoblasts from young and old donors. A panel of collagen members was downregulated in aged osteoblasts, including COL12A1, COL5A1, COL5A3, COL8A1 and COL8A2. Co-expression analysis followed by GO analysis revealed that oxidoreductase activity and kinase activity were inversely correlated with collagen synthesis in osteoblasts. GESA analysis further showed that JNK signaling was upregulated in aged osteoblasts. Consistently, MAP3K4 and MAP4K2, upstream of JNK, were also increased in aged osteoblasts. Moreover, expression levels of MAP3K4 were significantly inversely correlated with levels of the collagen genes. Those transcriptomic results were further verified by examining clinical specimens of osteoporosis by immunohistochemistry. These results provide transcriptomic evidence that deregulated JNK signaling may impair collagen synthesis in osteoblasts and imply a therapeutic value of JNK inhibitors for treating osteoporosis and preventing skeletal aging by counteracting the age-related reduction in the function of osteoblasts.
Collapse
Affiliation(s)
- Xin Zhang
- Department of Laboratory, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, 214062, China
| | - Gang Zhao
- Department of Laboratory, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, 214062, China
| | - Ya Zhang
- Department of Laboratory, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, 214062, China
| | - Jian Wang
- Department of Laboratory, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, 214062, China
| | - Yapeng Wang
- Department of Laboratory, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, 214062, China
| | - Long Cheng
- Diagnostic Laboratory, Kunshan Denuo-ruier Biotechnology Co., LTD, Suzhou, Jiangsu, 215300, China
| | - Minxuan Sun
- Jiangsu Key Lab of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.
| | - Yongjun Rui
- Department of Laboratory, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, 214062, China.
| |
Collapse
|
16
|
Jensen CM, Overgaard S, Wiil UK, Smith AC, Clemensen J. Bridging the gap: A user-driven study on new ways to support self-care and empowerment for patients with hip fracture. SAGE Open Med 2018; 6:2050312118799121. [PMID: 30210796 PMCID: PMC6130081 DOI: 10.1177/2050312118799121] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives In future healthcare systems, individuals are expected to be more involved in managing their health and preventing illness. A previous study of patient empowerment on a hip fracture pathway uncovered a gap between what the healthcare system provided and patients' needs and wishes. The aim of this study was to investigate whether a user-driven approach and a participatory design could provide a solution that would bridge this gap. Methods Four workshops and a laboratory test were conducted with healthcare professionals to co-create a final prototype. This was performed in iterative processes through continuous interviews and face-to-face evaluation with patients, together with field studies in patients' homes, to maintain relevance to end-users, that is, patients and healthcare professionals. The data were analysed according to the plan, act, observe and reflect methodology of iterative processes in participatory design. Results Our results contribute to a key research area within patient involvement. By using participatory design, patients and healthcare professionals gained a mutual understanding and collaborated to create a technological solution that would encompass needs and wishes. Patient empowerment also involved giving healthcare professionals a means of empowerment, by providing them with a platform to support patient education. We found that one solution to bridging the aforementioned gap could be an app, including a range of educational features that would accommodate different learning styles. Conclusion In developing a technological solution, user involvement in a participatory design ensures usability and inclusion of the requested functionalities. This can help bridge the gap between what the healthcare system provided and patients' needs and wishes and support patients' individual empowerment needs and self-care capacity. Together with the tools and techniques, the setting in which PD unfolds should be thoughtfully planned.
Collapse
Affiliation(s)
- Charlotte Myhre Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Soren Overgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
| | - Uffe Kock Wiil
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Anthony C Smith
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia
| | - Jane Clemensen
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| |
Collapse
|
17
|
Zhu S, Ehnert S, Rouß M, Häussling V, Aspera-Werz RH, Chen T, Nussler AK. From the Clinical Problem to the Basic Research-Co-Culture Models of Osteoblasts and Osteoclasts. Int J Mol Sci 2018; 19:ijms19082284. [PMID: 30081523 PMCID: PMC6121694 DOI: 10.3390/ijms19082284] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 07/26/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022] Open
Abstract
Bone tissue undergoes constant remodeling and healing when fracture happens, in order to ensure its structural integrity. In order to better understand open biological and clinical questions linked to various bone diseases, bone cell co-culture technology is believed to shed some light into the dark. Osteoblasts/osteocytes and osteoclasts dominate the metabolism of bone by a multitude of connections. Therefore, it is widely accepted that a constant improvement of co-culture models with both cell types cultured on a 3D scaffold, is aimed to mimic an in vivo environment as closely as possible. Although in recent years a considerable knowledge of bone co-culture models has been accumulated, there are still many open questions. We here try to summarize the actual knowledge and address open questions.
Collapse
Affiliation(s)
- Sheng Zhu
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Institute for Trauma Research, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany.
| | - Sabrina Ehnert
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Institute for Trauma Research, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany.
| | - Marc Rouß
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Institute for Trauma Research, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany.
| | - Victor Häussling
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Institute for Trauma Research, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany.
| | - Romina H Aspera-Werz
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Institute for Trauma Research, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany.
| | - Tao Chen
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Institute for Trauma Research, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany.
| | - Andreas K Nussler
- Department of Trauma and Reconstructive Surgery, Siegfried Weller Institute for Trauma Research, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, 72076 Tuebingen, Germany.
| |
Collapse
|
18
|
Nguyen ET, Posas-Mendoza T, Siu AM, Ahn HJ, Choi SY, Lim SY. Low rates of osteoporosis treatment after hospitalization for hip fracture in Hawaii. Osteoporos Int 2018; 29:1827-1832. [PMID: 29744567 DOI: 10.1007/s00198-018-4553-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/25/2018] [Indexed: 11/28/2022]
Abstract
UNLABELLED We evaluated osteoporosis treatment and DEXA utilization rates of patients who were admitted for hip fracture in a single healthcare system in Hawaii from 2015 to 2016. We found that osteoporosis treatment and DEXA utilization rates were low, highlighting a critical gap in osteoporosis care after admission for hip fracture. INTRODUCTION The objective of this study was to evaluate osteoporosis care after an admission for hip fracture at three community hospitals within a single healthcare system in Hawaii. METHODS A retrospective chart review was conducted (n = 428) of patients ≥ 50 years and hospitalized for hip fractures between January 1, 2015, and May 31, 2016, at three major hospitals within Hawaii Pacific Health, a large healthcare system in Hawaii. Basic demographics were collected, and medications prescribed were quantified and described within 1 year of hip fracture. Logistic regression was used to evaluate the association between collected variables and the odds of osteoporosis treatment. RESULTS Only 115 (26.9%) patients were prescribed a medication for osteoporosis as a secondary prevention within a year of hospitalization for hip fracture. DEXA scans were performed in 137 (32.0%) patients. Most of the treated patients were prescribed oral bisphosphonates. Treatment facility, female gender, and higher BMI were found to be predictive factors for osteoporosis treatment. CONCLUSION The use of osteoporosis medication for secondary prevention after admission for hip fracture in Hawaii is low. Efforts need to be made to improve treatment rates, especially among males.
Collapse
Affiliation(s)
- E T Nguyen
- Lewis and Clark College, Portland, OR, USA
| | - T Posas-Mendoza
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
| | - A M Siu
- Hawaii Pacific Health Research Institute, Honolulu, HI, USA
| | - H J Ahn
- Department of Complementary and Integrative Medicine, University of Hawaii, Honolulu, HI, USA
| | - S Y Choi
- Department of Complementary and Integrative Medicine, University of Hawaii, Honolulu, HI, USA
| | - S Y Lim
- Hawaii Pacific Health, Bone and Joint Center, Straub Clinic, 888 S. King Street, Honolulu, HI, 96813, USA.
| |
Collapse
|
19
|
Venugopal Menon K, Al Harthy HHS, Al Habsi KSK, Al Ruzaiqi HAH. Are we treating osteoporotic fractures of the hip adequately? A Middle Eastern cohort study. Arch Osteoporos 2018; 13:6. [PMID: 29368309 DOI: 10.1007/s11657-018-0417-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/21/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Fragility hip fractures treated in a center in the Middle East were retrospectively studied for adequacy of osteoporosis management. Of the 318 patients treated, over 70% did not have a structured investigation and about 30% did not receive any therapeutic supplements. Our series showed a preventable 8.8% secondary fracture rate. PURPOSE To study the adequacy of evaluation and treatment of osteoporosis after fragility fractures of the hip. The study also attempts to estimate the prevalence of secondary fractures after the original injury. METHODS This is a retrospective evaluation of the electronic database to search all the admissions for fractures of the hip in patients over 50 years at a tertiary care Trauma and Orthopaedic center in the Sultanate of Oman. The study period was defined as October 2010 to December 2015. Their case records, BMD reports, and laboratory data were analyzed. Pharmacological interventions and the documented compliance with such therapy were also recorded. RESULTS Over the study period, 318 fragility fractures of the hip were treated. Of these, 233 (73.3%) did not receive a DEXA scan and 94% did not have their vitamin D3 (vit D) tested. About 29.9% percent cases did not receive any nutritional supplement or therapeutic intervention though diagnosed as fragility fracture. Twenty-eight patients (8.8%) reported for secondary fractures of the hip. Of these, 86% was initiated on supplement after their index fracture though 78.6% had not had a BMD study. CONCLUSIONS Less than 27% patients receive BMD test following fragility fracture of the hip and only 6% a vit D3 assay. Secondary fractures of the hip tend to occur in approximately 9% of the cases in Oman; this seems to occur equally in patients who have had as well as not had any calcium and vit D supplements after the index injury.
Collapse
|
20
|
Abstract
PURPOSE OF THE REVIEW The purposes of this study are to examine the literature within the past 5 years regarding osteoporosis and offer a discussion on new topics and controversies. RECENT FINDINGS Patient compliance with therapy remains an issue. The effectiveness of Vitamin D and calcium are being called into question Atypical femur fractures have been associated with bisphosphonate and denosumab use. Treatment is both surgical and pharmaceutical. A multidisciplinary approach to osteoporotic fractures is important and having some form of fracture liaison service (FLS) improves the efficacy of osteoporotic care and decreases secondary fractures. Screening for osteoporosis remains low. Ultrasound may be cost-effective for diagnosis. Understanding of osteoporosis has come a long way in the medical community, but the translation to the lay community has lagged behind. Patients often take a laissez-faire attitude toward osteoporosis that can affect compliance. Information read by patients often focuses on complications, such as atypical femur fractures and myocardial infarctions. It is essential for providers to be able to discuss these issues with patients. Newer medications and more cost-effective diagnostic tests exist, but availability may be limited. FLS are effective, but the most cost-effective model for therapy still eludes us. Areas for further investigation include FLS models, the effectiveness of vitamin supplementation, and more ubiquitous and cost-effective diagnostic tools.
Collapse
Affiliation(s)
- Kyle M Schweser
- Department of Orthopaedic Surgery, University of Missouri, N116, One Hospital Dr, Columbia, MO, 65212, USA
| | - Brett D Crist
- Department of Orthopaedic Surgery, University of Missouri, N116, One Hospital Dr, Columbia, MO, 65212, USA.
| |
Collapse
|
21
|
Maria S, Swanson MH, Enderby LT, D'Amico F, Enderby B, Samsonraj RM, Dudakovic A, van Wijnen AJ, Witt-Enderby PA. Melatonin-micronutrients Osteopenia Treatment Study (MOTS): a translational study assessing melatonin, strontium (citrate), vitamin D3 and vitamin K2 (MK7) on bone density, bone marker turnover and health related quality of life in postmenopausal osteopenic women following a one-year double-blind RCT and on osteoblast-osteoclast co-cultures. Aging (Albany NY) 2017; 9:256-285. [PMID: 28130552 PMCID: PMC5310667 DOI: 10.18632/aging.101158] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/15/2017] [Indexed: 11/25/2022]
Abstract
This one-year double blind randomized control trial assessed the effects of nightly melatonin, strontium (citrate), vitamin D3 and vitamin K2 (MK7; MSDK) on bone mineral density (BMD) and quality of life (QOL) in postmenopausal osteopenic women (ages 49-75). Compared to placebo, MSDK treatment increased BMD in lumbar spine (4.3%) and left femoral neck (2.2%), with an upward trend for total left hip (p=0.069). MSDK increased serum P1NP levels and reduced bone turnover (CTx:P1NP). Psychometric analyses indicated that mood and sleep quality improved for the MSDK group. MSDK-exposed human mesenchymal stem cells (hMSCs) and human peripheral blood monocytes (hPBMCs) plated in transwells or layered demonstrated increases in osteoblastogenesis, decreases in osteoclastogenesis, increases in OPG (TNFRSF11B) and decreases in RANKL (TNFSF11) levels. In transwell osteoblasts, MSDK increased pERK1/2 (MAPK1/MAPK3) and RUNX2 levels; decreased ERK5 (MAPK7); and did not affect the expression of NFκB (NFKB1) and β1integrin (ITGB1). In layered osteoblasts, MSDK also decreased expression of the metabolic proteins PPARγ (PPARG) and GLUT4 (SLC2A4). In adipose-derived human MSCs, MSDK induced osteoblastogenesis. These findings provide both clinical and mechanistic support for the use of MSDK for the prevention or treatment of osteopenia, osteoporosis or other bone-related diseases.
Collapse
Affiliation(s)
- Sifat Maria
- Division of Pharmaceutical Sciences, Duquesne University School of Pharmacy, Pittsburgh, PA 15282, USA
| | - Mark H. Swanson
- Functional Medicine, Heart Preventics, LLC, Sequim, WA 98382, USA
| | - Larry T. Enderby
- Enderby Healthcare/Legal Consulting, LLC, Pittsburgh, PA 15102, USA
| | - Frank D'Amico
- Department of Mathematics, Duquesne University School of Liberal Arts, Pittsburgh, PA 15282, USA
| | - Brianna Enderby
- Division of Pharmaceutical Sciences, Duquesne University School of Pharmacy, Pittsburgh, PA 15282, USA
| | | | - Amel Dudakovic
- Mayo Clinic, Department of Orthopedic Surgery, Rochester, MN 55905, USA
| | | | - Paula A. Witt-Enderby
- Division of Pharmaceutical Sciences, Duquesne University School of Pharmacy, Pittsburgh, PA 15282, USA
| |
Collapse
|
22
|
Yeh JJ, Wang YC, Lin CC, Lin CL, Hsu WH. Association of Respiratory Tuberculosis with Incident Bone Fracture: Bridging the Tuberculosis Airway Infection and the Osteoporotic Bone. PLoS One 2016; 11:e0168673. [PMID: 28005963 PMCID: PMC5178997 DOI: 10.1371/journal.pone.0168673] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 11/23/2016] [Indexed: 01/31/2023] Open
Abstract
Objective The relationship between respiratory tuberculosis (RT) and incident fragility fracture and osteoporosis/fragility fracture in the general population is not well determined; therefore, we conducted a nationwide cohort study to investigate this relationship. Methods We used the National Health Insurance Research Database of Taiwan to identify 6612 newly diagnosed patients with RT (RT cohort) and 13220 patients without RT (non-RT cohort) from 1999 to 2005. The mean durations of follow-up were (6.73 ± 4.00 years, 8.11 ± 3.24 years) in the (RT cohort, non- RT cohort); respectively. The occurrence of incident fragility fracture and osteoporosis/fragility fracture were followed up until the end of 2011. The adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) and 98% CIs of incident fragility fracture and osteoporosis/fragility fracture were estimated using the multivariable Cox proportional hazard model after adjusting for age, sex, occupation, drug use, and comorbidities. Results A Cox proportional hazards regression analysis was performed and showed the aHRs of [incident fragility fracture; osteoporosis/fragility fracture] were [1.69 (95% CI = 1.26–2.28, 98% CI = 1.18–2.44); 1.42 (95% CI = 1.25–1.61, 98% CI = 1.21–1.65)] between the RT and non-RT cohorts. Regarding the sex, the aHRs of the [incident fragility fracture; osteoporosis / fragility fracture] were [1.57 (98% CI = 1.10–2.23, 98% CI = 1.02–2.41); 1.15 (95% CI = 0.97–1.36, 98% CI = 0.94–1.41)] in the men. The aHRs of the RT cohort without oral steroid use in the [incident fragility fracture; osteoporosis / fragility fracture] were [1.87 (95% CI = 1.20–2.90, 98% CI = 1.09–3.19); 1.41 (95% CI = 1.19–1.67, 98% CI = 1.14–1.74)]. Conclusion The RT associated with the incident fragility fracture, either in men or absence of oral steroid use.
Collapse
Affiliation(s)
- Jun-Jun Yeh
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Meiho University, Pingtung, Taiwan
| | - Yu-Chiao Wang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Wu-Huei Hsu
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
| |
Collapse
|
23
|
Li F, Zhou C, Xu L, Tao S, Zhao J, Gu Q. Effect of Stem Cell Therapy on Bone Mineral Density: A Meta-Analysis of Preclinical Studies in Animal Models of Osteoporosis. PLoS One 2016; 11:e0149400. [PMID: 26882451 PMCID: PMC4755606 DOI: 10.1371/journal.pone.0149400] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/01/2016] [Indexed: 01/01/2023] Open
Abstract
Background Preclinical studies of the therapeutic role of stem cell based therapy in animal models of osteoporosis have largely yielded inconsistent results. We performed a meta-analysis to provide an overview of the currently available evidence. Methods Pubmed, Embase and Cochrane Library databases were systematically searched for relevant controlled studies. A random-effect model was used for pooled analysis of the effect of stem cell based therapy on bone mineral density (BMD). Stratified analyses were performed to explore the effect of study characteristics on the outcomes. Results Pooled results from 12 preclinical studies (110 animals in stem cell treatment groups, and 106 animals in control groups) indicated that stem cell based treatment was associated with significantly improved BMD (standardized mean difference [SMD] = 1.29, 95% Confidence Interval [CI]: 0.84–1.74, P < 0.001) with moderate heterogeneity (Cochrane’s Q test: P = 0.02, I2 = 45%) among the constituent studies. Implantation of bone marrow cells, bone marrow mesenchymal stem cells, adipose-derived stem cells, and human umbilical cord blood-derived CD34+ cells, were all associated with improved BMD as compared to that in the controls (P < 0.05 for all); the only exception being the use of embryonic stem cell transplantation (P > 0.05). Egger’s test detected potential publication bias (P = 0.055); however, ‘trim and fill’ analysis yielded similar results after statistically incorporating the hypothetical studies in the analysis (SMD = 1.24, 95% CI: 0.32–2.16, P < 0.001). Conclusions Stem cell transplantation may improve BMD in animal models of osteoporosis. Our meta-analysis indicates a potential therapeutic role of stem cell based therapy for osteoporosis, and serves to augment the rationale for clinical studies.
Collapse
Affiliation(s)
- Feng Li
- Department of Bone joint surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, 150086, China
| | - Changlin Zhou
- Department of emergency surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, 150086, China
- * E-mail:
| | - Liang Xu
- Department of Bone joint surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, 150086, China
| | - Shuqing Tao
- Department of Bone joint surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, 150086, China
| | - Jingyi Zhao
- Heilongjiang academy of traditional Chinese medicine, Harbin, Heilongjiang Province, 150086, China
| | - Qun Gu
- Department of Bone joint surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, 150086, China
| |
Collapse
|
24
|
Naranjo A, Ojeda-Bruno S, Bilbao-Cantarero A, Quevedo-Abeledo JC, Diaz-González BV, Rodríguez-Lozano C. Two-year adherence to treatment and associated factors in a fracture liaison service in Spain. Osteoporos Int 2015; 26:2579-85. [PMID: 26048675 DOI: 10.1007/s00198-015-3185-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/20/2015] [Indexed: 12/22/2022]
Abstract
UNLABELLED A fracture liaison service in Spain is able to maintain 73 % of the patients on antiresorptive 2 years after the fracture. INTRODUCTION The purpose of this study was to evaluate the 2-year effectiveness of a program for the secondary prevention of fractures. METHODS Fragility fractures in patients over 50 attending the emergency room in our centre are captured by the recruitment system of a secondary prevention program. The unit is attended by a nurse, coordinated by two rheumatologists and with the collaboration of primary care consisted of a training program and annual meetings. The outcome of the program was analysed 2 years after implementation, including: (1) percentage of attendees/eligible; (2) percentage of attendees who start treatment with antiresorptive; (3) percentage of patients who retain treatment after 6, 12, 18 and 24 months; and (4) factors associated to adherence. RESULTS After 2 years of implementation, the program detected 1674 patients with fracture, of whom 759 finally entered the program (57 % of eligible). After 3 months, 82 % of patients prescribed an antiresorptive started treatment. After a year, 52 % of the patients in the program, 72 % of those of a prescribed treatment, were taking antiresorptives. Adherence at 24 months among those who had prescribed anti-fracture drugs was 73 %. Factors associated with adherence at 12 months were female sex (76 vs 45 %; p = 0.01) and previous treatment with antiresorptive (86 vs 68 %; p = 0.02). CONCLUSIONS In Spain, a program designed to prevent secondary fragility fractures based on the collaboration between primary care and rheumatology seems effective in terms of recruitment of patients and adherence to treatment in the mid/long-term.
Collapse
Affiliation(s)
- A Naranjo
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain.
- Medical and Surgical Sciences Department, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - S Ojeda-Bruno
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain
| | - A Bilbao-Cantarero
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain
| | - J C Quevedo-Abeledo
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain
| | - B V Diaz-González
- Primary Care Service, Gerencia de Atención Primaria de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - C Rodríguez-Lozano
- Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Barranco de La Ballena s/n, 35011, Las Palmas de Gran Canaria, Spain
| |
Collapse
|
25
|
Mesa-Lampré M, Canales-Cortés V, Castro-Vilela M, Clerencia-Sierra M. Initial experiences of an orthogeriatric unit. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015. [DOI: 10.1016/j.recote.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
26
|
Mesa-Lampré MP, Canales-Cortés V, Castro-Vilela ME, Clerencia-Sierra M. [Initial experiences of an orthogeriatric unit]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2015; 59:429-38. [PMID: 25920894 DOI: 10.1016/j.recot.2015.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/11/2015] [Accepted: 02/25/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To report the design and outcomes obtained during the first operational years of the Orthogeriatric Unit (OGU) established in the Zaragoza-1 (Spain) Health-Sector. MATERIAL AND METHODS A total of 494 patients >70 years old treated in the OGU from February 2009 to December 2012. An analysis was performed using the following variables: demography, previous functional level, comorbidities, surgical delay, fracture type and surgical technique, complications, hospital stay, functional outcomes, destination after hospital discharge, and short and long term mortality. RESULTS Mean age 85.22 years. High incidence of comorbidities (Charlson Index): 24.3%. Dementia: 38.5%. Surgical delay: 2.57 days. Mean hospital stay between admission and discharge/transfer to convalescence unit, 20.9 days (Traumatology 6.45+OGU 14.49). More than a third (34.6%) of patients suffered from delirium. Mean functional improvement (Barthel index at hospital discharge-Barthel index at hospital admission): 27.25 points. Montebello index: 0.49. In-hospital mortality: 6.9%. CONCLUSION Hip fracture is such a frequent and disabling pathology among the geriatric population that its treatment requires an interdisciplinary approach. This must be managed by the geriatrician, who has to assure the continuity and integration of the diverse treatment and care schedules, with the participation of the entire professional team in the decision-making process. We are very satisfied with the creation of our interdisciplinary Unit that enables us to report competitive outcomes. We believe that the progression of this Unit from providing subacute to acute care will improve the general outcomes in the future.
Collapse
Affiliation(s)
- M P Mesa-Lampré
- Servicio de Geriatría, Unidad de Ortogeriatría, Hospital Nuestra Señora de Gracia, Zaragoza, España
| | - V Canales-Cortés
- Servicio de Cirugía Ortopédica y Traumatología, Sector Zaragoza 1, Unidad de Ortogeriatría, Hospitales Royo Villanova y Nuestra Señora de Gracia, Zaragoza, España.
| | | | - M Clerencia-Sierra
- Unidad de Valoración Sociosanitaria, Hospital Universitario Miguel Servet, Zaragoza, España
| |
Collapse
|