Fall Prevention and Anti-Osteoporosis in Osteopenia Patients of 80 Years of Age and Older: A Randomized Controlled Study

To evaluate the effects of two fall‐prevention and anti‐osteoporotic protocols in elderly patients with osteopenia (OPA).

Methods

The present randomized controlled study included patients with OPA (n =123). The age of these patients was ≥80 years old, with the mean age of 83.54 ± 2.99 years, and the male‐to‐female ratio was 2.97:1.00. Fall‐prevention guidance was given to all patients. Patients in the experiment group (n = 62) orally received 600 mg/d of calcium carbonate, 0.5 μg/d of alfacalcidol, and 70 mg/week of alendronate, while patients in the control group (n = 61) orally received 600 mg/d of calcium carbonate and 0.5 μg/d of alfacalcidol for 18 months. The grip strength, gait speed, bone turnover markers, serum calcium, serum phosphorus, parathyroid hormone (PTH), and bone mineral density were measured, and the Timed Up and Go (TUG) test and the chair rising test (CRT) were performed. Falls, fragility fractures, medication compliance, and side effects of the drugs were recorded.

Results

The serum levels of bone turnover markers (type I procollagen amino‐terminal peptide [P1NP], type I collagen carboxyl terminal peptide [β‐CTx], and osteocalcin [OC]) decreased, while the bone mineral density of the lumbar spine and bilateral femoral neck increased after treatment in the experiment group (P < 0.05, P < 0.01). The rate of change in bone mineral density of the bilateral femoral neck was higher in the experiment group than the control group (3.43% vs 0.03%, P < 0.05; 2.86% vs −0.02%, P < 0.01). After treatment, the proportion of patients with increased hip T scores in the experiment group (66.1%, 41/62) was significantly higher than the proportion (35.0%, 21/60) in the control group (P = 0.001). The incidence of fall decreased in both groups after treatment compared to that before treatment (54.8% vs 33.9% and 54.1% vs 36.7%, respectively; P < 0.05). The incidence of fragility fractures was lower in the experiment group than the control group (8.1% vs 20.0%, P = 0.057). During the intervention period, the incidence of fragility fractures in patients who did not fall (3.8%, 3/79) was significantly lower than that in patients who fell (32.6%, 14/43) (P = 0.000). The risk of fragility fractures was significantly lower in patients who did not fall compared to patients who fell (relative risk: 0.117, 95% confidence interval: 0.035–0.384).

Conclusion

The combination of alendronate sodium with alfacalcidol and calcium can significantly improve the bone mineral density of the lumbar spine and femoral neck. For older patients with OPA, subjectively paying attention to avoiding falls can significantly reduce the risk of fragility fractures.

Mesoporous bioactive glasses for the combined application of osteosarcoma treatment and bone regeneration

In this study, mesoporous bioactive glass (MBG) sub-micro particles were prepared through sol-gel synthesis and possessed a uniform and spherical structure with particle size of 302 ± 43 nm, a pore size of 4 nm and a high surface area of 354 m² g^-1. Alendronate (AL) is often used for the treatment of bone associated diseases, in particular osteosarcoma. However, due to the low bioavailability and high toxicity at increased doses, local and sustained release would be an ideal approach to AL delivery. Here, MBGs and aminated MBGs (AMBG) were applied as carriers for AL loading. High encapsulation efficiency of 75% and 85% and loading efficiency of 60% and 63%, for MBG and AMBG, respectively, was achieved. The release profile of AL from AMBG showed a better sustained and controlled release mechanism compared to MBG. In vitro results demonstrated the non-cytotoxic nature of both MBG and AMBG following exposure to MG63 osteoblast like cell line. AL release from MBG and AMBG, even at lower concentration, provoked decreased MG63 proliferation. The osteogenic potential of MBG and AMBG following exposure to dental pulp stem cells was evaluated using alizarin red assay.

Injectable nanoparticle-loaded hydrogel system for local delivery of sodium alendronate

Systemic administration of bisphosphonates, e.g. sodium alendronate (Aln) is characterized by extremely low bioavailability and high toxicity. To omit aforementioned drawbacks an injectable system for the intra-bone delivery of Aln based on Aln-loaded nanoparticles (NPs-Aln) suspended in a hydrogel matrix (gellan gum, GG) was developed. Aln was encapsulated in poly(lactide-co-glycolide) (PLGA 85:15) by solid-oil-water emulsification. Drug release tests showed that within 25 days all the encapsulated drug was released from NPs-Aln and the release rate was highest at the beginning and decreased with time. In contrast, by suspending NPs-Aln in a GG matrix, the release rate was significantly lower and more constant in time. The GG-NPs-Aln system was engineered to be easily injectable and was able to reassemble its structure after extrusion as shown by rheological measurements. Invitro studies showed that the GG-NPs-Aln was cytocompatible with MG-63 osteoblast-like cells and it inhibited RANKL-mediated osteoclastic differentiation of RAW 264.7 cells. The injectability, the sustained local delivery of small doses of Aln and the biological activity render the GG-NPs-Aln system promising for the local treatment of osteoporosis and other bone tissue disorders.