Growth hormone: does it have a therapeutic role in fracture healing?

Injuries in female and male elite Korean rowing athletes: an epidemiological study

This study aimed to determine the patterns of injury associated with training activities in elite South Korean rowing athletes training for the Olympic Games. Data were prospectively collected between 2010 and 2019 at the Korea National Training Center in South Korea. Three sports medicine doctors assessed athletes, and the data were stratified according to sex, rowing style, weight class, site of injury, and severity of injury. The groups were compared using the c 2 test. The 95 % confidence interval with Poisson rates and exact Poisson test were used for comparison of rates. In total 514 injuries were recorded during the study period, with an average of 2.86 injuries per athlete annually; among these, over half (57.8 %) were mild injuries. Most injuries occurred in the lower extremities (42.0 %), followed by the trunk (30.2 %), the upper extremities (24.9 %), and the head and neck area (2.9 %). Weight class was significantly associated with severity of injury in all rowing athletes (p < 0.001), for both male and female rowing athletes (p = 0.006 and p = 0.014, respectively). Lightweight male athletes demonstrated higher incidence rate of injury than open-weight male athletes (p < 0.001). On the contrary, lightweight female athletes demonstrated lower incidence rates of injury than open-weight female athletes (p < 0.001). These findings on the incidence of training injuries and patterns based on rowing styles, sexes, and weight classes may elucidate the circumstances leading to injuries in elite Korean rowing athletes. Furthermore, these findings may contribute to the development of programs to enhance athletic performance and reduce the incidence of sports injuries.

Growth hormone effects on healing efficacy, bone resorption and renal morphology of rats: histological and histometric study in rat calvaria

Previous reports demonstrated the utility of systemic application of growth hormone (GH) in the treatment of bone defects. Very few studies correlated bone repair efficacy with hepatic and renal side effects promoted by locally-delivered GH. The objectives of this study were to assess the bone repair properties along with hepatic and renal adverse effects promoted by local application of GH in a rat model. Thirty-two rats were randomly divided (4 groups; n = 8/group), as follows: (i) AB (autogenous bone + local application of saline solution [SS]), (ii) AB+ (autogenous bone + SS local application + SS irrigation), (iii) AB/GH+ (autogenous bone + SS local application + GH irrigation) and (iv) AB/GHL+ (autogenous bone + GH local application + GH irrigation). Critical-sized defects (diameter = 5.0 mm) were surgically created by a single operator in the calvaria of rats. Defects were filled with ground autogenous bone. Defects pertaining to AB+ and AB/GH+ received a mixture of autogenous bone and a SS-saturated (0.02 mL) collagen sponge covered with bovine cortical membrane. Defects in group AB/GHL+, were filled with the same biomaterials saturated with GH (0.02 mL). SS (0.1 mL) or GH (0.1 mL, equivalent to 0.4 IU) were applied locally on alternate days (8 weeks) in animals in groups AB, AB+ and AB/GH+ or AB/GHL+, respectively. Bone repair properties was determined in hematoxylin/eosin-stained slices using traditional histologic and histomorphometric techniques along with optical microscopy and digital image analysis. Statistical differences among groups was determined using Kruskal-Wallis and Tukey post hoc tests (α = 0.05). Histology results indicated that AB and AB+ displayed greater presence of autogenous bone as compared to AB/GH+ and AB/GHL+. Histomorphometric results indicated significantly higher osteoid matrix formation in AB and AB+ when compared to AB/GHL+ (p = 0.009). Kidneys and livers were found to have their glomeruli preserved in AB and AB+. Strong glomeruli necrosis and large areas of protein deposition were found in AB/GH+. Abnormal small-sized glomeruli were found in AB/GHL+. The utilization of autogenous bone graft associated with local application and irrigation with GH was shown to not improve the bone repair in calvarial critical-sized defects in a rat model.

Recent biological trends in management of fracture non-union

Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. Currently, there is a plethora of different strategies to augment the impaired or “insufficient” bone-regeneration process, including the “gold standard” autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved “local” strategies in terms of tissue engineering and gene therapy, or even “systemic” enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis. An improved understanding of the molecular and cellular events that occur during bone repair and remodeling has led to the development of biologic agents that can augment the biological microenvironment and enhance bone repair. Orthobiologics, including stem cells, osteoinductive growth factors, osteoconductive matrices, and anabolic agents, are available clinically for accelerating fracture repair and treatment of compromised bone repair situations like delayed unions and nonunions. A lack of standardized outcome measures for comparison of biologic agents in clinical fracture repair trials, frequent off-label use, and a limited understanding of the biological activity of these agents at the bone repair site have limited their efficacy in clinical applications.

Transforming growth factor Beta family: insight into the role of growth factors in regulation of fracture healing biology and potential clinical applications

The transforming growth factor beta (TGF-β) family forms a group of three isoforms, TGF-β1, TGF-β2, and TGF-β3, with their structure formed by interrelated dimeric polypeptide chains. Pleiotropic and redundant functions of the TGF-β family concern control of numerous aspects and effects of cell functions, including proliferation, differentiation, and migration, in all tissues of the human body. Amongst many cytokines and growth factors, the TGF-β family is considered a group playing one of numerous key roles in control of physiological phenomena concerning maintenance of metabolic homeostasis in the bone tissue. By breaking the continuity of bone tissue, a spread-over-time and complex bone healing process is initiated, considered a recapitulation of embryonic intracartilaginous ossification. This process is a cascade of local and systemic phenomena spread over time, involving whole cell lineages and various cytokines and growth factors. Numerous in vivo and in vitro studies in various models analysing cytokines and growth factors' involvement have shown that TGF-β has a leading role in the fracture healing process. This paper sums up current knowledge on the basis of available literature concerning the role of the TGF-β family in the fracture healing process.

Recommendations and considerations for the use of biologics in orthopedic surgery

Reconstruction of extensive bone defects remains technically challenging and has considerable medical and financial impact on our society. Surgical procedures often require a bone/substitute graft to enhance and accelerate bone repair. Bone autografts are associated with morbidity related to bone harvesting and are limited in quantity. Alternatively, bone allografts expose the patient to the risk of transmission of infectious disease. Synthetic bone graft substitutes, such as calcium sulfates, hydroxyapatite, tricalcium phosphate, and combinations, circumvent some of the disadvantages of auto- and allografts, but have limited indications. Biomedical research has made possible the stimulation of the body's own healing mechanisms, either by delivering exogenous growth factors locally, or by stimulating their local production by gene transfer. Among all known factors having osteoinductive properties, only two bone morphogenetic proteins (for specific indications) and demineralized bone matrix have been approved for clinical use. In addition, ongoing research is exploring the efficacy of cell therapy and tissue engineering. The present report examines the composition, biological properties, indications, clinical experience and regulations of several of the biotherapeutics employed for bone reconstruction.

The dynamic changes of circulating OCN+ cells versus insulinlike growth factor-I during primary healing of orthognathic surgeries

OBJECTIVE

The objective of this study was to determine the dynamic changes of circulating osteocalcin(+) (OCN(+)) cells and insulinlike growth factor-I (IGF-I) in peripheral blood during early primary repair of jaw bones in patients with orthognathic surgery.

STUDY DESIGN

The expression of bone-related genes was detected by RT-PCR in circulating OCN(+) cells. The numbers of OCN(+) cells and serum level of IGF-I were determined by flow cytometry, immunocytochemical staining, and ELISA.

RESULTS

OCN(+) cells significantly increased in peripheral blood, and reached the peak at 1 to 2 weeks after surgery (P < .05). IGF-I in patients significantly decreased 1 week after surgery (P < .05), and then returned gradually to the normal level. There was no significant correlation between the number of circulating OCN(+) cells and the level of IGF-I (P > .05).

CONCLUSIONS

These findings suggested that circulating OCN(+) cells, at least in part, could be mobilized in response to bone injury, and contribute to bone repair in patients with orthognathic surgery.

Osteocalcin: a new link between bone and energy metabolism. Some evolutionary clues

PURPOSE OF REVIEW

Recent findings suggest that the bone is an active regulator of energy and glucose metabolism. The purpose of this review is to summarize current evidence in humans.

RECENT FINDINGS

Both cross-sectional and longitudinal studies support osteocalcin as an active regulator of carbohydrate metabolism in humans, being the muscular load of physical activity one of the possible links between the osteoblast and the insulin axis. This axis could also have been involved in the modulation of nonalcoholic steatohepatitis. The osteoblast-to-insulin axis seems to act paradoxically in patients with increased growth hormone (acromegaly) and during bone repair. Some possible evolutionary implications are suggested.

SUMMARY

Osteocalcin may have a role in the regulation of systemic energy metabolism, given the common origin of the osteoblast with the two other cells implicated (adipocytes and muscle cells). Bioactivity of circulating human carboxylated and uncarboxylated osteocalcin should be characterized in depth, especially in those patients with increased concentrations (renal failure). Osteocalcin is one of the clues in the interaction between calcium and glucose metabolism, and the discovery of the osteocalcin receptor will aid in the study of these relationships.

Bone regeneration: current concepts and future directions

Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. However, there are complex clinical conditions in which bone regeneration is required in large quantity, such as for skeletal reconstruction of large bone defects created by trauma, infection, tumour resection and skeletal abnormalities, or cases in which the regenerative process is compromised, including avascular necrosis, atrophic non-unions and osteoporosis. Currently, there is a plethora of different strategies to augment the impaired or 'insufficient' bone-regeneration process, including the 'gold standard' autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved 'local' strategies in terms of tissue engineering and gene therapy, or even 'systemic' enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis.