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Geng Z, Wang P, Yang G, Li Y, Zhao Y. Circulating Hsa-miR499a-5p as markers in dysmobility syndrome patients: a new index for diagnosing dysmobility syndrome based on osteoporosis and predicting fracture risk. Postgrad Med J 2024; 100:297-304. [PMID: 38263934 DOI: 10.1093/postmj/qgae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 11/25/2024] [Accepted: 12/25/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Dysmobility syndrome based on osteoporosis (ODS) is a disease characterized by low bone mass and low muscle mass. Its features are high fracture and high fall risk. Falls and fractures are the most important factors affecting the quality of life and lifespan of ODS. However, there is no serum marker for the evaluation of ODS patients.Our previous studies have shown that the expression of circulating miRNA is stable and is a good marker for disease diagnosis. Therefore, this study aims to explore potential serum markers of ODS. METHODS A total of 78 subjects were included in this study. The data including appendicular skeletal muscle mass index, bone mineral density, bone metabolism markers, and other relevant information were collected for analysis. Real-time quantitative polymerase chain reaction was used to detect 19 miRNAs associated with muscle mass reduction. The correlation of quantitative data was analyzed by Pearson. The receiver operating characteristic curve was used to evaluate the performance of miRNA as a biomarker. RESULTS In this study, we found that the muscle mass and strength of patients with ODS are significantly reduced and are negatively correlated with the risk of fracture. The hsa-miR-499a-5p is specifically downregulated in ODS, and is positively correlated with muscle mass and strength, and negatively correlated with the risk of fracture. Compared with muscle mass and strength, hsa-miR-499a-5p has better sensitivity and specificity as a diagnostic marker. CONCLUSION hsa-miR-499a-5p is a potential serum biomarker for assessing muscle function and predicting fall or fracture risk in the ODS population.
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Affiliation(s)
- Zixiang Geng
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine , Shanghai 201203, China
- Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Peige Wang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine , Shanghai 201203, China
- Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Guangyue Yang
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine , Shanghai 201203, China
- Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yifei Li
- Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yongfang Zhao
- Shi's Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine , Shanghai 201203, China
- Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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Gao P, Li S, Dong Z, Luo Y, Zhang X, Han L, Peng S, Shen J, Xu F, Deng Z. A plasma-derived exosomal microRNA signature by small RNA sequencing for early detection of postmenopausal osteoporosis. Clin Transl Med 2024; 14:e1637. [PMID: 38558507 PMCID: PMC10983017 DOI: 10.1002/ctm2.1637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/02/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Affiliation(s)
- Pan Gao
- College of Life SciencesUniversity of Chinese Academy of SciencesBeijingChina
- BGI CellShenzhenChina
- BGI ResearchShenzhenChina
| | - Sijia Li
- College of Health Science and Environmental EngineeringShenzhen Technology UniversityShenzhenGuangdongChina
| | | | | | - Xiuqing Zhang
- College of Life SciencesUniversity of Chinese Academy of SciencesBeijingChina
- BGI ResearchShenzhenChina
| | - Linbo Han
- College of Health Science and Environmental EngineeringShenzhen Technology UniversityShenzhenGuangdongChina
| | - Songlin Peng
- Department of Spine SurgeryShenzhen People's HospitalThe First Affiliated HospitalSouthern University of Science and TechnologyShenzhenGuangdongChina
| | - Jianliang Shen
- National Engineering Research Center of Ophthalmology and OptometryEye HospitalWenzhou Medical UniversityWenzhouZhejiangP. R. China
- Zhejiang Engineering Research Center for Tissue Repair MaterialsWenzhou InstituteWenzhouChina
- University of Chinese Academy of SciencesWenzhouZhejiangP. R. China
| | - Fengping Xu
- College of Life SciencesUniversity of Chinese Academy of SciencesBeijingChina
- BGI CellShenzhenChina
- BGI ResearchShenzhenChina
| | - Zaian Deng
- College of Health Science and Environmental EngineeringShenzhen Technology UniversityShenzhenGuangdongChina
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He Y, Chen Y. The Potential of Exosomes for Osteoporosis Treatment: A Review. Drug Des Devel Ther 2024; 18:979-989. [PMID: 38562519 PMCID: PMC10984200 DOI: 10.2147/dddt.s437596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
As a continuous process comprising bone resorption and formation, bone remodeling, plays an essential role in maintaining the balance of bone metabolism. One type of metabolic osteopathy is osteoporosis, which is defined by low bone mass and deteriorating bone microstructure. Osteoporosis patients are more likely to experience frequent osteoporotic fractures, which makes osteoporosis prevention and treatment crucial. A growing body of research has revealed that exosomes, which are homogenous vesicles released by most cell types, play a major role in mediating a number of pathophysiological processes, including osteoporosis. Exosomes may act as a mediator in cell-to-cell communication and offer a fresh perspective on information sharing. This review discusses the characteristics of exosomes and outlines the exosomes' underlying mechanism that contributes to the onset of osteoporosis. Recent years have seen a rise in interest in the role of exosomes in osteoporosis, which has given rise to innovative therapeutic approaches for the disease prevention and management.
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Affiliation(s)
- Yinxi He
- Department of Orthopaedic Trauma, The Third Hospital of Shijiazhuang, Shijiazhuang, Hebei, 050000, People’s Republic of China
| | - Yanxia Chen
- Department of Endocrinology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050000, People’s Republic of China
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Fang F, Yang J, Wang J, Li T, Wang E, Zhang D, Liu X, Zhou C. The role and applications of extracellular vesicles in osteoporosis. Bone Res 2024; 12:4. [PMID: 38263267 PMCID: PMC10806231 DOI: 10.1038/s41413-023-00313-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 01/25/2024] Open
Abstract
Osteoporosis is a widely observed condition characterized by the systemic deterioration of bone mass and microarchitecture, which increases patient susceptibility to fragile fractures. The intricate mechanisms governing bone homeostasis are substantially impacted by extracellular vesicles (EVs), which play crucial roles in both pathological and physiological contexts. EVs derived from various sources exert distinct effects on osteoporosis. Specifically, EVs released by osteoblasts, endothelial cells, myocytes, and mesenchymal stem cells contribute to bone formation due to their unique cargo of proteins, miRNAs, and cytokines. Conversely, EVs secreted by osteoclasts and immune cells promote bone resorption and inhibit bone formation. Furthermore, the use of EVs as therapeutic modalities or biomaterials for diagnosing and managing osteoporosis is promising. Here, we review the current understanding of the impact of EVs on bone homeostasis, including the classification and biogenesis of EVs and the intricate regulatory mechanisms of EVs in osteoporosis. Furthermore, we present an overview of the latest research progress on diagnosing and treating osteoporosis by using EVs. Finally, we discuss the challenges and prospects of translational research on the use of EVs in osteoporosis.
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Affiliation(s)
- Fei Fang
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Jie Yang
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Jiahe Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Tiantian Li
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Erxiang Wang
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Demao Zhang
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Xiaoheng Liu
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China.
| | - Chenchen Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
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Sun Z, Shi J, Yang C, Chen X, Chu J, Chen J, Wang Y, Zhu C, Xu J, Tang G, Shao S. Identification and evaluation of circulating exosomal miRNAs for the diagnosis of postmenopausal osteoporosis. J Orthop Surg Res 2023; 18:533. [PMID: 37496029 PMCID: PMC10373377 DOI: 10.1186/s13018-023-04020-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Postmenopausal osteoporosis (PMOP) is a common condition that leads to a loss of bone density and an increased risk of fractures in women. Recent evidence suggests that exosomal miRNAs are involved in regulating bone development and osteogenesis. However, exosomal miRNAs as biomarkers for PMOP diagnosis have not been systematically evaluated. In this study, we aim to identify PMOP-associated circulating exosomal miRNAs and evaluate their diagnostic performance. METHODS We performed next-generation sequencing and bioinformatics analysis of plasma exosomal miRNAs from 12 PMOP patients and 12 non-osteoporosis controls to identify PMOP-associated exosomal miRNAs, and then validated them in an independent natural community cohort with 26 PMOP patients and 21 non-osteoporosis controls. Exosomes were isolated with the size exclusion chromatography method from the plasma of elder postmenopausal women. The plasma exosomal miRNA profiles were characterized in PMOP paired with controls with next-generation sequencing. Potential plasma exosomal miRNAs were validated by qRT-PCR in the validation cohort, and their performance in diagnosing PMOP was systematically evaluated with the receiver operating characteristic curve. RESULTS Twenty-seven miRNAs were identified as differentially expressed in PMOP versus controls in sequencing data, of which six exosomal miRNAs (miR-196-5p, miR-224-5p, miR320d, miR-34a-5p, miR-9-5p, and miR-98-5p) were confirmed to be differentially expressed in PMOP patients by qRT-PCR in the validation cohort. The three miRNAs combination (miR-34a-5p + miR-9-5p + miR-98-5p) demonstrated the best diagnostic performance, with an AUC = 0.734. In addition, the number of pregnancies was found to be an independent risk factor that can improve the performance of exosomal miRNAs in diagnosing PMOP. CONCLUSIONS These results suggested that the plasma exosomal miRNAs had the potential to serve as noninvasive diagnostic biomarkers for PMOP.
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Affiliation(s)
- Zhibang Sun
- Department of Orthopedics, The Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, People's Republic of China
| | - Junjie Shi
- Department of Orthopedics, The Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, People's Republic of China
| | - Chenyang Yang
- Department of Orthopedics, The Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, People's Republic of China
| | - Xukun Chen
- Department of Orthopedics, The Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, People's Republic of China
| | - Jiaqi Chu
- Department of Orthopedics, The Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, People's Republic of China
| | - Jing Chen
- Department of R&D, Echo Biotech Co., Ltd, Beijing, People's Republic of China
| | - Yuan Wang
- Department of R&D, Echo Biotech Co., Ltd, Beijing, People's Republic of China
| | - Chenxin Zhu
- Department of Orthopedics, The Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, People's Republic of China
| | - Jinze Xu
- Department of Orthopedics, The Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, People's Republic of China
| | - Guozhen Tang
- Department of Orthopedics, The Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, People's Republic of China
| | - Song Shao
- Department of Orthopedics, The Lu'an Affiliated Hospital of Anhui Medical University, Lu'an, People's Republic of China.
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Huber J, Longaker MT, Quarto N. Circulating and extracellular vesicle-derived microRNAs as biomarkers in bone-related diseases. Front Endocrinol (Lausanne) 2023; 14:1168898. [PMID: 37293498 PMCID: PMC10244776 DOI: 10.3389/fendo.2023.1168898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/31/2023] [Indexed: 06/10/2023] Open
Abstract
MicroRNAs (miRNA) are small non-coding RNA molecules that regulate posttranscriptional gene expression by repressing messengerRNA-targets. MiRNAs are abundant in many cell types and are secreted into extracellular fluids, protected from degradation by packaging in extracellular vesicles. These circulating miRNAs are easily accessible, disease-specific and sensitive to small changes, which makes them ideal biomarkers for diagnostic, prognostic, predictive or monitoring purposes. Specific miRNA signatures can be reflective of disease status and development or indicators of poor treatment response. This is especially important in malignant diseases, as the ease of accessibility of circulating miRNAs circumvents the need for invasive tissue biopsy. In osteogenesis, miRNAs can act either osteo-enhancing or osteo-repressing by targeting key transcription factors and signaling pathways. This review highlights the role of circulating and extracellular vesicle-derived miRNAs as biomarkers in bone-related diseases, with a specific focus on osteoporosis and osteosarcoma. To this end, a comprehensive literature search has been performed. The first part of the review discusses the history and biology of miRNAs, followed by a description of different types of biomarkers and an update of the current knowledge of miRNAs as biomarkers in bone related diseases. Finally, limitations of miRNAs biomarker research and future perspectives will be presented.
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Affiliation(s)
- Julika Huber
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, United States
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Department of Plastic Surgery, University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - Michael T. Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, United States
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Natalina Quarto
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, United States
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, United States
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
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Yang J, Wu J. Discovery of potential biomarkers for osteoporosis diagnosis by individual omics and multi-omics technologies. Expert Rev Mol Diagn 2023:1-16. [PMID: 37140363 DOI: 10.1080/14737159.2023.2208750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Global aging has made osteoporosis an increasingly serious public health problem. Osteoporotic fractures seriously affect the quality of life of patients and increase disability and mortality rates. Early diagnosis is important for timely intervention. The continuous development of individual- and multi-omics methods is helpful for the exploration and discovery of biomarkers for the diagnosis of osteoporosis. AREAS COVERED In this review, we first introduce the epidemiological status of osteoporosis and then describe the pathogenesis of osteoporosis. Furthermore, the latest progress in individual- and multi-omics technologies for exploring biomarkers for osteoporosis diagnosis is summarized. Moreover, we clarify the advantages and disadvantages of the application of osteoporosis biomarkers obtained using the omics method. Finally, we put forward valuable views on the future research direction of diagnostic biomarkers of osteoporosis. EXPERT OPINION Omics methods undoubtedly provide greatly contribute to the exploration of diagnostic biomarkers of osteoporosis; however, in the future, the clinical validity and clinical utility of the obtained potential biomarkers should be thoroughly examined. In addition, the improvement and optimization of the detection methods for different types of biomarkers and standardization of the detection process guarantee the reliability and accuracy of the detection results.
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Affiliation(s)
- Jing Yang
- Department of Clinical Laboratory Medicine, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Jun Wu
- Department of Clinical Laboratory Medicine, Beijing Jishuitan Hospital, Peking University, Beijing, China
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Ollodart J, Contino KF, Deep G, Shiozawa Y. The impacts of exosomes on bone metastatic progression and their potential clinical utility. Bone Rep 2022; 17:101606. [PMID: 35910404 PMCID: PMC9335387 DOI: 10.1016/j.bonr.2022.101606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Bone is one of the most common sites of cancer metastasis. Once cancer metastasizes to the bone, the mortality rate of cancer patients dramatically increases. Although the exact mechanisms for this observation remain elusive, recent studies have revealed that the complex crosstalk between bone marrow microenvironment and bone metastatic cancer cells is responsible for the induction of treatment resistance. Consequently, bone metastasis is currently considered incurable. Bone metastasis not only impairs the patients' survival, but also negatively affects their quality of life by causing painful complications. It has recently been implicated the regulatory role of exosomes in cancer development and/or progression as a delivery biomaterial between cancer cells and tumor microenvironment. However, little is known as to how exosomes contribute to the progression of bone metastasis by impaction on the crosstalk between bone metastatic cancer cells and bone marrow microenvironment. Here, we highlighted the emerging roles of cancer-derived exosomes in (i) the process of dissemination and bone colonization of bone metastatic cancer cells, (ii) the enhancement of crosstalk between bone marrow microenvironment and bone metastatic cancer cells, (iii) the development of its resultant painful complications, and (iv) the clinical applications of exosomes in the bone metastatic setting. Cancer-derived exosomes facilitate cancer dissemination and colonization to bone. Cancer-derived exosomes are crucial for controlling bone metastatic phenotype. Cancer-derived exosomes prime bone marrow microenvironment for further metastasis. Cancer-derived exosomes are involved in development of cancer-induced bone pain. Exosomes can be used as therapies and/or diagnostic tools for bone metastasis.
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Affiliation(s)
- Jenna Ollodart
- Department of Cancer Biology and Comprehensive Cancer Center, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Kelly F Contino
- Department of Cancer Biology and Comprehensive Cancer Center, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Gagan Deep
- Department of Cancer Biology and Comprehensive Cancer Center, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
| | - Yusuke Shiozawa
- Department of Cancer Biology and Comprehensive Cancer Center, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA
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Wang B, Sun Y, Shi D, Han X, Liu N, Wang B. Impact of Alendronate Sodium plus Elcatonin on Postoperative Bone Pain in Patients with Osteoporotic Fractures. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1213278. [PMID: 36119926 PMCID: PMC9473873 DOI: 10.1155/2022/1213278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/03/2022] [Accepted: 08/16/2022] [Indexed: 11/21/2022]
Abstract
Objective This research aims to investigate and analyze the impact of alendronate sodium (ALN) plus elcatonin (EC) in treating postoperative bone pain (BP) in patients with osteoporotic fractures (OPFs). Methods One hundred and thirty-eight cases of OPFs admitted between July 2018 and July 2021 were selected, of which 68 cases receiving ALN were set as the control group and 70 cases receiving ALN plus EC were set as the research group. Intercomparisons were performed in terms of BP, curative effect, complication rate, and serum bone metabolism indexes such as bone Gla protein (BGP), parathyroid hormone (PTH), and bone alkaline phosphatase (BALP). Results Better postoperative BP relief, higher overall response rate, and lower complication rate were identified in the research group versus the control group. On the other hand, the research group presented with increased BGP and BALP after treatment, higher than those in the control group, while the posttreament PTH decreased obviously and was lower versus the control group. Conclusions For OPF patients, ALN plus EC contributes to significantly reduced postoperative BP, improved clinical efficacy, higher treatment safety, and better bone metabolism, which has high clinical application value.
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Affiliation(s)
- Baohui Wang
- Pain Ward of Orthopedics Department of TCM, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000 Shaanxi Province, China
| | - Yindi Sun
- Pain Ward of Orthopedics Department of TCM, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000 Shaanxi Province, China
| | - Da Shi
- Joint Ward of Orthopedics Department of TCM, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000 Shaanxi Province, China
| | - Xiuwei Han
- Joint Ward of Orthopedics Department of TCM, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000 Shaanxi Province, China
| | - Na Liu
- Pain Ward of Orthopedics Department of TCM, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000 Shaanxi Province, China
| | - Bo Wang
- Joint Ward of Orthopedics Department of TCM, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000 Shaanxi Province, China
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