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Oftebro I, Skjaker SA, Fridheim HL, Frihagen F, Meyer HE, Nordsletten L, Solberg LB. Decrease in incidence of distal radius fractures in Oslo, Norway. Arch Osteoporos 2024; 19:28. [PMID: 38602605 PMCID: PMC11009733 DOI: 10.1007/s11657-024-01383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/09/2024] [Indexed: 04/12/2024]
Abstract
This study reported the incidence of validated adult distal radius fractures in Oslo, Norway, in 2019. The incidence has been reduced over the last 20 years. However, it is still high compared to other regions in Norway and some of the other Nordic countries. PURPOSE We aimed to report the incidence of distal radius fractures in Oslo in 2019 and compare it to the incidence rates in 1998/1999. METHODS Patients aged ≥ 20 years resident in Oslo sustaining a distal radius fracture in 2019 were identified by electronic diagnosis registers, patient protocols, and/or radiology registers. The diagnosis was verified using medical records and/or radiology descriptions. We used the same method as the previous study from Oslo, making the comparison over time more accurate. The age-adjusted incidence rates and the age-standardized incidence rate ratio (IRR) were calculated. RESULTS The absolute number of fractures decreased from 1490 in 1998/1999 to 1395 in 2019. The IRR for women and men in the age group ≥ 20 years in 2019 compared to 1998/1999 was 0.77 (95% CI 0.71-0.84) and 0.77 (95% CI 0.66-0.90), respectively. The IRR for women and men in the age group ≥ 50 years in 2019 compared to 1998/1999 was 0.78 (95% CI 0.71-0.86) and 0.78 (95% CI 0.63-0.97), respectively. For the population in Oslo with Asian background compared to Norwegian background in the age group ≥ 50 years, the IRR in 2019 was 0.57 (95% CI 0.40-0.80) for women and 0.77 (95% CI 0.44-1.37) for men. CONCLUSIONS The incidence of distal radius fractures in Oslo has decreased over the last 20 years. It is still, however, higher than in other areas of Norway and in some of the other Nordic countries.
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Affiliation(s)
- I Oftebro
- Department of Orthopedic Surgery, Oslo University Hospital, Nydalen, 0424, Postbox 4950, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - S A Skjaker
- Department of Orthopedic Surgery, Oslo University Hospital, Nydalen, 0424, Postbox 4950, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - H L Fridheim
- Department of Orthopedic Surgery, Diakonhjemmet, Oslo, Norway
| | - F Frihagen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Orthopedic Surgery, Østfold Hospital Trust, Grålum, Norway
| | - H E Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - L Nordsletten
- Department of Orthopedic Surgery, Oslo University Hospital, Nydalen, 0424, Postbox 4950, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - L B Solberg
- Department of Orthopedic Surgery, Oslo University Hospital, Nydalen, 0424, Postbox 4950, Oslo, Norway
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Munir A, Reseland JE, Tiainen H, Haugen HJ, Sikorski P, Christiansen EF, Reinholt FP, Syversen U, Solberg LB. Osteocyte-Like Cells Differentiated From Primary Osteoblasts in an Artificial Human Bone Tissue Model. JBMR Plus 2023; 7:e10792. [PMID: 37701151 PMCID: PMC10494512 DOI: 10.1002/jbm4.10792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 09/14/2023] Open
Abstract
In vitro models of primary human osteocytes embedded in natural mineralized matrix without artificial scaffolds are lacking. We have established cell culture conditions that favored the natural 3D orientation of the bone cells and stimulated the cascade of signaling needed for primary human osteoblasts to differentiate into osteocytes with the characteristically phenotypical dendritic network between cells. Primary human osteoblasts cultured in a 3D rotating bioreactor and incubated with a combination of vitamins A, C, and D for up to 21 days produced osteospheres resembling native bone. Osteocyte-like cells were identified as entrapped, stellate-shaped cells interconnected through canaliculi embedded in a structured, mineralized, collagen matrix. These cells expressed late osteoblast and osteocyte markers such as osteocalcin (OCN), podoplanin (E11), dentin matrix acidic phosphoprotein 1 (DMP1), and sclerostin (SOST). Organized collagen fibrils, observed associated with the cell hydroxyapatite (HAp) crystals, were found throughout the spheroid and in between the collagen fibrils. In addition to osteocyte-like cells, the spheroids consisted of osteoblasts at various differentiation stages surrounded by a rim of cells resembling lining cells. This resemblance to native bone indicates a model system with potential for studying osteocyte-like cell differentiation, cross-talk between bone cells, and the mineralization process in a bonelike structure in vitro without artificial scaffolds. In addition, natural extracellular matrix may allow for the study of tissue-specific biochemical, biophysical, and mechanical properties. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Arooj Munir
- Department of BiomaterialsInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Janne Elin Reseland
- Department of BiomaterialsInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Hanna Tiainen
- Department of BiomaterialsInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Håvard Jostein Haugen
- Department of BiomaterialsInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Pawel Sikorski
- Department of PhysicsNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | | | | | - Unni Syversen
- Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
| | - Lene Bergendal Solberg
- Department of PathologyOslo University HospitalOsloNorway
- Division of Orthopedic SurgeryOslo University HospitalOsloNorway
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Solberg LB, Vesterhus EB, Hestnes I, Ahmed MV, Ommundsen N, Westberg M, Frihagen F. Comparing two different orthogeriatric models of care for hip fracture patients: an observational prospective cross-sectional study. BMJ Open Qual 2023; 12:e002302. [PMID: 37783524 PMCID: PMC10565326 DOI: 10.1136/bmjoq-2023-002302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/09/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Patients with hip fractures are almost always operated with quite extensive surgery and are often frail with a high risk of complications, increased dependency, and death. Orthogeriatric interdisciplinary care has shown better results compared with orthopaedic care alone. The best way of delivering orthogeriatric care, however, is still largely unknown. It is believed that a high degree of integration and shared care is better than on-demand consultative services. We aimed to evaluate two different orthogeriatric models for patients with hip fracture. METHODS A prospective hip fracture quality database was used to evaluate two coexisting models of care from 2019 to 2021 in our hospital. An 'integrated care model' (ICM) was compared with a 'geriatric consult service' (GCS). RESULTS 516 patients were available for analysis, 360 from ICM and 156 from GCS. Mean age was 84 years. There were 370 (72%) women. American Society of Anesthesiologists class and prefracture cognitive impairment was similar between the groups. There were more patients with femoral neck fractures in the ICM group, and more patients were living independently prefracture. A logistic regression adjusting for the variables above showed that more patients in the ICM group were given a nerve block preoperatively (OR 2.0 (95% CI 1.31 to 2.97); p<0.01), had their urinary catheter removed the first day after surgery (OR 1.9 (95% CI 1.27 to 2.89); p<0.01), were mobilised to standing or seated in a chair beside the bed the first day after surgery (OR 1.5 (95% CI 1.03 to 2.30); p=0.033) and more ICM patients were considered for treatment against osteoporosis (OR 8.58 (95% CI 4.03 to 18.28); p<0.001). There were no significant differences in time to surgery, length of stay, discharge destination or mortality. CONCLUSION The ICM group performed equally good or better on all quality indicators than the GCS.
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Affiliation(s)
| | | | - Ingvild Hestnes
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Marc Vali Ahmed
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Nina Ommundsen
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Marianne Westberg
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Frede Frihagen
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Ingstad F, Solberg LB, Nordsletten L, Thorsby PM, Hestnes I, Frihagen F. Vitamin D status and complications, readmissions, and mortality after hip fracture. Osteoporos Int 2021; 32:873-881. [PMID: 33201249 DOI: 10.1007/s00198-020-05739-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022]
Abstract
UNLABELLED Low vitamin D in patients with hip fracture is common. In the present study, 407 of 872 (47%) patients had serum calcidiol less than 50 nmol/L. Patients with low vitamin D had more delirium, more new hip fractures, and more medical readmissions, but not more orthopedic complications after 1 year. INTRODUCTION We wanted to study the relation between vitamin D level and postoperative orthopedic and medical complications in patients with hip fracture. In addition, we investigated the effect of giving a single-dose cholecalciferol 100.000 IU. METHODS Data were taken from the local hip fracture register. Logistic regression analyses including vitamin D level and potentially confounding variables were performed for complications and readmissions. RESULTS A total of 407 (47%) of 872 included hip fractures had low vitamin D at baseline. A total of 155 (18%) developed delirium, and the risk was higher in vitamin D-deficient patients (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04 to 2.12; p = 0.03). A total of 261 (30%) were readmitted for non-hip-related conditions. Low vitamin D was associated with a higher risk of medical readmissions within 30 days (OR 1.64 (1.03 to 2.61); p = 0.036) and 12 weeks (OR 1.47 (95% CI 1.02 to 2.12); p = 0.039). There was a higher risk of a new hip fracture (OR 2.84 (95% CI 1.15 to 7.03) p = 0.024) in vitamin D-deficient patients. A total of 105 (12%) developed at least one orthopedic complication, with no correlation to baseline vitamin D. Among vitamin D-deficient patients, those receiving a single-dose of 100.000 IU cholecalciferol had fewer orthopedic complications (OR 0.32 (95% CI 0.11 to 0.97) p = 0.044) the first 30 days after surgery. CONCLUSION Low vitamin D at admission for hip fracture increased the risk of delirium, a new hip fracture, and medical readmissions, but not orthopedic complications. The role of vitamin D supplementation to prevent orthopedic complications requires further study.
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Affiliation(s)
- F Ingstad
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
- University of Copenhagen, Copenhagen, Denmark.
| | - L B Solberg
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - L Nordsletten
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - P M Thorsby
- Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - I Hestnes
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - F Frihagen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
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Borgen TT, Bjørnerem Å, Solberg LB, Andreasen C, Brunborg C, Stenbro MB, Hübschle LM, Figved W, Apalset EM, Gjertsen JE, Basso T, Lund I, Hansen AK, Stutzer JM, Dahl C, Nordsletten L, Frihagen F, Eriksen EF. Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT. Osteoporos Int 2020; 31:505-514. [PMID: 31754755 PMCID: PMC7075860 DOI: 10.1007/s00198-019-05215-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/28/2019] [Indexed: 12/15/2022]
Abstract
UNLABELLED Determinants of trabecular bone score (TBS) and vertebral fractures assessed semiquantitatively (SQ1-SQ3) were studied in 496 women with fragility fractures. TBS was associated with age, parental hip fracture, alcohol intake and BMD, not SQ1-SQ3 fractures. SQ1-SQ3 fractures were associated with age, prior fractures, and lumbar spine BMD, but not TBS. INTRODUCTION Trabecular bone score (TBS) and vertebral fractures assessed by semiquantitative method (SQ1-SQ3) seem to reflect different aspects of bone strength. We therefore sought to explore the determinants of and the associations between TBS and SQ1-SQ3 fractures. METHODS This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative included 496 women aged ≥ 50 years with fragility fractures. All responded to a questionnaire about risk factors for fracture, had bone mineral density (BMD) of femoral neck and/or lumbar spine assessed, TBS calculated, and 423 had SQ1-SQ3 fracture assessed. RESULTS Mean (SD) age was 65.6 years (8.6), mean TBS 1.27 (0.10), and 33.3% exhibited SQ1-SQ3 fractures. In multiple variable analysis, higher age (βper SD = - 0.26, 95% CI: - 0.36,- 0.15), parental hip fracture (β = - 0.29, 95% CI: - 0.54,- 0.05), and daily alcohol intake (β = - 0.43, 95% CI - 0.79, - 0.08) were associated with lower TBS. Higher BMD of femoral neck (βper SD = 0.34, 95% CI 0.25-0.43) and lumbar spine (βper SD = 0.40, 95% CI 0.31-0.48) were associated with higher TBS. In multivariable logistic regression analyses, age (ORper SD = 1.94, 95% CI 1.51-2.46) and prior fragility fractures (OR = 1.71, 95% CI 1.09-2.71) were positively associated with SQ1-SQ3 fractures, while lumbar spine BMD (ORper SD = 0.75 95% CI 0.60-0.95) was negatively associated with SQ1-SQ3 fractures. No association between TBS and SQ1-SQ3 fractures was found. CONCLUSION Since TBS and SQ1-SQ3 fractures were not associated, they may act as independent risk factors, justifying the use of both in post-fracture risk assessment.
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Affiliation(s)
- T T Borgen
- Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Box 800, 3004, Drammen, Norway.
- Department of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Å Bjørnerem
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - L B Solberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - C Andreasen
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - C Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - M-B Stenbro
- Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Box 800, 3004, Drammen, Norway
| | - L M Hübschle
- Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
| | - W Figved
- Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway
| | - E M Apalset
- Bergen group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - J-E Gjertsen
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - T Basso
- Department of Orthopedic Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - I Lund
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - A K Hansen
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - J-M Stutzer
- Department of Orthopedic Surgery, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway
| | - C Dahl
- Department of Community Medicine and Global health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - L Nordsletten
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - F Frihagen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - E F Eriksen
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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Solberg LB, Stang E, Brorson SH, Andersson G, Reinholt FP. Tartrate-resistant acid phosphatase (TRAP) co-localizes with receptor activator of NF-KB ligand (RANKL) and osteoprotegerin (OPG) in lysosomal-associated membrane protein 1 (LAMP1)-positive vesicles in rat osteoblasts and osteocytes. Histochem Cell Biol 2014; 143:195-207. [PMID: 25201349 PMCID: PMC4298672 DOI: 10.1007/s00418-014-1272-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 12/19/2022]
Abstract
Tartrate-resistant acid phosphatase (TRAP) is well known as an osteoclast marker; however, a recent study from our group demonstrated enhanced number of TRAP + osteocytes as well as enhanced levels of TRAP located to intracellular vesicles in osteoblasts and osteocytes in experimental osteoporosis in rats. Such vesicles were especially abundant in osteoblasts and osteocytes in cancellous bone as well as close to bone surface and intracortical remodeling sites. To further investigate TRAP in osteoblasts and osteocytes, long bones from young, growing rats were examined. Immunofluorescence confocal microscopy displayed co-localization of TRAP with receptor activator of NF-KB ligand (RANKL) and osteoprotegerin (OPG) in hypertrophic chondrocytes and diaphyseal osteocytes with Pearson's correlation coefficient ≥0.8. Transmission electron microscopy showed co-localization of TRAP and RANKL in lysosomal-associated membrane protein 1 (LAMP1) + vesicles in osteoblasts and osteocytes supporting the results obtained by confocal microscopy. Recent in vitro data have demonstrated OPG as a traffic regulator for RANKL to LAMP1 + secretory lysosomes in osteoblasts and osteocytes, which seem to serve as temporary storage compartments for RANKL. Our in situ observations indicate that TRAP is located to RANKL-/OPG-positive secretory lysosomes in osteoblasts and osteocytes, which may have implications for osteocyte regulation of osteoclastogenesis.
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Affiliation(s)
- L B Solberg
- Department of Pathology, The Core Facility for Advanced Electron Microscopy, Oslo University Hospital, Rikshospitalet, P.O. Box 4950, Nydalen, 0424, Oslo, Norway,
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Bøe BG, Støen RØ, Solberg LB, Reinholt FP, Ellingsen JE, Nordsletten L. Coating of titanium with hydroxyapatite leads to decreased bone formation: A study in rabbits. Bone Joint Res 2012; 1:125-30. [PMID: 23610682 PMCID: PMC3626199 DOI: 10.1302/2046-3758.16.2000050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 05/30/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES An experimental rabbit model was used to test the null hypothesis, that there is no difference in new bone formation around uncoated titanium discs compared with coated titanium discs when implanted into the muscles of rabbits. METHODS A total of three titanium discs with different surface and coating (1, porous coating; 2, porous coating + Bonemaster (Biomet); and 3, porous coating + plasma-sprayed hydroxyapatite) were implanted in 12 female rabbits. Six animals were killed after six weeks and the remaining six were killed after 12 weeks. The implants with surrounding tissues were embedded in methyl methacrylate and grinded sections were stained with Masson-Goldners trichrome and examined by light microscopy of coded sections. RESULTS Small amounts of bone were observed scattered along the surface of five of the 12 implants coated with porous titanium, and around one out of 12 porous coated surfaces with Bonemaster. No bone formation could be detected around porous coated implants with plasma-sprayed hydroxyapatite. CONCLUSION Porous titanium coating is to some degree osteoinductive in muscles.
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Affiliation(s)
- B G Bøe
- Vestre Viken HF, Ringerike Hospital, Postboks 3024, 3501 Hønefoss, Norway
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