Osteoporosis: social and economic impact

Skeletal site-specific effects of jump training on bone mineral density in adults: a systematic review and meta-analysis

Preserving or preventing declines in bone mineral density (BMD) is imperative. As jumping is a high-impact bone-loading action, this meta-analysis evaluated the efficacy of jump training to improve BMD and bone turnover relative to non-jumping controls in men and women > 18 years, following Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines. PubMed and COCHRANE Library databases were searched until February 2022. Fifteen articles (19 jumping-trials) met the predetermined search criteria. Eighteen trials were included for BMD data (n = 666 participants). There was a significant small-moderate effect of jumping on femoral neck BMD (%mean difference: 95%CI, +1.50%: 0.83%; 2.17%, p < 0.0001), that remained significant after sub-analysis by age for both younger (+1.81%: 0.98%; 2.65%) and older adults (+1.03%: 0.02%; 2.03%). BMD of total hip (+1.26%: 0.56%; 1.96% vs + 0.06%: -0.96%; 1.08%), and trochanter (+0.84%: 0.20%; 1.48% vs -0.16%: -1.08%; 0.76%) increased significantly with jump training only in younger adults and non-significantly at the lumbar spine (+0.84%: -0.02%; 1.7% vs -0.09%: -0.96%; 0.77%) only in younger but not older adults, respectively. The BMD response to jump training appears to be site-specific, with the highest sensitivity at the femoral neck. No dose-response effect suggests moderate certainty of a gain in femoral neck BMD when performing the median jump-load of 50 jumps four times weekly.

Aurora Kinase A Regulates Cell Transitions in Glucocorticoid-Induced Bone Loss

Glucocorticoid-induced bone loss is a severe and toxic effect of long-term therapy with glucocorticoids, which are currently prescribed for millions of people worldwide. Previous studies have uncovered that glucocorticoids reciprocally converted osteoblast lineage cells into endothelial-like cells to cause bone loss and showed that the modulations of Foxc2 and Osterix were the causative factors that drove this harmful transition of osteoblast lineage cells. Here, we find that the inhibition of aurora kinase A halts this transition and prevents glucocorticoid-induced bone loss. We find that aurora A interacts with the glucocorticoid receptor and show that this interaction is required for glucocorticoids to modulate Foxc2 and Osterix. Together, we identify a new potential approach to counteracting unwanted transitions of osteoblast lineage cells in glucocorticoid treatment and may provide a novel strategy for ameliorating glucocorticoid-induced bone loss.

Investigation of the effect of oral and internal bisphosphonate use on bone density in the jaws in patients with osteoporosis in panoramic radiography

OBJECTIVES

This study aims to quantitatively evaluate the effects of bisphosphonate use duration and route of administration on mandibular cortical and trabecular bone in postmenopausal women.

STUDY DESIGN

Ninety postmenopausal women over the age of 50 were included in this study. Trabecular bone density was specified numerically by fractal dimension (FD) in the region of interest selected on the panoramic radiograph. The width of the mandibular cortical (MCW) bone under the mental foramen of the mandible was measured. Mann-Whitney U test was used for parameters that did not show a normal distribution. Spearman rho correlation test was used to determine the relationship between continuous measurement parameters.

RESULTS

It was observed that FD and MCW of dentate and edentate individuals using bisphosphonate were statistically significantly lower than those of healthy individuals (P < .05). There was no significant correlation was found between the duration of use of bisphosphonates and the fractal values obtained from the relevant regions of the mandible (P > .05).

CONCLUSION

Fractal dimension was found to be lower in oral bisphosphonate use than in intravenous bisphosphonate use. The width of the mandibular cortical bone values was found to be lower in individuals using bisphosphonate than in healthy individuals. Fractal dimension and MCW may benefit clinicians as quantitative parameters in panoramic radiography in the diagnosis of osteoporosis.

Cell Transitions Contribute to Glucocorticoid-Induced Bone Loss

Glucocorticoid-induced bone loss is a toxic effect of long-term therapy with glucocorticoids resulting in a significant increase in the risk of fracture. Here, we find that glucocorticoids reciprocally convert osteoblast-lineage cells into endothelial-like cells. This is confirmed by lineage tracing showing the induction of endothelial markers in osteoblast-lineage cells following glucocorticoid treatment. Functional studies show that osteoblast-lineage cells isolated from glucocorticoid-treated mice lose their capacity for bone formation but simultaneously improve vascular repair. We find that the glucocorticoid receptor directly targets Foxc2 and Osterix, and the modulations of Foxc2 and Osterix drive the transition of osteoblast-lineage cells to endothelial-like cells. Together, the results suggest that glucocorticoids suppress osteogenic capacity and cause bone loss at least in part through previously unrecognized osteoblast-endothelial transitions.

Single intraoperative infrared laser optimized bone repair in rat femoral osteotomies with experimentally induced osteoporosis

This study aimed to evaluate the effect of infrared laser (IRL) on bone repair in ovariectomized rats subjected to femoral osteotomies. Of 32 rats, half underwent bilateral ovariectomy (OVX) and the other half underwent sham ovariectomy (SHAM). A period of 3 months was defined to observe the presence of osteoporosis. The rats were subjected to osteotomies in the femurs and then fixed with a miniplate and 1.5-mm system screws. Thereafter, half of the rats from both SHAM and OVX groups were not irradiated, and the other half were irradiated by IRL using the following parameters: wavelength, 808 nm; power, 100 mW; 60 s for each point; 6 J/point; and a total of 5 points of bone gap. All animals were euthanized 60 days after surgery. The femur gap was scanned using micro-computed tomography (micro-CT). The samples were then examined under a confocal laser microscope to determine the amounts of calcein and alizarin red. The slides were stained with alizarin red and Stevenel's blue for histometric analysis. In the micro-CT analysis, the OVX groups had the lowest bone volume (P < 0.05). When the laser was applied to the OVX groups, bone turnover increased (P < 0.05). New bone formation (NBF) was comparable between SHAM and OVX/IR (P > 0.05) groups; however, it was less in the OVX groups (P < 0.05). In conclusion, the results encourage the use of IRL intraoperatively as it optimizes bone repair, mainly in animals with low bone mineral density.

Effects of non-supervised exercise interventions on bone mineral density in adult women: a systematic review and meta‑analysis

Osteoporosis is a major health issue worldwide. This study analyzes the effects of non-supervised osteoporosis prevention programs on bone mineral density. Non-supervised exercise increases femoral neck and lumbar spine bone mineral density in adult women. Thus, it might be effective for preventing or treating osteoporosis or osteopenia in this population.

INTRODUCTION

Osteoporosis is a major health issue worldwide. Social distancing measures due to COVID-19 have hindered the chances to take part in supervised osteoporosis prevention exercise programs. The purpose of the present study is to systematically review and meta-analyze the effects of non-supervised osteoporosis prevention exercise programs on bone mineral density (BMD) in adult women.

METHODS

A comprehensive search of electronic databases (n = 7) was conducted including (a) prospective randomized controlled trials (RCTs) comparing at least one exercise group vs. a control group with sedentary lifestyle or sham exercises; (b) baseline and follow-up BMD values, or BMD changes from baseline, at any skeletal site; (c) women over 30 years old; and (d) non-supervised exercise programs only. Subgroup analyses were performed for menopausal status, intervention duration, type of exercise, and osteopenia/osteoporosis status.

RESULTS

Ten studies were included (n = 668). Random effect analyses showed that unsupervised exercise had beneficial effects on lumbar spine (LS) BMD with standardized mean difference (SMD) = 0.40 (95% confidence interval (CI): 0.03-0.77), and femoral neck (FN) BMD with SMD = 0.51 (95% CI: 0.16-0.85). Unsupervised exercise increased LS (SMD = 0.73 (95% CI: 0.13-1.33)) and FN BMD (SMD = 0.85 (95% CI: 0.33-1.37)) in women with osteopenia/osteoporosis, but not in healthy counterparts.

CONCLUSION

Non-supervised exercise improves FN and LS BMD in adult women. Beneficial effects of exercise on FN and LS BMD might be more pronounced in those with poor bone health compared with healthy counterparts. More RCTs prescribing non-supervised, osteogenic exercise are required in this population. It is necessary to investigate the efficacy of remote/assistive technologies for delivering and monitoring non-supervised exercise interventions.

Sclerostin as a biomarker of physical exercise in osteoporosis: A narrative review

Osteoporosis, a disease of low bone mass, is characterized by reduced bone mineral density (BMD) through abnormalities in the microarchitecture of bone tissue. It affects both the social and economic areas, therefore it has been considered a lifestyle disease for many years. Bone tissue is a dynamic structure exhibiting sensitivity to various stimuli, including mechanical ones, which are a regulator of tissue sclerostin levels. Sclerostin is a protein involved in bone remodeling, showing an anti-anabolic effect on bone density. Moderate to vigorous physical activity inhibits secretion of this protein and promotes increased bone mineral density. Appropriate exercise has been shown to have an osteogenic effect. The effectiveness of osteogenic training depends on the type, intensity, regularity and frequency of exercise and the number of body parts involved. The greatest osteogenic activity is demonstrated by exercises affecting bone with high ground reaction forces (GRF) and high forces exerted by contracting muscles (JFR). The purpose of this study was to review the literature for the effects of various forms of exercise on sclerostin secretion.

Recombinant Proteins-Based Strategies in Bone Tissue Engineering

The increase in fracture rates and/or problems associated with missing bones due to accidents or various pathologies generates socio-health problems with a very high impact. Tissue engineering aims to offer some kind of strategy to promote the repair of damaged tissue or its restoration as close as possible to the original tissue. Among the alternatives proposed by this specialty, the development of scaffolds obtained from recombinant proteins is of special importance. Furthermore, science and technology have advanced to obtain recombinant chimera’s proteins. This review aims to offer a synthetic description of the latest and most outstanding advances made with these types of scaffolds, particularly emphasizing the main recombinant proteins that can be used to construct scaffolds in their own right, i.e., not only to impregnate them, but also to make scaffolds from their complex structure, with the purpose of being considered in bone regenerative medicine in the near future.

Short-Term Supplemental Dietary Potassium from Potato and Potassium Gluconate: Effect on Calcium Retention and Urinary pH in Pre-Hypertensive-to-Hypertensive Adults

Potassium supplementation has been associated with reduced urinary calcium (Ca) excretion and increased Ca balance. Dietary interventions assessing the impact of potassium on bone are lacking. In this secondary analysis of a study designed primarily to determine blood pressure effects, we assessed the effects of potassium intake from potato sources and a potassium supplement on urinary Ca, urine pH, and Ca balance. Thirty men (n = 15) and women (n = 15) with a mean ± SD age and BMI of 48.2 ± 15 years and 31.4 ± 6.1 kg/m², respectively, were enrolled in a cross-over, randomized control feeding trial. Participants were assigned to a random order of four 16-day dietary potassium interventions including a basal diet (control) of 2300 mg/day (~60 mmol/day) of potassium, and three phases of an additional 1000 mg/day (3300 mg/day(~85 mmol/day) total) of potassium in the form of potatoes (baked, boiled, or pan-heated), French fries (FF), or a potassium (K)-gluconate supplement. Calcium intake for all diets was approximately 700–800 mg/day. Using a mixed model ANOVA there was a significantly lower urinary Ca excretion in the K-gluconate phase (96 ± 10 mg/day) compared to the control (115 ± 10 mg/day; p = 0.027) and potato (114 ± 10 mg/day; p = 0.033). In addition, there was a significant difference in urinary pH between the supplement and control phases (6.54 ± 0.16 vs. 6.08 ± 0.18; p = 0.0036). There were no significant differences in Ca retention. An increased potassium intake via K-gluconate supplementation may favorably influence urinary Ca excretion and urine pH. This trial was registered at ClinicalTrials.gov as NCT02697708.

Effect of body mass index on bone mineral density is age-specific

BACKGROUND AND AIMS

Obesity and osteoporosis are two important and growing public health problems worldwide. Body mass index (BMI) has been found to be inversely related to the risk of osteoporotic fracture. We aimed to assess the association of BMI with thoracic vertebral bone mineral density (BMD) measured from a quantitative computed tomography (QCT).

METHODS AND RESULTS

We retrospectively evaluated the data from 15,758 consecutive patients (5675 females and 10,083 males) between age 20-90 years, who underwent Coronary Artery Calcium (CAC) scoring. Quantitative data analyses of thoracic trabecular BMD (mg/cm³) was performed with a phantom system or phantomless using validated software. The gender-specific subgroup was divided based on age (<45, 45-55, 55-65, >65 yrs in females; <40,40-60,>60 yrs in Males) and weight by BMI (kg/m²) as < 25 (normal or low weight), >25 - <30 (overweight) and >30 (obesity). Analysis of variance (ANOVA) and Scheffe's post hoc procedure tested the association of body weight/BMI on BMD. A significant positive association between the body weight and BMD existed in obese population in elder groups in both genders (p < 0.05). There was no significant difference in BMD in 40-60 years in men and <55 years in women with normal or low weight compared to overweight or obese cohorts.

CONCLUSIONS

We concluded that the effect of weight on BMD is age-specific and the BMD should be monitored routinely with a cardiac CT scan in the senile population.

Bone marrow stromal cells (BMSCs CD45- /CD44+ /CD73+ /CD90+ ) isolated from osteoporotic mice SAM/P6 as a novel model for osteoporosis investigation

Available therapies aimed at treating age‐related osteoporosis are still insufficient. Therefore, designing reliable in vitro model for the analysis of molecular mechanisms underlying senile osteoporosis is highly required. We have isolated and characterized progenitor cells isolated from bone marrow (BMSCs) of osteoporotic mice strain SAM/P6 (BMSC_SAM/P6). The cytophysiology of BMSC_SAM/P6 was for the first time compared with BMSCs isolated from healthy BALB/c mice (BMSC_BALB/c). Characterization of the cells included evaluation of their multipotency, morphology and determination of specific phenotype. Viability of BMSCs cultures was determined in reference to apoptosis profile, metabolic activity, oxidative stress, mitochondrial membrane potential and caspase activation. Additionally, expression of relevant biomarkers was determined with RT‐qPCR. Obtained results indicated that BMSC_SAM/P6 and BMSC_BALB/c show the typical phenotype of mesenchymal stromal cells (CD44+, CD73+, CD90+) and do not express CD45. Further, BMSC_SAM/P6 were characterized by deteriorated multipotency, decreased metabolic activity and increased apoptosis occurrence, accompanied by elevated oxidative stress and mitochondria depolarisation. The transcriptome analyses showed that BMSC_SAM/P6 are distinguished by lowered expression of molecules crucial for proper osteogenesis, including Coll‐1, Opg and Opn. However, the expression of Trap, DANCR1 and miR‐124‐3p was significantly up‐regulated. Obtained results show that BMSC_SAM/P6 present features of progenitor cells with disturbed metabolism and could serve as appropriate model for in vitro investigation of age‐dependent osteoporosis.

Racial and gender differences in the relationship between sarcopenia and bone mineral density among older adults

Both sarcopenia and low bone mineral density (BMD) have become public health concerns. We found that presarcopenic and/or sarcopenic individuals were more likely to have lower BMD. And this relationship has race and sex-specific discrepancy.

PURPOSE

The purpose of the study was to investigate the racial and gender differences in the relationship between sarcopenia and BMD among older adults.

METHODS

Totally, 5476 subjects (mean age = 65.7 ± 6.4) of non-Hispanic White (n = 3297), non-Hispanic Black (n = 1265), and non-Hispanic Asian (n = 914) were analyzed. Sarcopenia was defined according to the revised European consensus on definition and diagnosis of sarcopenia (EWGSOP2). General linear model and multivariable linear regression model were used to examine the relationship between sarcopenia and regional/whole body BMD stratified by race and sex. Adjustments were conducted for physiological, behavioral, and disease factors.

RESULTS

Comparing with normal older participants, presarcopenic and sarcopenic elderly were more likely to have lower BMD. Although the difference was not statistically significant in a few sub-groups, among the three racial groups, the strongest association between sarcopenia and BMD was found in non-Hispanic Black people, followed by non-Hispanic White people and non-Hispanic Asian people. In addition, significant differences of BMD across sarcopenia stages were found in more sub-groups in women than in men after adjusting for covariates.

CONCLUSIONS

In this older cohort, sarcopenia is significantly related to low regional/whole-body BMD, and these associations vary by race and sex. Consideration in race and sex is warranted when developing strategies to maintain or minimize BMD loss.

Is an anodizing coating associated to the photobiomodulation able to optimize bone healing in ovariectomized animal model?

This in vivo study investigated whether the bioactivity of anodizing coating, produced by plasma electrolytic oxidation (PEO), on mini-plate in femur fracture could be improved with the association of photobiomodulation (PBM) therapy. From the 20 ovariectomized Wistar female rats, 8 were used for model characterization, and the remaining 12 were divided into four groups according to the use of PBM therapy by diode laser (808 nm; power: 100 mW; energy: 6.0 J; energy density: 212 J/cm²; power density: 3.5 W/cm²) and the type of mini-plate surface (commercially pure titanium mini-plate -cpTi- and PEO-treated mini-plate) as follow: cpTi; PEO; cpTi/PBM; and PEO/PBM. After 60 days of surgery, fracture healing underwent microstructural, bone turnover, histometric, and histologic adjacent muscle analysis. Animals of groups with PEO and PBM showed greater fracture healing than cpTi control group under histometric and microstructural analysis (P < 0.05); however, bone turnover was just improved in PBM's groups (P < 0.05). there was no difference between cpTi and PEO without PBM (P > 0.05). Adjacent muscle analysis showed no metallic particles or muscle alterations in all groups. PEO and PBM are effective strategies for bone repair in fractures, however their association does not provide additional advantages.

Trabecular and cortical bone are unaltered in response to chronic lipopolysaccharide exposure via osmotic pumps in male and female CD-1 mice

Chronic low-grade inflammation has been identified as an underlying cause of many diseases including osteoporosis. Lipopolysaccharide (LPS) is a potent inducer of the inflammatory response that can negatively affect bone outcomes by upregulating bone resorption and inhibiting bone formation. The objective of this study was to assess the longitudinal response of trabecular and cortical bone structure and bone mineral density to LPS continuously administered for 12 weeks in male and female CD-1 mice. Mice were assigned to one of four LPS groups at 8-weeks of age: placebo (0.0 μg/d), low (0.9 μg/d), mid (3.6 μg/d) and high (14.4 μg/d) dose. Trabecular and cortical bone outcomes were measured at 8, 12, 16, and 20 weeks of age using in vivo micro-computed tomography. The anticipated serum LPS dose-dependent response was not observed. Therefore, the low, mid, and high LPS groups were combined for analysis. Compared to the placebo group, endpoint serum LPS was elevated in both males (p < 0.05) and females (p < 0.05) when all LPS treatment groups were combined. However, there was no significant change in trabecular or cortical bone outcomes in the combined LPS groups compared to the placebo following the 12-week LPS intervention for either sex. This suggests that although serum LPS was elevated following the 12-week LPS intervention, the dosages administered using the osmotic pumps was not sufficient to negatively impact trabecular or cortical bone outcomes in either male or female CD-1 mice.

Association between Body Composition, Physical Activity, Food Intake and Bone Status in German Children and Adolescents

Achieving a high bone mass during childhood and adolescence is important for the prevention of osteoporosis in later life. Herein, the purpose was to assess the relationship of various lifestyle factors and bone outcomes in school children. In 248 girls (13.4 ± 1.9 years, BMI: 20.2 ± 4.8 kg m⁻²) and 231 boys (13.6 ± 1.7 years, BMI: 19.3 ± 3.3 kg m⁻²), bone mass (stiffness index, SI; calcaneal quantitative ultrasonometry), body composition (bioelectrical impedance analysis), food intake (food frequency questionnaire), and physical activity level (PAL; standardized questionnaire) were assessed. The individual food intake of eight food groups was related to the German recommendations (Bone Healthy Eating Index, BoneHEI; 0–100 points). Relationships between SI and lifestyle factors (Spearman´s rank correlation) and the influence of the factors on the variance of SI (multiple linear regression) were tested (α = 0.05). SI correlated with age, BMI, absolute fat-free mass, relative fat mass, PAL, and puberty category score in both girls and boys (r = 0.18–0.56, p < 0.01), but not with BoneHEI (p > 0.05). Age, absolute fat-free mass, sex, and PAL explained 35% of the variance of SI (p < 0.0001): SI = −0.60 + 2.97∙age (years) + 0.65∙fat-free mass (kg) + 6.21∙sex (0 = male, 1 = female) + 17.55∙PAL. Besides age and sex, PAL and fat-free mass are important factors relating to bone health. School children should perform regular physical activity to improve their bone status.

ZFBONE: An ImageJ toolset for semi-automatic analysis of zebrafish bone structures

The last decade has seen an increased interest in the discovery of compounds with bone anabolic activity to treat skeletal disorders such as osteoporosis and increase the well-being of patients. Due to the many technical advantages over classical rodent systems, zebrafish (Danio rerio) has been increasingly used in screening pipelines, in particular those aiming at identifying osteoactive compounds with pharmacological potential. Because compound osteoactivity is mostly determined in zebrafish through the morphometric analysis of bone structures, image analysis, rather than screening assay implementation, molecule availability and image acquisition, represents a bottleneck to the screening throughput. The absence of auto/semi-automatic tools for image analysis of fish bone structures is also a limitation to a broader usage of zebrafish screening pipelines. We present here ZFBONE (for ZebraFish BONE), an open-source, freely available, user-friendly, rapid and reliable toolset, aiming at accelerating image analysis by automating the morphometric assessment of zebrafish bone structures, but also at increasing data accuracy by reducing operator bias. Tools included in ZFBONE allow users to assess, from 2D images, morphometric parameters of several bone structures (e.g. operculum, caudal fin rays and scales) but also the extent and the intensity of bone-specific colorations. ZFBONE has been developed using the open-source ImageJ software, to make it available to the whole zebrafish research community, but also to have it easily modifiable according to user demands. ZFBONE can also be used toward the standardization of zebrafish screening protocols in academia and industry.

Impact of physical activity, anthropometric, body composition, and dietary factors on bone stiffness in German university students

BACKGROUND

Bone density in the young-adult life is associated with risk for osteoporosis in later life. Next to genetic factors, lifestyle seems to play an important role for bone health. Aim of the study was to clarify the relationship between various lifestyle factors and bone parameters in university students.

METHODS

In 233 women and 52 men (age: 22.7±3.1 vs. 24.0±3.2 years; BMI: 22.2±2.9 vs. 24.2±3.1 kg∙m^-2) the following parameters were assessed: calcaneal Stiffness Index ([SI]; quantitative ultrasound), body composition (bioelectrical impedance analysis), actual and past physical activity level ([PAL]; standardized questionnaire), and food/nutrient intake (3-day dietary record). Sex differences (Mann-Whitney-U-tests), relationships between SI and lifestyle factors (Spearman's rank correlation), and the influence of the factors on the variance of SI (multiple linear regression) were tested (α=0.05).

RESULTS

6.9% of the women and 5.8% of the men were classified as osteopenic (-2.5< T score <-1). Significant correlations between SI and BMI, absolute fat mass and fat-free mass, actual PAL, and physical activity during adolescence were found in women (r=0.18-0.24, all P<0.05), but not in men. Food/nutrient parameters did not significantly correlate with bone outcomes (P>0.05). In multiple regression analysis physical activity during adolescence, actual PAL, and BMI explained 8% of the variance of SI (P<0.0001): SI=32.2+3.5∙physical activity during adolescence [1: very low, 2: low, 3: medium, 4: high, 5: very high] +28.5∙PAL+0.8∙BMI [kg∙m^-2].

CONCLUSIONS

Parameters of physical activity seem to be more important for bone health than nutrition factors. Therefore, high levels of physical activity during childhood, adolescence, and early-adult life are highly recommended to improve bone parameters.

Evaluating the Performance of the WHO International Reference Standard for Osteoporosis Diagnosis in Postmenopausal Women of Varied Polygenic Score and Race

BACKGROUND

Whether the bone mineral density (BMD) T-score performs differently in osteoporosis classification in women of different genetic profiling and race background remains unclear.

METHODS

The genomic data in the Women's Health Initiative study was analyzed (n = 2417). The polygenic score (PGS) was calculated from 63 BMD-associated single nucleotide polymorphisms (SNPs) for each participant. The World Health Organization's (WHO) definition of osteoporosis (BMD T-score ≤-2.5) was used to estimate the cumulative incidence of fracture.

RESULTS

T-score classification significantly underestimated the risk of major osteoporotic fracture (MOF) in the WHI study. An enormous underestimation was observed in African American women (POR: 0.52, 95% CI: 0.30-0.83) and in women with low PGS (predicted/observed ratio [POR]: 0.43, 95% CI: 0.28-0.64). Compared to Caucasian women, African American, African Indian, and Hispanic women respectively had a 59%, 41%, and 55% lower hazard of MOF after the T-score was adjusted for. The results were similar when used for any fractures.

CONCLUSIONS

Our study suggested the BMD T-score performance varies significantly by race in postmenopausal women.

Bone microarchitectural parameters can detect oxytocin induced changes prior to bone density on mitigating bone deterioration in rabbit osteoporosis model using micro-CT

Background

This study is aimed to determine the efficacy of X-Ray Microtomography (micro-CT) in predicting oxytocin (OT) treatment response in rabbit osteoporosis(OP) model.

Methods

Sixty-five rabbits were randomly divided into three groups: control group, ovariectomy (OVX) -vehicle and OVX-oxytocin group. The controls underwent sham surgery. OVX-vehicle and OVX-oxytocin groups were subjected to bilateral OVX. The rabbits in OVX-oxytocin group were injected with oxytocin. In the 0th, 4th, 8th, 10th and 12th weeks post OVX operation, bone mineral density (BMD) and bone micro-architectural parameters were measured in three groups.

Results

Bone mineral density (BMD), bone volume fraction (BV/TV), Trabecular Number (Tb.N), and Trabecular Thickness (Tb.Th) decreased, while Trabecular Spacing (Tb.Sp) and Structure Model Index (SMI) increased overtime in all the three groups. In OVX-oxytocin group, the bone deterioration tendency is slowing down compared with that of the OVX-vehicle group. The BMD of the OVX-oxytocin group was significantly lower than those in the OVX-vehicle group at 12th week (P = 0.017). BV/TV and Tb.Sp in OVX-oxytocin group changed significantly from 8th week (P = 0.043) and 12th week (P = 0.014), which is earlier than that of BMD and other bone micro-architectural parameters.

Conclusion

BV/TV and Tb.Sp changed prior to BMD and other bone micro-architectural parameters with oxytocin intervention, which indicate that they are more sensitive markers for predicting early osteoporosis and treatment monitoring when using micro-CT to evaluate osteoporosis rabbit model.

Secular trends in major osteoporotic fractures among 50+ adults in Denmark between 1995 and 2010

We investigated the incidence trend in all major osteoporotic fractures for the whole country of Denmark between 1995 and 2010. Hip and other osteoporotic fractures declined for the general population and especially among women. But, we observed some increasing trend among men which needs more attention.

PURPOSE

The trend in osteoporotic fractures is varied across the globe, and there is no updated information in the case of Denmark for all major osteoporotic fractures (MOF). Thus, we investigated the incidence rates (IRs) of MOF among 50+ adults in Denmark over the period 1995-2010.

METHODS

A series of cross-sectional analyses was done using the Danish National Health Service Register. Participants were 50+ adults in the full country Denmark with a MOF between 1995 and 2010. Gender- specific IRs of MOF per 10,000 person years (PYs) were estimated, in addition to IRs of individual fracture sites (hip, vertebrae, humerus, and radius/ulna), and women-to-men IR ratios for MOF.

RESULTS

A general decline was observed in IRs of MOF for the whole population (from 169.8 per 10,000 PYs in 1995, to 148.0 in 2010), which was more pronounced among women. Thirty-one and nineteen percent of decline was observed in hip fracture rates among women and men, respectively. The trend in clinical vertebral fracture was slightly decreasing for women and increasing for men. The women-to-men rate ratio of MOF decreased noticeably from 2.93 to 2.72 during study period.

CONCLUSIONS

We observed declining trends in MOF and hip fracture for both sexes. However, a lower rate of decrease of hip fracture and an increasing trend in vertebral fracture was noticed among men. Considering our observations and the major economic burden that accompanies this devastating disease, more attention should be paid to MOF, especially in men.

Rabbit as model for osteoporosis research

Osteoporosis is a major public health problem affecting more than 200 million people worldwide. The use of different animal models, for the study of its pathophysiology and treatments, is important being actually the ovariectomized rat the most widely used; although this model has several problems due its small size, lack of true closure of epiphyseal plate and bone differences with humans. This review is aimed at summarizing the most common methods published for osteoporosis induction in rabbits as model for human disease with their advantages and disadvantages. The paper shows the advantages of the use of this specie compared with the rat. All the techniques seemed to achieve the osteoporotic condition, but the one which obtained the most consistent bone mineral reduction in less time was the combination of surgery and corticoid treatment. The conclusion of the review was that rabbits are promising as a model of osteoporosis research because of their size, haversian remodelling and closure of epiphyseal plate, which solve some of the problems of the rat model. There are different techniques in the literature used to achieve the osteoporotic condition with diverse results, but there is a lack of consensus as to the best one.

Osteoporosis and dry eye syndrome: A previously unappreciated association that may alert active prevention of fall

Objective

Osteoporosis is a multifactorial disease associated with inflammation and hormone imbalance. It is noteworthy that dry eye syndrome shares a similar pathophysiology with osteoporosis. Both diseases are more prevalent among the elderly and females. Dry eye syndrome can result in impaired vision, which increases the risk of fall and fracture when osteoporosis exists. In this study, we investigated whether osteoporosis is associated with an increased risk of developing dry eye syndrome.

Methods

Claims data from the National Health Insurance Research Database (NHIRD) of Taiwan were used to conduct a retrospective population-based cohort study covering the period from January 1, 2000, to December 31, 2011. Multiple logistic regression was used to determine whether osteoporosis is an independent factor in the risk of developing dry eye syndrome, with risk estimates presented in the form of odds ratios (ORs).

Results

The exclusion of patients with specific autoimmune diseases and those younger than 50 years old resulted in 42,365 patients in the osteoporosis group and 147,460 patients in the comparison group during the study period. The number of patients newly diagnosed with dry eye syndrome was 6,478 (15.29%) in the osteoporosis group and 15,396 (10.44%) in the comparison group. The crude OR of patients with osteoporosis developing dry eye syndrome was 1.55 and the 95% confidence interval (95% CI) was 1.50–1.60. After adjusting for patients’ age, sex, and underlying comorbidities, the adjusted OR was 1.26 and the 95% CI was 1.22–1.30. Subgroup analysis revealed this association in each age group and among females but not among males.

Conclusions

Our results demonstrate that osteoporosis is a risk factor for the subsequent development of dry eye syndrome. Clinicians should be aware of the early symptoms of dry eye syndrome in osteoporotic patients in order to prevent further complications.

Bone health consequence of adjuvant Anastrozole in monotherapy or associated with biochanin-A in ovariectomized rat model

AIMS

We investigate the consequence of adjuvant anastrozole (ANA) in monotherapy or associated with biochanin A (BCA) in ovariectomized (OVX) rat model and the degree of developing bone loss in both conditions.

MATERIALS AND METHODS

Sixty female rats were assigned to six groups. Five groups were bilaterally OVX, and one was sham operated. The five groups were; ANA group (0.5 mg/kg b.wt orally), BCA (5 mg/kg b.wt intraperitoneally (I/P), co-treated group (BCA + ANA), two control groups receiving even distilled water orally or DMSO I/P for twenty weeks. Bone turnover biomarkers BALP, OC, PTH, TRAP and TNFα were determined in serum. Bone mineral content, histological and morphometric measurements on rat femurs were performed. BMD by X-ray technique on tibias of rats and CT analysis of lumbar vertebrae of all treated and sham groups were applied.

KEY FINDINGS

There was marked elevation in bone turnover biomarkers with high serum Ca and P content in the ANA-treated rats. Moreover marked elevation of TNFα, PTH, TC and TG, ANA caused severe changes in the BMD detected by X-ray in tibial bones and CT analysis of lumbar vertebrae of OVX rats. While I/P injection of BCA ameliorated the adverse bone health decrements caused by ANA.

SIGNIFICANCE

The study highlights the importance of the BCA supplementation in accordance with the ANA therapy in case of ovariectomized rat model of osteoporosis which is clinically presented in Postmenopausal women with breast cancer during which considerable risk of developing osteoporosis is predicted during treatment.

Potential of electrical impedance spectroscopy to differentiate between healthy and osteopenic bone

Osteoporosis involves loss of structural stability of bone due to an increase in bone porosity. Dual energy X-ray absorptometry is used to evaluate bone in terms of quantity. However, it does not give an evaluation of the patient's bone quality. For this, present study has been carried out to assess the structural deterioration of bone using electrical impedance spectroscopy.

METHODS

Electrical Impedance Spectroscopy has been applied to evaluate the structural and compositional changes of cortical bone in the frequency range of 50 Hz to 5 MHz for the ovariectomized rat model. Initially, bone resorption in the ovariectomized group has been confirmed by estimating tartaric resistant acid phosphatase levels; morphometric parameters; bone matrix components, hydroxyapatite crystallite size and bone micro architecture. The mid diaphyseal regions from the femora and tibiae of sixty days post ovariectomy and control rats were used for the measurement of dielectric parameters. A dispersion model based analysis has been developed by a complex least square fitting of the dielectric data.

FINDINGS

Increased tartaric resistant acid phosphatase levels, altered bone matrix components, hydroxyapatite crystallite size and disturbed microarchitecture in the ovariectomized group give us the confirmation of increased bone resorption following estrogen deficiency. These changes were shown to be reflected by single dispersion model based fitted parameters which shows the considerable change in all the parameters of ovariectomized group compared to the control.

INTERPRETATION

It has been demonstrated that the parameters of the dispersion model can reflect the bone structural and compositional changes.

Antibody-based inhibition of circulating DLK1 protects from estrogen deficiency-induced bone loss in mice

Soluble delta-like 1 homolog (DLK1) is a circulating protein that belongs to the Notch/Serrate/delta family, which regulates many differentiation processes including osteogenesis and adipogenesis. We have previously demonstrated an inhibitory effect of DLK1 on bone mass via stimulation of bone resorption and inhibition of bone formation. Further, serum DLK1 levels are elevated and positively correlated to bone turnover markers in estrogen (E)-deficient rodents and women. In this report, we examined whether inhibition of serum DLK1 activity using a neutralizing monoclonal antibody protects from E deficiency-associated bone loss in mice. Thus, we generated mouse monoclonal anti-mouse DLK1 antibodies (MAb DLK1) that enabled us to reduce and also quantitate the levels of bioavailable serum DLK1 in vivo. Ovariectomized (ovx) mice were injected intraperitoneally twice weekly with MAb DLK1 over a period of one month. DEXA-, microCT scanning, and bone histomorphometric analyses were performed. Compared to controls, MAb DLK1 treated ovx mice were protected against ovx-induced bone loss, as revealed by significantly increased total bone mass (BMD) due to increased trabecular bone volume fraction (BV/TV) and inhibition of bone resorption. No significant changes were observed in total fat mass or in the number of bone marrow adipocytes. These results support the potential use of anti-DLK1 antibody therapy as a novel intervention to protect from E deficiency associated bone loss.

Risk factors for mortality in elderly patients with hip fractures: a meta-analysis of 18 studies

BACKGROUND

Hip fracture is common and associated with poor outcomes in elderly patients. This meta-analysis aims to investigate the risk factors that might increase the mortality rate in elderly patients with hip fracture.

METHODS

PubMed, Embase, and Web of Science were systematically searched for observational studies regarding the prognostic factors of mortality in elderly patients with hip fracture. A fixed-effects or random-effects model was used to calculate pooled hazard ratio (HR) and 95% confidence intervals (95% CIs).

RESULTS

Eighteen cohort studies, involving 223,875 patients, were included in this meta-analysis. The most prominent factors associated with mortality were higher age (HR 1.51, 95% CI 1.37, 1.67; P < 0.001), male gender (HR 1.91, 95% CI 1.67, 2.19; P < 0.001), cognitive impairment (HR 2.06, 95% CI 1.25, 3.40; P = 0.005), delirium (HR 2.14, 95% CI 1.50, 3.05; P < 0.001), dementia (HR 2.72, 95% CI 1.41, 5.26; P = 0.003), depression (HR 1.71, 95% CI 1.43, 2.05; P < 0.001), living with caregiver (HR 1.61, 95% CI 1.43, 1.82; P < 0.001), cardiovascular disease (HR 2.10, 95% CI 1.14, 3.86; P = 0.018), renal disease (HR 1.66, 95% CI 1.52, 1.82; P < 0.001), and malignancy (HR 1.75, 95% CI 1.30, 2.37; P = 0.031), whereas respiratory disease (HR 1.49, 95% CI 0.99, 2.24; P = 0.056), diabetes (HR 1.15, 95% CI 0.96, 1.37; P = 0.121), and smoking (HR 1.54, 95% CI 0.64, 3.71; P = 0.337) did not increase the risk of mortality.

CONCLUSION

The current study investigated several factors that might increase the risk of mortality in elderly patients with hip fracture. Further studies are needed to evaluate the effectiveness of specific interventions to reduce the risk of mortality.

Imaging of metabolic bone disease

Osteoporosis is the most important metabolic bone disease, with a wide distribution among the elderly. It is characterized by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. Identify bone weakening with an appropriate and accurate use of diagnostic imaging is of critical importance in the diagnosis and follow-up of osteoporotic patients. The aim of this review is to evaluate the detection rates of the different imaging modalities in the evaluation of bone strength, in the assessment of fracture risk and in the management of fragility fractures. (www.actabiomedica.it)

Secular trends in major osteoporotic fractures among 50+ adults in Denmark between 1995 and 2010

We investigated the incidence trend in all major osteoporotic fractures for the whole country of Denmark between 1995 and 2010. Hip and other osteoporotic fractures declined for the general population and especially among women. But, we observed some increasing trend among men which needs more attention.

PURPOSE

The trend in osteoporotic fractures is varied across the globe, and there is no updated information in the case of Denmark for all major osteoporotic fractures (MOF). Thus, we investigated the incidence rates (IRs) of MOF among 50+ adults in Denmark over the period 1995-2010.

METHODS

A series of cross-sectional analyses was done using the Danish National Health Service Register. Participants were 50+ adults in the full country Denmark with a MOF between 1995 and 2010. Gender- specific IRs of MOF per 10,000 person years (PYs) were estimated, in addition to IRs of individual fracture sites (hip, vertebrae, humerus, and radius/ulna), and women-to-men IR ratios for MOF.

RESULTS

A general decline was observed in IRs of MOF for the whole population (from 169.8 per 10,000 PYs in 1995, to 148.0 in 2010), which was more pronounced among women. Thirty-one and nineteen percent of decline was observed in hip fracture rates among women and men, respectively. The trend in clinical vertebral fracture was slightly decreasing for women and increasing for men. The women-to-men rate ratio of MOF decreased noticeably from 2.93 to 2.72 during study period.

CONCLUSIONS

We observed declining trends in MOF and hip fracture for both sexes. However, a lower rate of decrease of hip fracture and an increasing trend in vertebral fracture was noticed among men. Considering our observations and the major economic burden which accompanies this devastating disease, more attention should be paid to MOF, especially in men.

Impairment of PTX3 expression in osteoblasts: a key element for osteoporosis

Pentraxin 3 (PTX3) is a multifunctional glycoprotein regulating inflammatory response, cell proliferation and migration and deposition and remodelling of the extracellular matrix by a variety of cells. In this study, we investigated the possible role of PTX3 in bone homeostasis. To this end, we compared the expression and function of PTX3 in human osteoblasts of osteoporotic, osteoarthritic patients and young subjects not affected by bone diseases. Immunohistochemical analysis performed on bone head biopsies showed a close association between bone health and the number of osteoblasts expressing PTX3. Noteworthy, the proportion of PTX3-positive osteoblasts resulted to be significantly lower in osteoporotic patients compared with both young patients and osteoarthritic patients of the same age. Ex vivo culture of osteoblasts isolated from the three groups of patients confirmed in vivo observation. Specifically, we observed rare runt-related transcription factor 2 (RUNX2) immunopositive osteoblasts expressing PTX3 in cell cultures derived from osteoporotic patients and western blotting analysis showed 80% reduction of PTX3 in the corresponding culture extracts compared with young and osteoarthritic patients. The treatment of human osteoblast primary cultures derived from young patients with anti-PTX3 antibody dramatically affected osteoblast behaviour. Indeed, they lost the morphological and molecular features typical of mature osteoblasts, acquiring fibroblast-like shape and highly decreasing nuclear factor kappa-B ligand (RANKL) and RUNX2 expression. Also, the inhibition of PTX3 negatively affected osteoblast proliferation and their ability to form cell clusters and microhydroxyapatite crystals. Altogether, these results suggest a central role of PTX3 in bone homeostasis showing its involvement in osteoblast proliferation, differentiation and function.

Socioeconomic status and bone mineral density in adults by race/ethnicity and gender: the Louisiana osteoporosis study

Low bone mineral density (BMD) and osteoporosis have become a public health problem. We found that non-Hispanic white, black, and Asian adults with extremely low education and personal income are more likely to have lower BMD. This relationship is gender-specific. These findings are valuable to guide bone health interventions.

INTRODUCTION

The evidence is limited regarding the relationship between socioeconomic status (SES) and bone mineral density (BMD) for minority populations in the USA, as well as the relationship between SES and BMD for men. This study explored and examined the relationship between SES and BMD by race/ethnicity and gender.

METHODS

Data (n = 6568) from the Louisiana Osteoporosis Study (LOS) was examined, including data for non-Hispanic whites (n = 4153), non-Hispanic blacks (n = 1907), and non-Hispanic Asians (n = 508). General linear models were used to estimate the relationship of SES and BMD (total hip and lumbar spine) stratified by race/ethnicity and gender. Adjustments were made for physiological and behavioral factors.

RESULTS

After adjusting for covariates, men with education levels below high school graduate experienced relatively low hip BMD than their counterparts with college or graduate education (p < 0.05). In addition, women reporting a personal annual income under $20,000 had relatively low hip and spine BMD than their counterparts with higher income level(s) (p < 0.05).

CONCLUSIONS

Establishing a conclusive positive or negative association between BMD and SES proved to be difficult. However, individuals who are at an extreme SES disadvantage are the most vulnerable to have relatively low BMD in the study population. Efforts to promote bone health may benefit from focusing on men with low education levels and women with low individual income.

Legumain Regulates Differentiation Fate of Human Bone Marrow Stromal Cells and Is Altered in Postmenopausal Osteoporosis

Secreted factors are a key component of stem cell niche and their dysregulation compromises stem cell function. Legumain is a secreted cysteine protease involved in diverse biological processes. Here, we demonstrate that legumain regulates lineage commitment of human bone marrow stromal cells and that its expression level and cellular localization are altered in postmenopausal osteoporotic patients. As shown by genetic and pharmacological manipulation, legumain inhibited osteoblast (OB) differentiation and in vivo bone formation through degradation of the bone matrix protein fibronectin. In addition, genetic ablation or pharmacological inhibition of legumain activity led to precocious OB differentiation and increased vertebral mineralization in zebrafish. Finally, we show that localized increased expression of legumain in bone marrow adipocytes was inversely correlated with adjacent trabecular bone mass in a cohort of patients with postmenopausal osteoporosis. Our data suggest that altered proteolytic activity of legumain in the bone microenvironment contributes to decreased bone mass in postmenopausal osteoporosis.

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Legumain determines differentiation fate of BMSCs in vitro and in vivo

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Legumain regulates BMSC proliferation independent of its enzymatic activity

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Inhibition of legumain leads to precocious bone formation in zebrafish

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Legumain is overexpressed in bone marrow adipocytes of osteoporotic patients

7T MRI of distal radius trabecular bone microarchitecture: How trabecular bone quality varies depending on distance from end-of-bone

PURPOSE

To use 7T magnetic resonance imaging (MRI) to determine how trabecular bone microarchitecture varies at the epiphysis, metaphysis, and diaphysis of the distal radius.

MATERIALS AND METHODS

The distal radius of 24 females (mean age = 56 years, range = 24-78 years) was scanned on a 7T MRI using a 3D fast low-angle shot sequence (0.169 × 0.169 × 1 mm). Digital topological analysis was applied at the epiphysis, metaphysis, and diaphysis to compute: total trabecular bone volume; trabecular thickness, number, connectivity, and erosion index (a measure of network resorption). Differences and correlations were assessed using standard statistical methods.

RESULTS

The metaphysis and epiphysis had 83-123% greater total bone volume and 14-16% greater trabecular number than the diaphysis (both P < 0.0001). The erosion index was significantly higher at the diaphysis than the metaphysis and epiphysis (both P < 0.01). The most elderly volunteers had lower trabecular number (<66 years mean 0.29 ± 0.01; ≥66 years, 0.27 ± 0.02, P < 0.05) and higher erosion index (<66 years mean 1.18 ± 0.17; age ≥66 years, mean 1.42 ± 0.46, P < 0.05) at the epiphysis; differences not detected by total trabecular bone volume.

CONCLUSION

7T MRI reveals trabecular bone microarchitecture varies depending on scan location at the end-of-bone, being of overall higher quality distally (epiphysis) than proximally (diaphysis). Age-related differences in trabecular microarchitecture can be detected by 7T MRI. The results highlight the potential sensitivity of 7T MRI to microarchitectural differences and the potential importance of standardizing scan location for future clinical studies of fracture risk or treatment response.

LEVEL OF EVIDENCE

3 J. Magn. Reson. Imaging 2017;45:872-878.

Expression levels of estrogen receptor α mRNA in peripheral blood cells are an independent biomarker for postmenopausal osteoporosis

BACKGROUND

The up- and down-regulation of the osteoclastogenesis response depends on the estrogen/estrogen receptor (ER) signaling pathway. Previous reports have shown that the promoter hypermethylation and gene polymorphism of ERα are risks for menopausal osteoporosis. No previous study has evaluated the expression levels of ERα mRNA in menopausal osteoporosis using human subjects. We hypothesized that ERα mRNA expression may show less resistance to postmenopausal osteoporosis.

METHODS

In this study, we enrolled 107 women older than 45 years without menstruation and classified them into control, osteopenia, and osteoporosis groups depending on their T-scores. The ERα mRNA levels in peripheral blood cells (PBCs) were analyzed via quantitative real-time reverse-transcription polymerase chain reaction (QRT-PCR), and estrogen in the serum was detected via ELISA.

RESULTS

ERα mRNA levels in PBCs had a negative correlation with age and a positive correlation with estrogen and BAP in the osteopenia and osteoporosis groups, but not in the control group. Additionally, multivariate analysis showed that older age (> 55 years), and low ERα mRNA levels in PBLs (≦ 250.39 copies/μg DNA) were associated with an approximately 9.188-, and 31.25-fold risk of osteoporosis.

CONCLUSION

We conclude that ERα mRNA levels in PBLs could be used as an independent risk factor for postmenopausal osteoporosis.

GENERAL SIGNIFICANCE

Our findings suggested that ERα mRNA levels in PBLs may be more important than age and serum estrogen levels.

Genetic Sharing with Cardiovascular Disease Risk Factors and Diabetes Reveals Novel Bone Mineral Density Loci

Bone Mineral Density (BMD) is a highly heritable trait, but genome-wide association studies have identified few genetic risk factors. Epidemiological studies suggest associations between BMD and several traits and diseases, but the nature of the suggestive comorbidity is still unknown. We used a novel genetic pleiotropy-informed conditional False Discovery Rate (FDR) method to identify single nucleotide polymorphisms (SNPs) associated with BMD by leveraging cardiovascular disease (CVD) associated disorders and metabolic traits. By conditioning on SNPs associated with the CVD-related phenotypes, type 1 diabetes, type 2 diabetes, systolic blood pressure, diastolic blood pressure, high density lipoprotein, low density lipoprotein, triglycerides and waist hip ratio, we identified 65 novel independent BMD loci (26 with femoral neck BMD and 47 with lumbar spine BMD) at conditional FDR < 0.01. Many of the loci were confirmed in genetic expression studies. Genes validated at the mRNA levels were characteristic for the osteoblast/osteocyte lineage, Wnt signaling pathway and bone metabolism. The results provide new insight into genetic mechanisms of variability in BMD, and a better understanding of the genetic underpinnings of clinical comorbidity.

Diffusion-weighted imaging in musculoskeletal radiology-clinical applications and future directions

Diffusion-weighted imaging (DWI) is an established diagnostic tool with regards to the central nervous system (CNS) and research into its application in the musculoskeletal system has been growing. It has been shown that DWI has utility in differentiating vertebral compression fractures from malignant ones, assessing partial and complete tears of the anterior cruciate ligament (ACL), monitoring tumor response to therapy, and characterization of soft-tissue and bone tumors. DWI is however less useful in differentiating malignant vs. infectious processes. As of yet, no definitive qualitative or quantitative properties have been established due to reasons ranging from variability in acquisition protocols to overlapping imaging characteristics. Even with these limitations, DWI can still provide clinically useful information, increasing diagnostic accuracy and improving patient management when magnetic resonance imaging (MRI) findings are inconclusive. The purpose of this article is to summarize recent research into DWI applications in the musculoskeletal system.

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.

Longitudinal assessment of oxytocin efficacy on bone and bone marrow fat masses in a rabbit osteoporosis model through 3.0-T magnetic resonance spectroscopy and micro-CT

This study aims to longitudinally assess the effect of oxytocin on bone and bone fat masses using micro-CT, in vivo magnetic resonance spectroscopy (MRS), and histopathological adipocyte quantification. Early in vivo oxytocin (OT) treatment to the osteoporosis (OP) rabbit model may reliably inhibit bone degeneration and reduce bone marrow fat accumulation by decreasing marrow adipocyte size and density.

INTRODUCTION

This study aims to longitudinally assess the effect of early OT treatment on bone and bone fat masses in a rabbit OP model by comparing the results of MRS and micro-CT with histopathological findings.

METHODS

Sixty 20-week-old female rabbits were randomly assigned into three groups. The control and OP groups were subjected to either sham surgery or bilateral ovariectomy (OVX). The OT group was subcutaneously injected with OT daily from the second week after OVX for 8 weeks. The left proximal femurs of the rabbits were evaluated through MRS, micro-CT, and histopathological examination at 0, 4, 8, 10, and 12 weeks after operation. Differences in fat fraction (FF) values, micro-CT parameters, and calculated pathological marrow adipocytes among three groups were analyzed.

RESULTS

The FF values of the OP group significantly increased (p = 0.019), but the tissue mineral density (TMD) decreased (p = 0.037) from eighth week compared with those of the control group. The FF values of the OT group significantly decreased (p = 0.044), but the TMD values increased (p = 0.042) from eighth week compared with those of the OP group. The adypocyte diameter of the OT group significantly decreased (p = 0.041) from eighth week and then adypocyte density did so too from tenth week, compared with those of the OP group at the same time point. No difference in adypocyte calculation was found between the OT and control groups until the 12th week after operation.

CONCLUSION

Early in vivo OT treatment slowed down bone deterioration and reduced bone marrow adiposity accumulation in a rabbit OP model, which is consistent with pathologic findings. OT treatment is a promising preventive OP therapy.

Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures

BACKGROUND AND PURPOSE

Osteoporotic fractures are an increasing problem in the world due to the ageing of the population. Different models of orthogeriatric co-management are currently in use worldwide. These models differ for instance by the health-care professional who has the responsibility for care in the acute and early rehabilitation phases. There is no international consensus regarding the best model of care and which outcome parameters should be used to evaluate these models. The goal of this project was to identify which outcome parameters and assessment tools should be used to measure and compare outcome changes that can be made by the implementation of orthogeriatric co-management models and to develop recommendations about how and when these outcome parameters should be measured. It was not the purpose of this study to describe items that might have an impact on the outcome but cannot be influenced such as age, co-morbidities and cognitive impairment at admission.

METHODS

Based on a review of the literature on existing orthogeriatric co-management evaluation studies, 14 outcome parameters were evaluated and discussed in a 2-day meeting with panellists. These panellists were selected based on research and/or clinical expertise in hip fracture management and a common interest in measuring outcome in hip fracture care.

RESULTS

We defined 12 objective and subjective outcome parameters and how they should be measured: mortality, length of stay, time to surgery, complications, re-admission rate, mobility, quality of life, pain, activities of daily living, medication use, place of residence and costs. We could not recommend an appropriate tool to measure patients' satisfaction and falls. We defined the time points at which these outcome parameters should be collected to be at admission and discharge, 30 days, 90 days and 1 year after admission.

CONCLUSION

Twelve objective and patient-reported outcome parameters were selected to form a standard set for the measurement of influenceable outcome of patients treated in different models of orthogeriatric co-managed care.

Podoplanin immunopositive lymphatic vessels at the implant interface in a rat model of osteoporotic fractures

Insertion of bone substitution materials accelerates healing of osteoporotic fractures. Biodegradable materials are preferred for application in osteoporotic patients to avoid a second surgery for implant replacement. Degraded implant fragments are often absorbed by macrophages that are removed from the fracture side via passage through veins or lymphatic vessels. We investigated if lymphatic vessels occur in osteoporotic bone defects and whether they are regulated by the use of different materials. To address this issue osteoporosis was induced in rats using the classical method of bilateral ovariectomy and additional calcium and vitamin deficient diet. In addition, wedge-shaped defects of 3, 4, or 5 mm were generated in the distal metaphyseal area of femur via osteotomy. The 4 mm defects were subsequently used for implantation studies where bone substitution materials of calcium phosphate cement, composites of collagen and silica, and iron foams with interconnecting pores were inserted. Different materials were partly additionally functionalized by strontium or bisphosphonate whose positive effects in osteoporosis treatment are well known. The lymphatic vessels were identified by immunohistochemistry using an antibody against podoplanin. Podoplanin immunopositive lymphatic vessels were detected in the granulation tissue filling the fracture gap, surrounding the implant and growing into the iron foam through its interconnected pores. Significant more lymphatic capillaries were counted at the implant interface of composite, strontium and bisphosphonate functionalized iron foam. A significant increase was also observed in the number of lymphatics situated in the pores of strontium coated iron foam. In conclusion, our results indicate the occurrence of lymphatic vessels in osteoporotic bone. Our results show that lymphatic vessels are localized at the implant interface and in the fracture gap where they might be involved in the removal of lymphocytes, macrophages, debris and the implants degradation products. Therefore the lymphatic vessels are involved in implant integration and fracture healing.

A new metaphyseal bone defect model in osteoporotic rats to study biomaterials for the enhancement of bone healing in osteoporotic fractures

The intention of this study was to establish a new critical size animal model that represents clinically relevant situations with osteoporotic bone status and internally fixated metaphyseal defect fractures in which biomaterials for the enhancement of fracture healing in osteoporotic fracture defects can be studied. Twenty-eight rats were ovariectomized (OVX) and treated with a calcium-, phosphorus-, vitamin D3-, soy- and phytoestrogen-free diet. After 3months Dual-energy X-ray absorptiometry measurements showed statistically significant reductions in bone mineral density of the spine of -25.9% and of the femur of -21.3% of the OVX rats compared with controls, confirming osteoporosis in the OVX rats. The OVX rats then underwent either 3 or 5mm wedge-shaped osteotomy of the distal metaphyseal area of the femur that was internally stabilized with a T-shaped mini-plate. After 42days biomechanical testing yielded completely unstable conditions in the 5mm defect femora (bending stiffness 0Nmm(-2)) and a bending stiffness of 12,500Nmm(-2) in the 3mm defects, which showed the beginning of fracture consolidation. Micro-computed tomography showed statistically significant more new bone formation in the 3mm defects (4.83±0.37mm(2)), with bridging of the initial fracture defect area, compared with the 5mm defects (2.68±0.34mm(2)), in which no bridging of the initial defect was found. These results were confirmed by histology. In conclusion, the 5mm defect can be considered as a critical size defect model in which biomaterials can be tested.

Potassium and health

Potassium was identified as a shortfall nutrient by the Dietary Guidelines for Americans 2010 Advisory Committee. The committee concluded that there was a moderate body of evidence of the association between potassium intake and blood pressure reduction in adults, which in turn influences the risk of stroke and coronary heart disease. Evidence is also accumulating of the protective effect of adequate dietary potassium on age-related bone loss and reduction of kidney stones. These benefits depend on organic anions associated with potassium as occurs in foods such as fruits and vegetables, in contrast to similar blood pressure-lowering benefits of potassium chloride. Benefits to blood pressure and bone health may occur at levels below current recommendations for potassium intake, especially from diet, but dose-response trials are needed to confirm this. Nevertheless, intakes considerably above current levels are needed for optimal health, and studies evaluating small increases in fruit and vegetable intake on bone and heart outcomes for short periods have had disappointing results. In modern societies, Western diets have led to a decrease in potassium intake with reduced consumption of fruits and vegetables with a concomitant increase in sodium consumption through increased consumption of processed foods. Consumption of white vegetables is associated with decreased risk of stroke, possibly related to their high potassium content. Potatoes are the highest source of dietary potassium, but the addition of salt should be limited. Low potassium-to-sodium intake ratios are more strongly related to cardiovascular disease risk than either nutrient alone. This relationship deserves further attention for multiple target tissue endpoints.

A cohort study for the impact of activity-limiting injuries based on the Canadian National Population Health Survey 1994-2006

OBJECTIVE

To examine the prevalence and factors affecting activity-limiting injuries (ALI) in individuals and in the Canadian population; to estimate the short and long term impact on health status and well-being because of ALI in Canada from 1994 to 2006 using the Canadian National Population Health Survey (NPHS).

DESIGN

The NPHS is a randomised longitudinal cohort study with biennial interviews, with information on age, sex, education, marital status, income, residence, height and weight to self-perceived health status, healthcare utilisation and medication use in addition to ALI.

SETTING

The study population was a random sample of male and female participants 20 years and older from 10 provinces and three territories in Canada.

PRIMARY AND SECONDARY OUTCOME MEASURES

Logistic regression models were used to assess the potential impact of ALI on individuals and on the Canadian population. The interviews 2 years before and 2 years after the ALI were compared to examine long-term effects, and the McNemar test option in SAS was used for the matched analysis.

RESULTS

The immediate impacts of ALI were pain, disability and disruption of regular life. Long-term effects in patients were chronic pain and increased medical doctor visits. Population impact included a considerable increase in healthcare access and cost. The odds ratios (OR) for the 20-39 age group compared with those 60+ was 2.2; 95% CI 1.8 to 2.7, while the OR associated with male participants was 1.4; 95% CI 1.1 to 1.6. Individuals consuming nine or more alcoholic drinks per week were also significantly more likely to report an ALI (OR, 1.5; 95% CI 1.3 to 1.8).

CONCLUSIONS

The findings from this study illustrated the immediate and long-term impact of individuals and population level injuries in Canada. Injury control policies should aim to prevent the number of injuries, fatalities as well as the consequences among survivors.

Advances in bone imaging for osteoporosis

The diagnosis and management of osteoporosis have been improved by the development of new quantitative methods of skeletal assessment and by the availability of an increasing number of therapeutic options, respectively. A number of imaging methods exist and all have advantages and disadvantages. Dual-energy X-ray absorptiometry (DXA) is the most widely available and commonly utilized method for clinical diagnosis of osteoporosis and will remain so for the foreseeable future. The WHO 10-year fracture risk assessment tool (FRAX(®)) will improve clinical use of DXA and the cost-effectiveness of therapeutic intervention. Improved reporting of radiographic features that suggest osteoporosis and the presence of vertebral fracture, which are powerful predictors of future fractures, could increase the frequency of appropriate DXA referrals. Quantitative CT remains predominantly a research tool, but has advantages over DXA--allowing measurement of volumetric density, separate measures of cortical and trabecular bone density, and evaluation of bone shape and size. High resolution imaging, using both CT and MRI, has been introduced to measure trabecular and cortical bone microstructure. Although these methods provide detailed insights into the effects of disease and therapies on bone, they are technically challenging and not widely available, so they are unlikely to be used in clinical practice.