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Kjellevold M, Kippler M. Fluoride - a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 2023; 67:10327. [PMID: 38187801 PMCID: PMC10770722 DOI: 10.29219/fnr.v67.10327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/23/2022] [Accepted: 10/25/2023] [Indexed: 01/09/2024] Open
Abstract
Fluoride has a well-documented role in the prevention and treatment of dental caries, but the mechanism is attributed to local effects on the tooth enamel surface rather than systemic effects. Fluoride is not considered essential for humans, no deficiencies are known, and no optimal range, which will not result in moderate fluorosis in some individuals, can be set. Recently, research studies have shown evidence for a relationship between fluoride intake and cognitive outcomes and interaction with iodine nutrition, but the evidence is weak so more data are warranted. For performing longitudinal cohort studies in the Nordic and Baltic region, data on fluoride in food and beverages need to be implemented in food composition tables. As the preventive effects of fluoride are mainly from topical treatment, monitoring of fluoride intake and establishing reference values for fluoride in urine and plasma are warranted to establish safe intake values.
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Affiliation(s)
- Marian Kjellevold
- Department of Seafood, Nutrition and Environmental State, Institute of Marine Research, Bergen, Norway
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Lindsay SE, Smith S, Yang S, Yoo J. Community Water Fluoridation and Rate of Pediatric Fractures. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202310000-00001. [PMID: 37796978 PMCID: PMC10558222 DOI: 10.5435/jaaosglobal-d-22-00221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The effect of community water fluoridation on bone fragility and fracture has been inconclusive in the literature. The null hypothesis of this study was that no association was observed between water fluoride level and risk of fracture in children. METHODS Community fluoridation data were obtained from the Centers for Disease Control and Prevention while data on fracture rates were obtained from the PearlDiver database. The rate of fracture type for each state was then compared with state-level fluoridation data using Pearson correlation coefficients and Wilcoxon rank-sum tests. RESULTS Positive correlations were found between the percentage of state water fluoridation and fracture rates for both bone forearm fracture (BBFFx) and femur fracture. Fluoride levels had positive correlations with fracture rates for all fracture types. Increased fracture rates were found between states in the highest quartiles of percentage of state water fluoridation and fluoride water levels for supracondylar humerus fracture and BBFFx. CONCLUSIONS A higher level of water fluoridation was associated with higher rates of supracondylar humerus fracture and BBFFx in children aged 4 to 10 years. These findings do not imply causality, but they suggest that additional investigation into the effect of fluoride on pediatric bone health may be indicated.
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Affiliation(s)
| | - Spencer Smith
- From the Oregon Health & Science University, Portland, OR
| | - Scott Yang
- From the Oregon Health & Science University, Portland, OR
| | - Jung Yoo
- From the Oregon Health & Science University, Portland, OR
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Skalny AV, Aschner M, Silina EV, Stupin VA, Zaitsev ON, Sotnikova TI, Tazina SI, Zhang F, Guo X, Tinkov AA. The Role of Trace Elements and Minerals in Osteoporosis: A Review of Epidemiological and Laboratory Findings. Biomolecules 2023; 13:1006. [PMID: 37371586 DOI: 10.3390/biom13061006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
The objective of the present study was to review recent epidemiological and clinical data on the association between selected minerals and trace elements and osteoporosis, as well as to discuss the molecular mechanisms underlying these associations. We have performed a search in the PubMed-Medline and Google Scholar databases using the MeSH terms "osteoporosis", "osteogenesis", "osteoblast", "osteoclast", and "osteocyte" in association with the names of particular trace elements and minerals through 21 March 2023. The data demonstrate that physiological and nutritional levels of trace elements and minerals promote osteogenic differentiation through the up-regulation of BMP-2 and Wnt/β-catenin signaling, as well as other pathways. miRNA and epigenetic effects were also involved in the regulation of the osteogenic effects of trace minerals. The antiresorptive effect of trace elements and minerals was associated with the inhibition of osteoclastogenesis. At the same time, the effect of trace elements and minerals on bone health appeared to be dose-dependent with low doses promoting an osteogenic effect, whereas high doses exerted opposite effects which promoted bone resorption and impaired bone formation. Concomitant with the results of the laboratory studies, several clinical trials and epidemiological studies demonstrated that supplementation with Zn, Mg, F, and Sr may improve bone quality, thus inducing antiosteoporotic effects.
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Affiliation(s)
- Anatoly V Skalny
- Laboratory of Ecobiomonitoring and Quality Control, Yaroslavl State University, 150003 Yaroslavl, Russia
- Center of Bioelementology and Human Ecology, Institute of Biodesign and Modeling of Complex Systems, Department of Therapy of the Institute of Postgraduate Education, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ekaterina V Silina
- Center of Bioelementology and Human Ecology, Institute of Biodesign and Modeling of Complex Systems, Department of Therapy of the Institute of Postgraduate Education, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Victor A Stupin
- Department of Hospital Surgery No. 1, Pirogov Russian National Research Medical University, 117997 Moscow, Russia
| | - Oleg N Zaitsev
- Department of Physical Education, Yaroslavl State Technical University, 150023 Yaroslavl, Russia
| | - Tatiana I Sotnikova
- Center of Bioelementology and Human Ecology, Institute of Biodesign and Modeling of Complex Systems, Department of Therapy of the Institute of Postgraduate Education, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
- City Clinical Hospital n. a. S.P. Botkin of the Moscow City Health Department, 125284 Moscow, Russia
| | - Serafima Ia Tazina
- Center of Bioelementology and Human Ecology, Institute of Biodesign and Modeling of Complex Systems, Department of Therapy of the Institute of Postgraduate Education, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, Health Science Center, School of Public Health, Xi'an Jiaotong University, Xi'an 710061, China
| | - Xiong Guo
- Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission, Health Science Center, School of Public Health, Xi'an Jiaotong University, Xi'an 710061, China
| | - Alexey A Tinkov
- Laboratory of Ecobiomonitoring and Quality Control, Yaroslavl State University, 150003 Yaroslavl, Russia
- Center of Bioelementology and Human Ecology, Institute of Biodesign and Modeling of Complex Systems, Department of Therapy of the Institute of Postgraduate Education, IM Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
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Helte E, Donat Vargas C, Kippler M, Wolk A, Michaëlsson K, Åkesson A. Fluoride in Drinking Water, Diet, and Urine in Relation to Bone Mineral Density and Fracture Incidence in Postmenopausal Women. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:47005. [PMID: 33822648 PMCID: PMC8043127 DOI: 10.1289/ehp7404] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Although randomized controlled trials (RCTs) have demonstrated that high fluoride increases bone mineral density (BMD) and skeletal fragility, observational studies of low-dose chronic exposure through drinking water (<1.5mg/L, the maximum recommended by the World Health Organization) have been inconclusive. OBJECTIVE We assessed associations of fluoride in urine, and intake via diet and drinking water, with BMD and fracture incidence in postmenopausal women exposed to drinking water fluoride ≤1mg/L. METHODS Data were from participants in the Swedish Mammography Cohort-Clinical, a population-based prospective cohort study. At baseline (2004-2009), fluoride exposure was assessed based on urine concentrations (n=4,306) and estimated dietary intake (including drinking water) (n=4,072), and BMD was measured using dual energy X-ray absorptiometry. Incident fractures were ascertained via register-linkage through 2017. Residential history was collected to identify women with long-term consistent drinking water exposures prior to baseline. RESULTS At baseline, mean urine fluoride was 1.2mg/g creatinine (±1.9) and mean dietary intake was 2.2mg/d (±0.9), respectively. During follow-up, 850, 529, and 187 cases of any fractures, osteoporotic fractures, and hip fractures, respectively, were ascertained. Baseline BMD was slightly higher among women in the highest vs. lowest tertiles of exposure. Fluoride exposures were positively associated with incident hip fractures, with multivariable-adjusted hazard ratios of 1.50 (95% CI: 1.04, 2.17) and 1.59 (95% CI: 1.10, 2.30), for the highest vs. lowest tertiles of urine fluoride and dietary fluoride, respectively. Associations with other fractures were less pronounced for urine fluoride, and null for dietary fluoride. Restricting the analyses to women with consistent long-term drinking water exposures prior to baseline strengthened associations between fractures and urinary fluoride. DISCUSSION In this cohort of postmenopausal women, the risk of fractures was increased in association with two separate indicators of fluoride exposure. Our findings are consistent with RCTs and suggest that high consumption of drinking water with a fluoride concentration of ∼1mg/L may increase both BMD and skeletal fragility in older women. https://doi.org/10.1289/EHP7404.
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Affiliation(s)
- Emilie Helte
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
| | - Carolina Donat Vargas
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
- Department of Preventive Medicine and Public Health, School of Medicine, Campus of International Excellence, Universidad Autónoma de Madrid and Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Maria Kippler
- Unit of Metals and Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Agneta Åkesson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Sweden
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Lee N, Kang S, Lee W, Hwang SS. The Association between Community Water Fluoridation and Bone Diseases: A Natural Experiment in Cheongju, Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249170. [PMID: 33316869 PMCID: PMC7764285 DOI: 10.3390/ijerph17249170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022]
Abstract
The present study aimed to investigate the association between bone diseases and community water fluoridation (CWF). An ecological study with a natural experiment design was conducted in Cheongju, South Korea, from 1 January 2004 to 31 December 2013. The community water fluoridation program was implemented in Cheongju and divided into CWF and non-CWF areas. To observe adverse health effects related to bone diseases, we conducted a spatio-temporal analysis of the prevalence of hip fracture, osteoporosis, and bone cancer in residents who have lived in CWF and non-CWF areas using National Health Insurance Service data. First, we used standardized incidence ratios to estimate the disease risk. Second, the hierarchical Bayesian Poisson spatio-temporal regression model was used to investigate the association between the selected bone diseases and CWF considering space and time interaction. The method for Bayesian estimation was based on the R-integrated nested Laplace approximation (INLA). Comparing the CWF area with the non-CWF area, there was no clear evidence that exposure to CWF increased health risks at the town level in Cheongju since CWF was terminated after 2004. The posterior relative risks (RR) of hip fracture was 0.95 (95% confidence intervals 0.87, 1.05) and osteoporosis was 0.94 (0.87, 1.02). The RR in bone cancer was a little high because the sample size very small compared to the other bone diseases (RR = 1.20 (0.89, 1.61)). The relative risk of selected bone diseases (hip fractures, osteoporosis, and bone cancer) increased over time but did not increase in the CWF area compared to non-CWF areas. CWF has been used to reduce dental caries in all population groups and is known for its cost-effectiveness. These findings suggest that CWF is not associated with adverse health risks related to bone diseases. This study provides scientific evidence based on a natural experiment design. It is necessary to continue research on the well-designed epidemiological studies and develop public health prevention programs to help in make suitable polices.
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Crnosija N, Choi M, Meliker JR. Fluoridation and county-level secondary bone cancer among cancer patients 18 years or older in New York State. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:761-768. [PMID: 30109528 DOI: 10.1007/s10653-018-0170-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
The decision whether to fluoridate drinking water continues to be controversial in some communities. Dental and skeletal fluorosis in response to chronic fluoride overexposure are cited as reasons to avoid community water fluoridation in spite of evidence of the oral and skeletal health benefits fluoridation confers. Community fluoridation of ~ 1 mg/L fluoride has not been found to be associated with primary bone cancer but is associated with improved bone strength. No studies have examined fluoride exposure and secondary bone cancer, a common metastasis with significant morbidity. We hypothesize that fluoridation could diminish the likelihood of secondary bone cancer due to its role in bone fortification. We examined the association between community water fluoridation category and prevalence of secondary bone cancer from 2008 to 2010 among cancer patients of 18 years of age or older in counties in New York State. Relative to counties with less than 25% of the water supply fluoridated, we report no association between secondary bone cancer among cancer patients in counties with 25-75% of the water supply fluoridated (β = 0.02, p = 0.96) and among those in counties with > 75% fluoridated (β = 0.02, p = 0.97). We found no evidence of an association between community water fluoridation category and secondary bone cancer from 2008 to 2010 at the county level in New York State.
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Affiliation(s)
- Natalie Crnosija
- Stony Brook University Program in Public Health, Health Sciences Center, Stony Brook University, Level 3, Room 071, Stony Brook, NY, 11794-8338, USA.
| | - Minsig Choi
- Stony Brook University Department of Medicine, Oncology Division, Health Sciences Center, Stony Brook University, 020 Health Sciences Center, Stony Brook, NY, 11794-8160, USA
| | - Jaymie R Meliker
- Stony Brook University Program in Public Health, Health Sciences Center, Stony Brook University, Level 3, Room 071, Stony Brook, NY, 11794-8338, USA
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Oweis RR, Levy SM, Eichenberger-Gilmore JM, Warren JJ, Burns TL, Janz KF, Torner JC, Saha PK, Letuchy E. Fluoride intake and cortical and trabecular bone characteristics in adolescents at age 17: A prospective cohort study. Community Dent Oral Epidemiol 2018; 46:527-534. [PMID: 29962091 PMCID: PMC6237627 DOI: 10.1111/cdoe.12373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 02/08/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the associations between period-specific and cumulative fluoride (F) intakes from birth to age 17 years, and radial and tibial bone measures obtained using peripheral quantitative computed tomography (pQCT). METHODS Participants (n = 380) were recruited from hospitals at birth and continued their participation in the ongoing Iowa Fluoride Study/Iowa Bone Development Study until age 17. Fluoride intakes from water, other beverages, selected foods, dietary fluoride supplements and dentifrice were determined every 1.5-6 months using detailed questionnaires. Associations between F intake and bone measures (cortical and trabecular bone mineral content [BMC], density and strength) were determined in bivariate and multivariable analyses adjusted for height, weight, maturity offset, physical activity, and daily calcium and protein intake using robust regression analysis. RESULTS Fluoride intake ranged from 0.7 to 0.8 mg F/d for females and from 0.7 to 0.9 mg F/d for males. Spearman correlations between daily F intake and pQCT bone measures were weak. For females, Spearman correlations ranged from r = -.08 to .21, and for males, they ranged from r = -.03 to .30. In sex-specific, height-, weight- and maturity offset- partially adjusted regression analyses, associations between females' fluoride intake and bone characteristics were almost all negative; associations for males were mostly positive. In the fully adjusted models, which also included physical activity, and protein and calcium intakes, no significant associations were detected for females; significant positive associations were detected between F intake from 14 to 17 years and tibial cortical bone content (β = 21.40, P < .01) and torsion strength (β = 175.06, P < .01) for males. CONCLUSION In this cohort of 17-year-old adolescents, mostly living in optimally fluoridated areas, lifelong F intake from combined sources was weakly associated with bone pQCT measures.
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Affiliation(s)
- Reem Reda Oweis
- Department of Preventive and Community Dentistry, College of Dentistry, Iowa City, IA, USA
| | - Steven M Levy
- Department of Preventive and Community Dentistry, College of Dentistry, Iowa City, IA, USA
- Department of Epidemiology, College of Public Health, Iowa City, IA, USA
| | - Julie M Eichenberger-Gilmore
- Department of Preventive and Community Dentistry, College of Dentistry, Iowa City, IA, USA
- Department of Epidemiology, College of Public Health, Iowa City, IA, USA
- Nutrition and Food Services, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - John J Warren
- Department of Preventive and Community Dentistry, College of Dentistry, Iowa City, IA, USA
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, Iowa City, IA, USA
| | - Kathleen F Janz
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, Iowa City, IA, USA
| | - James C Torner
- Department of Epidemiology, College of Public Health, Iowa City, IA, USA
| | - Punam K Saha
- Department of Electrical and Computer Engineering, College of Engineering, The University of Iowa, Iowa City, IA, USA
| | - Elena Letuchy
- Department of Epidemiology, College of Public Health, Iowa City, IA, USA
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Luo W, Gao X, Zhang X. Geochemical processes controlling the groundwater chemistry and fluoride contamination in the Yuncheng Basin, China-An area with complex hydrogeochemical conditions. PLoS One 2018; 13:e0199082. [PMID: 30048448 PMCID: PMC6062146 DOI: 10.1371/journal.pone.0199082] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/31/2018] [Indexed: 11/18/2022] Open
Abstract
Hydrogeochemical and stable isotope analyses and geochemical modeling were carried out to identify the major geochemical processes controlling the groundwater chemistry and fluoride contamination in the aquifers of the Yuncheng Basin, China, an area with complex hydrogeochemical conditions and severe fluoride contamination of the groundwater. The major findings of this case study include the following: 1) Cation exchange and salt effects are vital controls on the enrichment of fluoride in groundwater in the area by reducing the activity of Ca2+/F- in groundwater via ion complexation. Cation exchange increased the fluoride concentration by 2.7 mg/L when the Na/Ca molar ratio increased from 0.24 to 9.0, while the salt effect led to a ca. 5–10% increase in complex F- in groundwater due to the further dissolution of fluoride-bearing minerals in the aquifers, as suggested by a model calculation. 2) Anthropogenic contamination from pesticide and fertilizer use and industrial waste discharge is also a main source of fluoride in the groundwater. 3) Evaporation and ion effects favor the enrichment of fluoride in groundwater by encouraging the removal of Ca via precipitation. 4) The desorption of fluoride from mineral/organic matter surfaces is enhanced under alkaline conditions and a high HCO3 content in groundwater.
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Affiliation(s)
- Wenting Luo
- School of Environmental Studies, China University of Geosciences, Wuhan, China
| | - Xubo Gao
- School of Environmental Studies, China University of Geosciences, Wuhan, China
- * E-mail:
| | - Xin Zhang
- School of Environmental Studies, China University of Geosciences, Wuhan, China
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Zhang JZ, Wang J, Qu WC, Wang XW, Liu Z, Ren JX, Han L, Sun TS. Plasma mitochondrial DNA levels were independently associated with lung injury in elderly hip fracture patients. Injury 2017; 48:454-459. [PMID: 28073488 DOI: 10.1016/j.injury.2017.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hip fracture in the elderly can induce systemic inflammatory response (SIRS) and lung injury which increases the risk of lung infection and death. Mitochondrial DNA (mtDNA) plays a role in SIRS and lung injury in patients with multi-trauma, and also in patients with hip fractures. This study evaluated the potential value of plasma mtDNA in the early prognosis of lung injury in elderly fracture patients. METHODS This study enrolled 156 elderly patients with intertrochanteric fracture. Plasma mtDNA, IL-6, IL-10, prostaglandin E2 (PGE2) levels were measured at admission. Sixty-one and 31 patients were diagnosed with systemic inflammatory response syndrome (SIRS) and lung injury, respectively. RESULTS Plasma mtDNA levels were higher in hip fracture patients compared to healthy controls (P<0.001) and significantly higher in the lung injury subgroup compared to the lung injury absent subgroup (P<0.001). MtDNA levels were correlated with the SIRS score (r=0.446, P<0.001), IL-6 (r=0.506, P<0.001), IL-10 (r=0.523, P<0.001), and PGE2 (r=0.360, P<0.001). Logistic regression analysis revealed that plasma mtDNA, IL-6, PGE2 and SIRS score were independent predictors of the risk of lung injury. CONCLUSION Plasma mtDNA release induced by hip fracture in elderly patients, might be an early predictor of lung injury in these patients.
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Affiliation(s)
- Jian-Zheng Zhang
- Department of Orthopedic, Beijing Army General Hospital, Beijing, 100700, China
| | - Juan Wang
- Department of Orthopedic, Beijing Army General Hospital, Beijing, 100700, China
| | - Wen-Chun Qu
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Mayo Clinic, Rochester, MN, 55901, USA
| | - Xiao-Wei Wang
- Department of Orthopedic, Beijing Army General Hospital, Beijing, 100700, China
| | - Zhi Liu
- Department of Orthopedic, Beijing Army General Hospital, Beijing, 100700, China
| | - Ji-Xin Ren
- Department of Orthopedic, Beijing Army General Hospital, Beijing, 100700, China
| | - Li Han
- Department of Orthopedic, Beijing Army General Hospital, Beijing, 100700, China
| | - Tian-Sheng Sun
- Department of Orthopedic, Beijing Army General Hospital, Beijing, 100700, China. suntiansheng-@163.com
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