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Colazo JM, Quirion J, Judice AD, Halpern J, Schwartz HS, Tanner SB, Lawrenz JM, Dahir KM, Holt GE. Utility of iliac crest tetracycline-labelled bone biopsy in osteoporosis and metabolic bone disease: An evaluation of 95 cases over a period of 25 years. Bone Rep 2023; 19:101715. [PMID: 37811524 PMCID: PMC10558706 DOI: 10.1016/j.bonr.2023.101715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background Metabolic bone diseases (MBD) are typically diagnosed by non-invasive imaging and clinical biomarkers. However, imaging does not provide structural information, and biomarkers can be transiently affected by many systemic factors. Bone biopsy and pathologic evaluation is the gold standard for diagnosis of MBD, however, it is rarely utilized. We describe our technique for iliac crest tetracycline-labelled bone using a cannulated drill and assess the utility of bone biopsies to provide diagnostic and therapeutic guidance. Methods In the 25-year period between March 1998 and January 2023, a total of 95 bone biopsies were performed on 94 patients for an osteological indication at Vanderbilt University Medical Center (VUMC). Patient demographics, bone biopsy indications, complications, diagnostic utility, and subsequent therapeutic guidance were retrospectively reviewed and analyzed. Results The procedure had minimal complications and was well tolerated by patients. This technique provided good quality specimens for pathology, which helped establish a diagnosis and treatment change in most patients. Patients that had biopsy-guided treatment alterations showed significant increases in Dual-Energy X-ray Absorptiometry (DEXA) bone mineral density (BMD) scores post-biopsy and subsequent treatment. Conclusion Despite scientific and technological progress in non-invasive diagnostic imaging, clinical biomarkers, and procedures for MBD, there remains a small but significant subset of patients who may benefit from inclusion of tetracycline-labelled bone biopsy into the diagnostic and therapeutic picture. Future prospective comparison studies are warranted. Mini abstract Tetracycline-labelled bone biopsies are under-utilized. Biopsy led to a histological diagnosis and ensuing treatment alteration in most patients with significant increases in bone mineral density. The biopsy procedure used herein provided good specimens with low pain/adverse events. Bone biopsy remains a valuable tool in a small, though significant, subset of patients.
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Affiliation(s)
- Juan M. Colazo
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Julia Quirion
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anthony D. Judice
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer Halpern
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Herbert S. Schwartz
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S. Bobo Tanner
- Department of Medicine, Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua M. Lawrenz
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathryn M. Dahir
- Department of Medicine, Division of Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ginger E. Holt
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Lu L, Huang J, Xu F, Xiao Z, Wang J, Zhang B, David NV, Arends D, Gu W, Ackert-Bicknell C, Sabik OL, Farber CR, Quarles LD, Williams RW. Genetic Dissection of Femoral and Tibial Microarchitecture. JBMR Plus 2019; 3:e10241. [PMID: 31844829 PMCID: PMC6894729 DOI: 10.1002/jbm4.10241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 12/29/2022] Open
Abstract
Our understanding of the genetic control of bone strength has relied mainly on estimates of bone mineral density. Here we have mapped genetic factors that influence femoral and tibial microarchitecture using high‐resolution x‐ray computed tomography (8‐μm isotropic voxels) across a family of 61 BXD strains of mice, roughly 10 isogenic cases per strain and balanced by sex. We computed heritabilities for 25 cortical and trabecular traits. Males and females have well‐matched heritabilities, ranging from 0.25 to 0.75. We mapped 16 genetic loci most of which were detected only in females. There is also a bias in favor of loci that control cortical rather than trabecular bone. To evaluate candidate genes, we combined well‐established gene ontologies with bone transcriptome data to compute bone‐enrichment scores for all protein‐coding genes. We aligned candidates with those of human genome‐wide association studies. A subset of 50 strong candidates fell into three categories: (1) experimentally validated genes already known to modulate bone function (Adamts4, Ddr2, Darc, Adam12, Fkbp10, E2f6, Adam17, Grem2, Ifi204); (2) candidates without any experimentally validated function in bone (eg, Greb1, Ifi202b), but linked to skeletal phenotypes in human cohorts; and (3) candidates that have high bone‐enrichment scores, but for which there is not yet any functional link to bone biology or skeletal system disease (including Ifi202b, Ly9, Ifi205, Mgmt, F2rl1, Iqgap2). Our results highlight contrasting genetic architecture between sexes and among major bone compartments. The alignment of murine and human data facilitates function analysis and should prove of value for preclinical testing of molecular control of bone structure. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Lu Lu
- Department of Genetics, Genomics and Informatics University of Tennessee Health Science Center Memphis TN USA
| | - Jinsong Huang
- Department of Genetics, Genomics and Informatics University of Tennessee Health Science Center Memphis TN USA
| | - Fuyi Xu
- Department of Genetics, Genomics and Informatics University of Tennessee Health Science Center Memphis TN USA
| | - Zhousheng Xiao
- Department of Medicine University of Tennessee Health Science Center Memphis TN USA
| | - Jing Wang
- Department of Molecular and Human Genetics Baylor College of Medicine Houston TX USA
| | - Bing Zhang
- Department of Molecular and Human Genetics Baylor College of Medicine Houston TX USA
| | - Nicolae Valentin David
- Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Danny Arends
- Breeding Biology and Molecular Animal Breeding Humboldt University Berlin Germany
| | - Weikuan Gu
- Department of Orthopaedic Surgery and Biomedical Engineering University of Tennessee Health Science Center Memphis TN USA
| | | | - Olivia L Sabik
- Center for Public Health Genomics University of Virginia Charlottesville VA USA
| | - Charles R Farber
- Center for Public Health Genomics University of Virginia Charlottesville VA USA
| | - Leigh Darryl Quarles
- Department of Medicine University of Tennessee Health Science Center Memphis TN USA
| | - Robert W Williams
- Department of Genetics, Genomics and Informatics University of Tennessee Health Science Center Memphis TN USA
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Xin J, Chu H, Ben S, Ge Y, Shao W, Zhao Y, Wei Y, Ma G, Li S, Gu D, Zhang Z, Du M, Wang M. Evaluating the effect of multiple genetic risk score models on colorectal cancer risk prediction. Gene 2018; 673:174-180. [PMID: 29908285 DOI: 10.1016/j.gene.2018.06.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/25/2018] [Accepted: 06/12/2018] [Indexed: 12/29/2022]
Abstract
Currently, genetic risk score (GRS) model has been a widely used method to evaluate the genetic effect of cancer risk prediction, but seldom studies investigated their discriminatory power, especially for colorectal cancer (CRC) risk prediction. In this study, we applied both simulation and real data to comprehensively compare the discriminability of different GRS models. The GRS models were fitted by logistic regression with three scenarios, including simple count GRS (SC-GRS), logistic regression weighted GRS (LR-GRS, including DL-GRS and OR-GRS) and explained variance weighted GRS (EV-GRS, including EV_DL-GRS and EV_OR-GRS) models. The model performance was evaluated by receiver operating characteristic (ROC) curves and area under curves (AUC) metric, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). In real data analysis, as DL-GRS and EV_DL-GRS models were carried with serious over-fitting, the other three models were kept for further comparison. Compared to unweighted SC-GRS model, reclassification was significantly decreased in OR-GRS model (NRI = -0.082, IDI = -0.002, P < 0.05), while EV_OR-GRS model showed negative NRI and IDI (NRI = -0.077, IDI = -5.54E-04, P < 0.05) compared to OR-GRS model. Besides, traditional model with smoking status (AUC = 0.523) performed lower discriminability compared to the combined model (AUC = 0.607) including genetic (i.e., SC-GRS) and smoking factors. Similarly, the findings from simulation were all consistent to real data results. It is plausible that SC-GRS model could be optimal for predicting genetic risk of CRC. Moreover, the addition of more significant genetic variants to traditional model could further improve predictive power on CRC risk prediction.
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Affiliation(s)
- Junyi Xin
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China; Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Haiyan Chu
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China; Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Shuai Ben
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China; Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yuqiu Ge
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China; Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wei Shao
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China; Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China; China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Yongyue Wei
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China; China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Gaoxiang Ma
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China; Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Shuwei Li
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China; Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Dongying Gu
- Department of Oncology, The Affiliated Nanjing Hospital of Nanjing Medical University, Nanjing, China
| | - Zhengdong Zhang
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China; Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Mulong Du
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China; Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China; China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China.
| | - Meilin Wang
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China; Department of Genetic Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China; China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China.
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Tabatabaei-Malazy O, Salari P, Khashayar P, Larijani B. New horizons in treatment of osteoporosis. Daru 2017; 25:2. [PMID: 28173850 PMCID: PMC5297185 DOI: 10.1186/s40199-017-0167-z] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/31/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prevalence of osteoporosis is increasing both in developed and developing countries. Due to rapid growth in the burden and cost of osteoporosis, worldwide, it seems reasonable to focus on the reduction of fractures as the main goal of treatment. Although, efficient pharmacological agents are available for the treatment of osteoporosis, there still remains a need to more specific drugs with less adverse effects. MAIN BODY This review article provides a brief update on the pathogenesis, presenting current pharmacological products approved by the US Food and Drug Administration (FDA) or Europe, and also newer therapeutic agents to treat osteoporosis according to the clinical trial data available at PubMed, UpToDate, International Osteoporosis Foundation (IOF), and clinical practice guidelines. As well, the effect of combination therapy and recommendations for future research will be further discussed. SHORT CONCLUSION The use of current antiresorptive and anabolic agents alone or in combinations for the treatment of osteoporosis entails several limitations. Mainly, their efficacy on non-vertebral fracture reduction is lower than that observed on vertebral fracture. In addition, they have potential adverse events on long time usage. Development of newer agents such as cathepsin k inhibitor and strontium ranelate not only have increased the available options for treating osteoporosis, but also have opened doors of opportunity to improvements in the effective treatment. However, the high cost of new agents have restricted their usage in selective patients who are at high risk of fracture or whom failed response to first line treatment options. Thus, personalized medicine should be considered for future evaluation of genetic risk score and also for environmental exposure assessment. In addition to permanent attention to early diagnosis of osteoporosis and understanding of the pathophysiology of osteoporosis for novel approach in drug discovery, there seems a need to more well-designed clinical trials with larger sample sizes and longer duration on current as well as on newer agents. Also, continuous research on plant-derived components as the source of discovering new agents, and conducting more clinical trials with combination of two or more synthetic drugs, plants, or drug-plant for the treatment of osteoporosis are recommended. Summary of treatment modalities for osteoporosis.
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Affiliation(s)
- Ozra Tabatabaei-Malazy
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Fifth floor, Dr.Shariati Hospital, North Kargar Ave, Tehran, 14114 Iran
| | - Pooneh Salari
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Patricia Khashayar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Center for Microsystems Technology, Imec and Ghent University, Gent-Zwijnaarde, Belgium
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Fifth floor, Dr.Shariati Hospital, North Kargar Ave, Tehran, 14114 Iran
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