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Cha Y, Kim JT, Kim JW, Lee JG, Lee SY, Kim HB, Kang YJ, Choy WS, Yoo JI. Analysis of Changes in Sleep Quality and Patterns after Hip Fracture Using Real Evidence of Artificial Intelligence Linked (REAL) Hip Cohort Data. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2125. [PMID: 38138229 PMCID: PMC10744893 DOI: 10.3390/medicina59122125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Hip fractures are commonly found in elderly patients, and often result in chronic pain and decreased physical function, as well as worsening of overall health. It is known that early surgical intervention during the acute phase and rehabilitation are important for improving clinical outcomes for these patients. However, the importance of management for improving the quality of life of these patients is becoming more emphasized. Studies on changes in sleep patterns after hip fractures are rare overseas. Therefore, the aim of this study is to investigate the prevalence of sleep disturbance in patients with hip fractures and to analyze the changes in sleep disturbance after surgery by comparing the preoperative and postoperative results. Materials and Methods: During the period from August 2022 to January 2023, patients who underwent surgical treatment for hip fractures and were recruited into the REAL Hip Cohort were selected as research subjects. The sleep survey was conducted using the Pittsburgh Sleep Quality Index (PSQI). The PSQI is composed of 18 questions, each divided into areas of sleep quality, sleep latency, duration, efficiency, disturbance, use of medication, and daytime dysfunction. Each area is scored 0-3 points and the total is 0-21. A score greater than five indicates sleep disorder. The PSQI was surveyed during hospitalization and three months after surgery for post-fracture sleep status. To analyze changes before and after the fracture, paired T-tests and chi-square tests were performed. Results: From August 2022 to January 2023, a total of 40 patients who were recruited into the REAL Hip Cohort responded to the PSQI survey. The average age was 77.4 years and 36 were female. Sleep quality worsened from 0.75 ± 1.0 before surgery to 1.4 ± 1.0 three months after surgery (p = 0.019), and sleep efficiency also worsened from 0.4 ± 0.6 to 1.4 ± 1.0 (p < 0.001). The PSQI increased from an average of 5.2 ± 2.8 before surgery to 8.2 ± 4.2 three months after surgery (p = 0.007), and the number of patients who could be diagnosed with sleep disorders also increased from 12 (40%) to 24 (60%) (p = 0.030). Conclusions: A decline in overall sleep status was observed in patients in a survey on sleep patterns three months after hip fracture. Additional management is needed to improve their sleep patterns.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon 35233, Republic of Korea
| | - Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon 16499, Republic of Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, Republic of Korea
| | - Jin-Gu Lee
- Department of Psychiatry, Daejeon Hospital of Korea Worker’s Compensation and Welfare Service, Daejeon 34384, Republic of Korea
| | - Sang-Yeob Lee
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Hyun-Bin Kim
- Department of Biomedical Research Institute, Inha University Hospital, Incheon 22332, Republic of Korea;
| | - Yang Jae Kang
- Division of Life Science Department, Gyeongsang National University, Jinju 52828, Republic of Korea
| | - Won-Sik Choy
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon 35233, Republic of Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon 22332, Republic of Korea
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Caron R, Londono I, Seoud L, Villemure I. Segmentation of trabecular bone microdamage in Xray microCT images using a two-step deep learning method. J Mech Behav Biomed Mater 2023; 137:105540. [PMID: 36327650 DOI: 10.1016/j.jmbbm.2022.105540] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION One of the current approaches to improve our understanding of osteoporosis is to study the development of bone microdamage under mechanical loading. The current practice for evaluating bone microdamage is to quantify damage volume from images of bone samples stained with a contrast agent, often composed of toxic heavy metals and requiring long tissue preparation. This work aims to evaluate the potential of linear microcracks detection and segmentation in trabecular bone samples using well-known deep learning models, namely YOLOv4 and Unet, applied on microCT images. METHODS Six trabecular bovine bone cylinders underwent compression until ultimate stress and were subsequently imaged with a microCT at a resolution of 1.95 μm. Two of these samples (samples 1 and 2) were then stained using barium sulfate (BaSO4) and imaged again. The unstained samples (samples 3-6) were used to train two neural networks YOLOv4 to detect regions with microdamage further combined with Unet to segment the microdamage at the pixel level in the detected regions. Four different model versions of YOLOv4 were compared using the average Intersection over Union (IoU) and the mean average precision (mAP). The performance of Unet was also measured using two segmentation metrics, the Dice Score and the Intersection over Union (IoU). A qualitative comparison was finally done between the deep learning and the contrast agent approaches. RESULTS Among the four versions of YOLOv4, the YOLOv4p5 model resulted in the best performance with an average IoU of 45,32% and 51,12% and a mAP of 28.79% and 46.22%, respectively for samples 1 and 2. The segmentation performance of Unet provided better IoU and DICE score on sample 2 compared to sample 1. The poorer performance of the test on sample 1 could be explained by its poorer contrast to noise ratio (CNR). Indeed, sample 1 resulted in a CNR of 7,96, which was worse than the average CNR in the training samples, while sample 2 resulted in a CNR of 10,08. The qualitative comparison between the contrast agent and the deep learning segmentation showed that two different regions were segmented by the two techniques. Deep learning is segmenting the region inside the cracks while the contrast agent segments the region around it or even regions with no visible damage. CONCLUSION The combination of YOLOv4 for microdamage detection with Unet for damage segmentation showed a potential for the detection and segmentation of microdamage in trabecular bone. The accuracy of both neural networks achieved in this work is acceptable considering it is their first application in this specific field and the amount of data was limited. Even if the errors from both neural networks are accumulated, the two-steps approach is faster than the semantic segmentation of the whole volume.
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Affiliation(s)
- Rodrigue Caron
- Department of Mechanical Engineering, Polytechnique Montréal, Montréal, QC, Canada; Centre de recherche du CHU Sainte Justine, CHU Sainte Justine, Montréal, QC, Canada
| | - Irène Londono
- Centre de recherche du CHU Sainte Justine, CHU Sainte Justine, Montréal, QC, Canada
| | - Lama Seoud
- Centre de recherche du CHU Sainte Justine, CHU Sainte Justine, Montréal, QC, Canada; Institut de génie biomédical, Montréal, QC, Canada; Department of Computer Engineering and Software Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Isabelle Villemure
- Department of Mechanical Engineering, Polytechnique Montréal, Montréal, QC, Canada; Centre de recherche du CHU Sainte Justine, CHU Sainte Justine, Montréal, QC, Canada; Institut de génie biomédical, Montréal, QC, Canada.
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Huang T, Redline S, Gordon CM, Schernhammer E, Curhan GC, Paik JM. Self-reported sleep characteristics and risk for incident vertebral and hip fracture in women. Sleep Health 2022; 8:234-241. [PMID: 35241403 PMCID: PMC8995338 DOI: 10.1016/j.sleh.2021.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the relationships between self-reported sleep characteristics and risk of incident vertebral fracture and hip fracture in women. DESIGN Longitudinal cohort study. SETTING Nurses' Health Studies (NHS: 2002-2014, NHSII: 2001-2015). PARTICIPANTS Total 122,254 female registered nurses (46,129 NHS, 76,125 NHSII) without prior history of fracture. EXPOSURE Sleep was characterized by 4 sleep-related domains-sleep duration, sleep difficulty, snoring, and excessive daytime sleepiness-assessed by self-reported questionnaires. OUTCOMES Self-reports of vertebral fracture were confirmed by medical record review and hip fracture was assessed by biennial questionnaires. RESULTS Over 12-14 years of follow-up, 569 incident vertebral fracture cases (408 in NHS, 161 in NHSII) and 1,881 hip fracture cases (1,490 in NHS, 391 in NHSII) were documented. In the pooled analysis, the multivariable-adjusted HR (95% CI) for vertebral fracture was 1.20 (0.86, 1.66) for sleep duration ≤5 hours vs. 7 hours and 0.82 (0.60, 1.12) for ≥9 vs. 7 hours; 1.63 (0.93, 2.87) for sleep difficulties all-the-time vs. none/little-of-the-time (p-trend = 0.005); 1.47 (1.05, 2.05) for snoring every night/week vs. never/occasionally (p-trend = 0.03), and 2.20 (1.49, 3.25) for excessive daytime sleepiness daily vs. never (p-trend < 0.001). In contrast, associations were not observed with hip fracture risk. CONCLUSION Poorer sleep characteristics were associated with risk of vertebral fracture. Our study highlights the importance of multiple dimensions of sleep in the development of vertebral fractures. Further research is warranted to understand the role of sleep in bone health that may differ by fracture site, as well as sleep interventions that may reduce the risk of fracture.
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Affiliation(s)
- Tianyi Huang
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Catherine M Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Eva Schernhammer
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA; Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Gary C Curhan
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Julie M Paik
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
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Huang T, Tworoger SS, Redline S, Curhan GC, Paik JM. Obstructive Sleep Apnea and Risk for Incident Vertebral and Hip Fracture in Women. J Bone Miner Res 2020; 35:2143-2150. [PMID: 32909307 PMCID: PMC7719618 DOI: 10.1002/jbmr.4127] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/09/2020] [Accepted: 07/02/2020] [Indexed: 12/11/2022]
Abstract
Recent studies suggest a positive association between obstructive sleep apnea (OSA), a disorder associated with intermittent hypoxia and sleep fragmentation, and derangements in bone metabolism. However, no prospective study to date has investigated the association between OSA and fracture risk in women. We conducted a prospective study examining the relation between OSA and risk of incident vertebral fracture (VF) and hip fracture (HF) in the Nurses' Health Study. History of physician-diagnosed OSA was assessed by self-reported questionnaires. A previous validation study demonstrated high concordance between self-reports and medical record identification of OSA. OSA severity was further categorized according to the presence or absence of self-reported sleepiness. Self-reports of VF were confirmed by medical record review. Self-reported HF was assessed by biennial questionnaires. Cox proportional-hazards models estimated the hazard ratio for fracture according to OSA status, adjusted for potential confounders, including BMI, physical activity, calcium intake, history of osteoporosis, and falls, and use of sleep medications. Among 55,264 women without prior history of fracture, physician-diagnosed OSA was self-reported in 1.3% in 2002 and increased to 3.3% by 2012. Between 2002 and 2014, 461 incident VF cases and 921 incident HF cases were documented. The multivariable-adjusted hazard ratio (HR) for confirmed VF for women with history of OSA was 2.00 (95% CI, 1.29-3.12) compared with no OSA history, with the strongest association observed for OSA with daytime sleepiness (HR 2.86; 95% CI, 1.31-6.21). No association was observed between OSA history and self-reported HF risk (HR 0.83; 95% CI, 0.49-1.43). History of OSA is independently associated with higher risk of confirmed VF but did not have a statistically significant association with self-reported HF in women. Further research is warranted in understanding the role of OSA and intermittent hypoxia in bone metabolism and health that may differ by fracture site. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Tianyi Huang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Gary C Curhan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Julie M Paik
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
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Scheuren AC, Vallaster P, Kuhn GA, Paul GR, Malhotra A, Kameo Y, Müller R. Mechano-Regulation of Trabecular Bone Adaptation Is Controlled by the Local in vivo Environment and Logarithmically Dependent on Loading Frequency. Front Bioeng Biotechnol 2020; 8:566346. [PMID: 33154964 PMCID: PMC7591723 DOI: 10.3389/fbioe.2020.566346] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/23/2020] [Indexed: 12/23/2022] Open
Abstract
It is well-established that cyclic, but not static, mechanical loading has anabolic effects on bone. However, the function describing the relationship between the loading frequency and the amount of bone adaptation remains unclear. Using a combined experimental and computational approach, this study aimed to investigate whether trabecular bone mechano-regulation is controlled by mechanical signals in the local in vivo environment and dependent on loading frequency. Specifically, by combining in vivo micro-computed tomography (micro-CT) imaging with micro-finite element (micro-FE) analysis, we monitored the changes in microstructural as well as the mechanical in vivo environment [strain energy density (SED) and SED gradient] of mouse caudal vertebrae over 4 weeks of either cyclic loading at varying frequencies of 2, 5, or 10 Hz, respectively, or static loading. Higher values of SED and SED gradient on the local tissue level led to an increased probability of trabecular bone formation and a decreased probability of trabecular bone resorption. In all loading groups, the SED gradient was superior in the determination of local bone formation and resorption events as compared to SED. Cyclic loading induced positive net (re)modeling rates when compared to sham and static loading, mainly due to an increase in mineralizing surface and a decrease in eroded surface. Consequently, bone volume fraction increased over time in 2, 5, and 10 Hz (+15%, +21% and +24%, p ≤ 0.0001), while static loading led to a decrease in bone volume fraction (-9%, p ≤ 0.001). Furthermore, regression analysis revealed a logarithmic relationship between loading frequency and the net change in bone volume fraction over the 4 week observation period (R 2 = 0.74). In conclusion, these results suggest that trabecular bone adaptation is regulated by mechanical signals in the local in vivo environment and furthermore, that mechano-regulation is logarithmically dependent on loading frequency with frequencies below a certain threshold having catabolic effects, and those above anabolic effects. This study thereby provides valuable insights toward a better understanding of the mechanical signals influencing trabecular bone formation and resorption in the local in vivo environment.
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Affiliation(s)
| | - Paul Vallaster
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Gisela A. Kuhn
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Graeme R. Paul
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Angad Malhotra
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Yoshitaka Kameo
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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Winters M, Burr DB, van der Hoeven H, Condon KW, Bellemans J, Moen MH. Microcrack-associated bone remodeling is rarely observed in biopsies from athletes with medial tibial stress syndrome. J Bone Miner Metab 2019; 37:496-502. [PMID: 30066165 DOI: 10.1007/s00774-018-0945-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/18/2018] [Indexed: 01/31/2023]
Abstract
The pathology of medial tibial stress syndrome (MTSS) is unknown. Studies suggest that MTSS is a bony overload injury, but histological evidence is sparse. The presence of microdamage, and its potential association with targeted remodeling, could provide evidence for the pathogenesis of MTSS. Understanding the pathology underlying MTSS could contribute to effective preventative and therapeutic interventions for MTSS. Our aim was to retrospectively evaluate biopsies, previously taken from the painful area in athletes with MTSS, for the presence of linear microcracks, diffuse microdamage and remodeling. Biopsies, previously taken from athletes with MTSS, were evaluated at the Department of Anatomy and Cell Biology at the Indiana University. After preparing the specimens by en bloc staining, one investigator evaluated the presence of linear microcracks, diffuse microdamage and remodeling in the specimens. A total of six biopsies were evaluated for the presence of microdamage and remodeling. Linear microcracks were found in 4 out of 6 biopsies. Cracking in one of these specimens was artefactual due to the biopsy procedure. No diffuse microdamage was seen in any of the specimens, and only one potential remodeling front in association with the microcracks. We found only linear microcracks in vivo in biopsies taken from the painful area in 50% of the athletes with MTSS, consistent with the relationship between linear cracks and fatigue-associated overloading of bone. The nearly universal absence of a repair reaction was notable. This suggests that unrepaired microdamage accumulation may underlie the pathophysiological basis for MTSS in athletes.
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Affiliation(s)
- Marinus Winters
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, 9220, Aalborg, Denmark.
| | - David B Burr
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, USA
- Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, USA
| | | | - Keith W Condon
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, USA
| | - Johan Bellemans
- Department of Orthopedics, University Hasselt, ZOL Hospital Genk, Genk, Belgium
| | - Maarten H Moen
- Bergman Clinics, Naarden, The Netherlands
- The Sportsphysician Group, OLVG Hospital Amsterdam, Amsterdam, The Netherlands
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Rabelo GD, Portero-Muzy N, Gineyts E, Roux JP, Chapurlat R, Chavassieux P. Spatial Distribution of Microcracks in Osteoarthritic Femoral Neck: Influence of Osteophytes on Microcrack Formation. Calcif Tissue Int 2018; 103:617-624. [PMID: 30022227 DOI: 10.1007/s00223-018-0456-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/11/2018] [Indexed: 02/08/2023]
Abstract
Osteophytes have been suggested to influence the bone mechanical properties. The aim of this study was to compare the microcrack density in osteophytes with that in the other parts of the osteoarthritic femoral neck (FN). The presence of microcracks was investigated in the ultra-distal FN and in the osteophytes in samples obtained during hip arthroplasty in 24 postmenopausal women aged 67 ± 10 years. Furthermore, the 3D microarchitecture and the collagen crosslinks contents were assessed by high-resolution peripheral quantitative computed tomography and high-performance liquid chromatography, respectively. Osteophytes were present in the 24 FN, mainly at the level of the inferior quadrant. Microcracks were present in all FN with an average of 2.8 per sample. All observed microcracks were linear. The microcrack density (Cr.N/BV; #/mm2) was significantly higher in cancellous than in cortical bone (p = 0.004), whereas the microcrack length (Cr.Le, µm) was significantly greater in cortical bone (p = 0.04). The collagen crosslinks ratio pyridinoline/deoxypyridinoline was significantly and negatively correlated with Cr.N/BV in the posterior (r' = - 0.68, p = 0.01) and inferior (r' = - 0.53, p = 0.05) quadrants. Microcracks were observed in seven osteophytes in seven patients. When microcracks were present in the osteophyte area, Cr.N/BV was also significantly higher in the whole FN and in the quadrant of the osteophyte compared to the cases without microcrack in the osteophyte (p < 0.03). In conclusion, in FN from hip osteoarthritis microcracks are present in all FNs but in only 23% of the osteophytes. The microcrack formation was greater and their progression was smaller in the cancellous bone than in the cortex. The spatial distribution of microcracks varied according to the proximity of the osteophyte, and suggests that osteophyte may influence microcrack formation related to changes in local bone quality.
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Affiliation(s)
| | | | | | | | | | - Pascale Chavassieux
- INSERM UMR 1033, Université de Lyon, Lyon, France.
- INSERM UMR 1033 - UFR de Médecine Lyon-Est - Domaine Laennec, 7-11, Rue Guillaume Paradin, 69372, Lyon Cedex 08, France.
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Hao L, Rui-Xin L, Biao H, Bin Z, Bao-Hui H, Ying-Jie L, Xi-Zheng Z. Effect of athletic fatigue damage and the associated bone targeted remodeling in the rat ulna. Biomed Eng Online 2017; 16:99. [PMID: 28789651 PMCID: PMC5549390 DOI: 10.1186/s12938-017-0384-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/21/2017] [Indexed: 11/24/2022] Open
Abstract
Background Fatigue damage of the long bones is prevalent in running athletes and military recruits due to vigorous mid- and long-term physical activity. The current study attempted to know the features of bony athletic fatigue damage and to explore the mechanism of fatigue damage repair through bone targeted remodeling process. Methods Right ulnae of the Wistar rats were fatigue loaded on an INSTRON 5865 to construct the athletic fatigue damage model, and several time points (i.e. experimental days: 0, 7, 13 and 19) were selected to simulate physiological status, preliminary, mid-term and perennial stage during continuous high-intensive training, respectively. The multi-level responses of rat ulnae under the athletic fatigue loading, including cellular protein expression, micro damage or micro-crack and macro mechanical properties, were tested and statistically analyzed. Results Wistar rats, subjected to the athletic fatigue loading protocol, experienced a decrease of ulna fatigue mechanical properties and an active bone resorption of the loaded ulnae in the early stage, whereafter, a hyperactive bone formation and significant improvements of ulnae fatigue mechanical properties were detected. However, a deterioration of quasi-static mechanical properties in the subsequent period implied limitations of bone remodeling to maintain the bearing capacity of bone during long-term strenuous exercise. Conclusions In summary, after athletic fatigue loading, bone targeted remodeling is activated and proceeds to repair fatigue damage, but only to a certain extent.
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Affiliation(s)
- Li Hao
- Institute of Medical Equipment, Academy of Military Medical Sciences, Tianjin, China
| | - Li Rui-Xin
- Institute of Medical Equipment, Academy of Military Medical Sciences, Tianjin, China
| | - Han Biao
- Institute of Medical Equipment, Academy of Military Medical Sciences, Tianjin, China
| | - Zhao Bin
- Department of Orthopaedics Trauma, First Hospital of Jilin University, Changchun, China
| | - Hao Bao-Hui
- Department of Orthopaedics Trauma, First Hospital of Jilin University, Changchun, China
| | - Liu Ying-Jie
- Institute of Medical Equipment, Academy of Military Medical Sciences, Tianjin, China
| | - Zhang Xi-Zheng
- Institute of Medical Equipment, Academy of Military Medical Sciences, Tianjin, China.
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Goff MG, Lambers FM, Nguyen TM, Sung J, Rimnac CM, Hernandez CJ. Fatigue-induced microdamage in cancellous bone occurs distant from resorption cavities and trabecular surfaces. Bone 2015; 79:8-14. [PMID: 26008609 PMCID: PMC4501884 DOI: 10.1016/j.bone.2015.05.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/29/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
Abstract
Impaired bone toughness is increasingly recognized as a contributor to fragility fractures. At the tissue level, toughness is related to the ability of bone tissue to resist the development of microscopic cracks or other tissue damage. While most of our understanding of microdamage is derived from studies of cortical bone, the majority of fragility fractures occur in regions of the skeleton dominated by cancellous bone. The development of tissue microdamage in cancellous bone may differ from that in cortical bone due to differences in microstructure and tissue ultrastructure. To gain insight into how microdamage accumulates in cancellous bone we determined the changes in number, size and location of microdamage sites following different amounts of cyclic compressive loading. Human vertebral cancellous bone specimens (n=32, 10 male donors, 6 female donors, age 76 ± 8.8, mean ± SD) were subjected to sub-failure cyclic compressive loading and microdamage was evaluated in three-dimensions. Only a few large microdamage sites (the largest 10%) accounted for 70% of all microdamage caused by cyclic loading. The number of large microdamage sites was a better predictor of reductions in Young's modulus caused by cyclic loading than overall damage volume fraction (DV/BV). The majority of microdamage volume (69.12 ± 7.04%) was located more than 30 μm (the average erosion depth) from trabecular surfaces, suggesting that microdamage occurs primarily within interstitial regions of cancellous bone. Additionally, microdamage was less likely to be near resorption cavities than other bone surfaces (p<0.05), challenging the idea that stress risers caused by resorption cavities influence fatigue failure of cancellous bone. Together, these findings suggest that reductions in apparent level mechanical performance during fatigue loading are the result of only a few large microdamage sites and that microdamage accumulation in fatigue is likely dominated by heterogeneity in tissue material properties rather than stress concentrations caused by micro-scale geometry.
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Affiliation(s)
- M G Goff
- Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA; Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - F M Lambers
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - T M Nguyen
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - J Sung
- College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - C M Rimnac
- Departments of Mechanical and Aerospace Engineering and Orthopaedics, Case Western Reserve University, Cleveland, OH, USA
| | - C J Hernandez
- Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA; Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA; Hospital for Special Surgery, New York City, NY, USA.
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Affiliation(s)
- David B Burr
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, and Department of Biomedical Engineering, Indiana University-Purdue University, Indianapolis, IN, USA
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11
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Microdamage caused by fatigue loading in human cancellous bone: relationship to reductions in bone biomechanical performance. PLoS One 2013; 8:e83662. [PMID: 24386247 PMCID: PMC3875472 DOI: 10.1371/journal.pone.0083662] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/13/2013] [Indexed: 11/19/2022] Open
Abstract
Vertebral fractures associated with osteoporosis are often the result of tissue damage accumulated over time. Microscopic tissue damage (microdamage) generated in vivo is believed to be a mechanically relevant aspect of bone quality that may contribute to fracture risk. Although the presence of microdamage in bone tissue has been documented, the relationship between loading, microdamage accumulation and mechanical failure is not well understood. The aim of the current study was to determine how microdamage accumulates in human vertebral cancellous bone subjected to cyclic fatigue loading. Cancellous bone cores (n = 32) from the third lumbar vertebra of 16 donors (10 male, 6 female, age 76±8.8, mean ± SD) were subjected to compressive cyclic loading at σ/E0 = 0.0035 (where σ is stress and E0 is the initial Young’s modulus). Cyclic loading was suspended before failure at one of seven different amounts of loading and specimens were stained for microdamage using lead uranyl acetate. Damage volume fraction (DV/BV) varied from 0.8±0.5% (no loading) to 3.4±2.1% (fatigue-loaded to complete failure) and was linearly related to the reductions in Young’s modulus caused by fatigue loading (r2 = 0.60, p<0.01). The relationship between reductions in Young’s modulus and proportion of fatigue life was nonlinear and suggests that most microdamage generation occurs late in fatigue loading, during the tertiary phase. Our results indicate that human vertebral cancellous bone tissue with a DV/BV of 1.5% is expected to have, on average, a Young’s modulus 31% lower than the same tissue without microdamage and is able to withstand 92% fewer cycles before failure than the same tissue without microdamage. Hence, even small amounts of microscopic tissue damage in human vertebral cancellous bone may have large effects on subsequent biomechanical performance.
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12
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Hambli R. Micro-CT finite element model and experimental validation of trabecular bone damage and fracture. Bone 2013; 56:363-74. [PMID: 23850483 DOI: 10.1016/j.bone.2013.06.028] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/11/2013] [Accepted: 06/30/2013] [Indexed: 11/15/2022]
Abstract
Most micro-CT finite element modeling of human trabecular bone has focused on linear and non-linear analysis to evaluate bone failure properties. However, prediction of the apparent failure properties of trabecular bone specimens under compressive load, including the damage initiation and its progressive propagation until complete bone failure into consideration, is still lacking. In the present work, an isotropic micro-CT FE model at bone tissue level coupled to a damage law was developed in order to simulate the failure of human trabecular bone specimens under quasi-static compressive load and predict the apparent stress and strain. The element deletion technique was applied in order to simulate the progressive fracturing process of bone tissue. To prevent mesh-dependence that generally affects the damage propagation rate, regularization technique was applied in the current work. The model was validated with experimental results performed on twenty-three human trabecular specimens. In addition, a sensitivity analysis was performed to investigate the impact of the model factors' sensitivities on the predicted ultimate stress and strain of the trabecular specimens. It was found that the predicted failure properties agreed very well with the experimental ones.
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Affiliation(s)
- Ridha Hambli
- Prisme Laboratory Institute/MMH, 8, Rue Léonard de Vinci, 45072 Orléans cedex 2, France.
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13
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Wu Z, Laneve AJ, Niebur GL. In vivo microdamage is an indicator of susceptibility to initiation and propagation of microdamage in human femoral trabecular bone. Bone 2013; 55:208-15. [PMID: 23459314 PMCID: PMC3680136 DOI: 10.1016/j.bone.2013.02.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 02/20/2013] [Accepted: 02/21/2013] [Indexed: 11/17/2022]
Abstract
Microdamage has been cited as an important element of trabecular bone quality and fracture risk, as materials with flaws have lower modulus and strength than equivalent undamaged materials. However, the magnitude of the effect of damage on failure properties depends on its tendency to propagate. Human femoral trabecular bone from the neck and greater trochanter was subjected to one of compressive, torsional, or combined compression and torsion. The in vivo, new, and propagating damage were then quantified in thick sections under epifluorescent microscopy. Multiaxial loading, which was intended to represent an off-axis load such as a fall or accident, caused much more damage than either simple compression or shear, and similarly caused the greatest stiffness loss. In all cases, initiation of new damage far exceeded the propagation of existing damage. This may reflect stress redistribution away from damaged trabeculae, resulting in new damage sites. However, the accumulation of new damage was positively correlated with quantity of pre-existing damage in all loading modes, indicating that damaged bone is inherently more prone to further damage formation. Moreover, about 50% of in vivo microcracks propagated under each type of loading. Finally, damage formation was positively correlated to decreased compressive stiffness following both axial and shear loading. Taken together, these results demonstrate that damage in trabecular bone adversely affects its mechanical properties, and is indicative of bone that is more susceptible to further damage.
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Affiliation(s)
- Ziheng Wu
- Tissue Mechanics Laboratory, Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN 46556, USA
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14
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Abstract
Osteoporosis heightens vertebral fragility owing to the biomechanical effects of diminished bone structure and composition. These biomechanical effects are only partially explained by loss in bone mass, so additional factors that are independent of bone mass are also thought to play an important role in vertebral fragility. Recent advances in imaging equipment, imaging-processing methods, and computational capacity allow researchers to quantify trabecular architecture in the vertebra at the level of the individual trabecular elements and to derive biomechanics-based measures of architecture that are independent of bone mass and density. These advances have shed light on the role of architecture in vertebral fragility. In addition to the adverse biomechanical consequences associated with trabecular thinning and loss of connectivity, a reduction in the number of vertical trabecular plates appears to be particularly harmful to vertebral strength. In the clinic, detailed architecture analysis is primarily applied to peripheral sites such as the distal radius and tibia. Analysis of trabecular architecture at these peripheral sites has shown mixed results for discriminating between patients with and without a vertebral fracture independent of bone mass, but has the potential to provide unique insight into the effects of therapeutic treatments. Overall, it does appear that trabecular architecture has an independent role on vertebral strength. Additional research is required to determine how and where architecture should be measured in vivo and whether assessment of trabecular architecture in a clinical setting improves prospective fracture risk assessment for the vertebra.
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Affiliation(s)
- Aaron J Fields
- Department of Orthopaedic Surgery, University of California, 513 Parnassus Avenue, S-1161, San Francisco, CA, 94143-0514, USA.
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