Population trends in human rib cross-sectional shapes

Rib fractures remain the most frequent thoracic injury in motor vehicle crashes. Computational human body models (HBMs) can be used to simulate these injuries and design mitigation strategies, but they require adequately detailed geometry to replicate such fractures. Due to a lack of rib cross-sectional shape data availability, most commercial HBMs use highly simplified rib sections extracted from a single individual during original HBM development. This study provides human rib shape data collected from chest CT scans of 240 females and males across the full adult age range. A cortical bone mapping algorithm extracted cross-sectional geometry from scans in terms of local periosteal position with respect to the central rib axis and local cortex thickness. Principal component analysis was used to reduce the dimensionality of these cross-sectional shape data. Linear regression found significant associations between principal component scores and subject demographics (sex, age, height, and weight) at all rib levels, and predicted scores were used to explore the expected rib cross-sectional shapes across a wide range of subject demographics. The resulting detailed rib cross-sectional shapes were quantified in terms of their total cross-sectional area and their cortical bone cross-sectional area. Average-sized female ribs were smaller in total cross-sectional area than average-sized male ribs by between 20% and 36% across the rib cage, with the greatest differences seen in the central portions of rib 6. This trend persisted although to smaller differences of 14%-29% when comparing females and males of equal intermediate weight and stature. Cortical bone cross-sectional areas were up to 18% smaller in females than males of equivalent height and weight but also reached parity in certain regions of the rib cage. Increased age from 25 to 80 years was associated with reductions in cortical bone cross-sectional area (up to 37% in females and 26% in males at mid-rib levels). Total cross-sectional area was also seen to reduce with age in females but to a lesser degree (of up to 17% in mid-rib regions). Similar regions saw marginal increases in total cross-sectional area for male ribs, indicating age affects rib cortex thickness moreso than overall rib cross-sectional size. Increased subject height was associated with increased rib total and cortical bone cross-sectional areas by approximately 25% and 15% increases, respectively, in mid-rib sections for a given 30 cm increase in height, although the magnitudes of these associations varied by sex and rib location. Increased weight was associated with approximately equal changes in both cortical bone and total cross-sectional areas in males. These effects were most prominent (around 25% increases for an addition of 50 kg) toward lower ribs in the rib cage and had only modest effects (less than 12% change) in ribs 2-4. Females saw greater increases with weight in total rib area compared to cortical bone area, of up to 21% at the eighth rib level. Results from this study show the expected shapes of rib cross-sections across the adult rib cage and across a broad range of demographics. This detailed geometry can be used to produce accurate rib models representing widely varying populations.

Cortical bone architecture of hominid intermediate phalanges reveals functional signals of locomotion and manipulation

OBJECTIVES

Reconstruction of fossil hominin manual behaviors often relies on comparative analyses of extant hominid hands to understand the relationship between hand use and skeletal morphology. In this context, the intermediate phalanges remain understudied. Thus, here we investigate cortical bone morphology of the intermediate phalanges of extant hominids and compare it to the cortical structure of the proximal phalanges, to investigate the relationship between cortical bone structure and inferred loading during manual behaviors.

MATERIALS AND METHODS

Using micro-CT data, we analyze cortical bone structure of the intermediate phalangeal shaft of digits 2-5 in Pongo pygmaeus (n = 6 individuals), Gorilla gorilla (n = 22), Pan spp. (n = 23), and Homo sapiens (n = 23). The R package morphomap is used to study cortical bone distribution, cortical thickness and cross-sectional properties within and across taxa.

RESULTS

Non-human great apes generally have thick cortical bone on the palmar shaft, with Pongo only having thick cortex on the peaks of the flexor sheath ridges, while African apes have thick cortex along the entire flexor sheath ridge and proximal to the trochlea. Humans are distinct in having thicker dorsal shaft cortex as well as thick cortex at the disto-palmar region of the shaft.

DISCUSSION

Variation in cortical bone distribution and properties of the intermediate phalanges is consistent with differences in locomotor and manipulative behaviors in extant great apes. Comparisons between the intermediate and proximal phalanges reveals similar patterns of cortical bone distribution within each taxon but with potentially greater load experienced by the proximal phalanges, even in knuckle-walking African apes. This study provides a comparative context for the reconstruction of habitual hand use in fossil hominins and hominids.

Immature porcine cortical bone mechanical properties and composition change with maturation and displacement rate

Computational models of mature bone have been used to predict fracture; however, analogous study of immature diaphyseal fracture has not been conducted due to sparse experimental mechanical data. A model of immature bone fracture may be used to aid in the differentiation of accidental and non-accidental trauma fractures in young, newly ambulatory children (0-3 years). The objective of this study was to characterize the evolution of tissue-level mechanical behavior, composition, and microstructure of maturing cortical porcine bone with uniaxial tension, Raman spectroscopy, and light microscopy as a function of maturation. We asked: 1) How do the monotonic uniaxial tensile properties change with maturation and displacement rate; 2) How does the composition and microstructure change with maturation; and 3) Is there a correlation between composition and tensile properties with maturation? Elastic modulus (p < 0.001), fracture stress (p < 0.001), and energy absorption (p < 0.014) increased as a function of maturation at the quasistatic rate by 110%, 86%, and 96%, respectively. Fracture stress also increased by 90% with maturation at the faster rate (p = 0.001). Fracture stress increased as a function of increasing displacement rate by 28% (newborn p = 0.048; 1-month p = 0.004; 3-month p= < 0.001), and fracture strain decreased by 68% with increasing displacement rate (newborn p = 0.002; 1-month p = 0.036; 3-month p < 0.001). Carbonate-to-phosphate ratio was positively linearly related to elastic modulus, and fracture stress was positively related to carbonate-to-phosphate ratio and matrix maturation ratio. The results of this study support that immature bone is strain-rate dependent and becomes more brittle at faster rates, contributing to the foundation upon which a computational model can be built to evaluate immature bone fracture.

Adaptive enhancement of apatite crystal orientation and Young's modulus under elevated load in rat ulnar cortical bone

Functional adaptation refers to the active modification of bone structure according to the mechanical loads applied daily to maintain its mechanical integrity and adapt to the environment. Functional adaptation relates to bone mass, bone mineral density (BMD), and bone morphology (e.g., trabecular bone architecture). In this study, we discovered for the first time that another form of bone functional adaptation of a cortical bone involves a change in bone quality determined by the preferential orientation of apatite nano-crystallite, a key component of the bone. An in vivo rat ulnar axial loading model was adopted, to which a 3-15 N compressive load was applied, resulting in approximately 440-3200 μɛ of compression in the bone surface. In the loaded ulnae, the degree of preferential apatite c-axis orientation along the ulnar long axis increased in a dose-dependent manner up to 13 N, whereas the increase in BMD was not dose-dependent. The Young's modulus along the same direction was enhanced as a function of the degree of apatite orientation. This finding indicates that bone has a mechanism that modifies the directionality (anisotropy) of its microstructure, strengthening itself specifically in the loaded direction. BMD, a scalar quantity, does not allow for load-direction-specific strengthening. Functional adaptation through changes in apatite orientation is an excellent strategy for bones to efficiently change their strength in response to external loading, which is mostly anisotropic.

Study on the poroelastic behaviors of the defected osteochondral unit

Osteoarthritis has become a major disease threatening human health. The mechanism of injury under fluid involvement can be studied by finite element method. However, most models only model the articular cartilage to study the subchondral bone structure, which is too simplistic. In this study, a complete osteochondral unit was modeled and provided with a poroelastic material, and as osteoarthritis develops and the size, thickness, and shape of the osteochondral unit defect varies, the fluid flow behavior is altered, which may have functional consequences that feed back into the progression of the injury. The results of the study showed that interstitial fluid pressure and velocity decreased in defective osteochondral units. This trend was exacerbated as the size and thickness of the defect in the osteochondral unit increased. When the defect reached the trabeculae, pressure around the cartilage defect in the osteochondral unit was greatest, flow velocity in the subchondral cortical bone was greatest, and pressure and flow velocity around the trabecular defect were lowest. As osteoarthritis develops, the osteochondral unit becomes more permeable, and the pressure of the interstitial fluid decreases while the flow rate increases, resulting in severe nutrient loss. This may be the fluid flow mechanism behind osteochondral defects and osteoarthritis.

Compressive mechanical properties of dry antler cortical bone cylinders from different cervidae species

Antlers are bony structures composed predominantly of primary osteons with unique mechanical properties due to their specific use by deer as weapon and shield. Antler bone fracture resistance has attracted prior scrutiny through experimental tests and theoretical models. To characterize antler mechanical properties, compression of cubes, or bending or tensioning of rectangular bars have been performed in the literature with variations in the protocols precluding comparisons of the data. Compression testing is a widely used experimental technique for determining the mechanical properties of specimens excised from cortical or cancellous regions of bone. However, the recommended geometry for compression tests is the cylinder, being more representative of the real performances of the material. The purpose of research was to report data for compressive strength and stiffness of antler cortical bone following current guidelines. Cylinders (n = 296) of dry antler cortical bone from either the main beam or the tines of Cervus elaphus, Rangifer tarandus, Cervus nippon and Damadama were tested. This study highlights the fact that compression of antler cortical bone cylinders following current guidelines is feasible but not applicable in all species. Standardization of the testing protocols could help to compare data from the literature. This study also confirms that sample localization has no effect on the mechanical properties, that sample density has a significant impact and allows enriching the knowledge of the mechanical properties of dry antler cortical bone.

Drying irreversibly affects the elastic behavior of pelvic cortical bone

Various studies have shown that the water content affects the elastic behavior of cortical bone. However, there is disagreement regarding the reversibility of the elastic behavior with rewetting. This study investigates this issue using an intrinsic approach, i.e., moisture manipulation and material testing were always carried out on the same specimen. The test results were then evaluated separately for each of several specimens. In total, 24 specimens of human cortical bone from the ischiopubic ramus were examined. The water content was varied in 11 steps, and the corresponding elastic moduli were determined using three-point bending tests within the elastic range. Moisture adjustment was achieved mainly using desiccators, accelerated by forced convection. Reference samples stored in the same manner were evaluated microscopically. The experiments confirmed the known correlation between water content reduction and stiffness increase of cortical bone. Complete drying increased the elastic modulus by about 83 %. By rewetting, the stiffness was significantly reduced again, though not only to the initial state, but even about 24 % below this. Thus, an irreversible alteration of the elastic behavior was observed. Decay of the reference samples was not observed. Therefore, decay is not the main reason for the significant loss of stiffness. In terms of the storage conditions for cortical bone specimens, an environment with 100 % relative humidity yielded the best match with the initial state. This storage method can therefore be recommended for biomechanical specimens used to determine in-vivo-like material parameters.

Impact of heavy alcohol consumption on cortical bone mechanical properties in male rhesus macaques

Chronic heavy alcohol consumption may influence the skeleton by suppressing intracortical bone remodeling which may impact the quality of bone and its mechanical properties. However, this aspect has not been thoroughly assessed in either humans or animal models whose cortical bone microstructure resembles the microstructure of human cortical bone. The current study is the first to investigate the effects of chronic heavy alcohol consumption on various mechanical properties of bone in a non-human primate model with intracortical remodeling. Male rhesus macaques (5.3 years old at the initiation of treatment) were induced to drink alcohol and then given the choice to voluntarily self-administer water or ethanol (4 % w/v) for approximately 14 months, followed by three abstinence phases (lasting 34, 41, and 39-46 days) with approximately 3 months of ethanol access in between. During the initial 14 months of open-access, monkeys in the alcohol group consumed an average of 2.9 ± 0.8 g/kg/d ethanol (mean ± SD) resulting in a blood ethanol concentration of 89 ± 47 mg/dl in longitudinal samples taken at 7 h after the daily sessions began. To understand the impact of alcohol consumption on material properties, various mechanical tests were conducted on the distal tibia diaphysis of 2-5 monkeys per test group, including dynamic mechanical analysis (DMA) testing, nano-indentation, microhardness testing, compression testing, and fracture resistance curve (R-curve) testing. Additionally, compositional analyses were performed using Fourier-transform infrared (FTIR) spectroscopy. Significant differences in microhardness, compressive stress-strain response, and composition were not observed with alcohol consumption, and only minor differences were detected in hardness and elastic modulus of the matrix and osteons from nanoindentation. Furthermore, the R-curves of both groups overlapped, with similar crack initiation toughness, despite a significant decrease in crack growth toughness (p = 0.032) with alcohol consumption. However, storage modulus (p = 0.029) and loss factor (p = 0.015) from DMA testing were significantly increased in the alcohol group compared to the control group, while loss modulus remained unchanged. These results indicate that heavy alcohol consumption may have only a minor influence on the material properties and the composition of cortical bone in young adult male rhesus macaques.

Effectiveness of maxillary cortical bone graft chips harvested by bone scraper, covered with platelet-rich fibrin (PRF), in reconstruction of alveolar clefts: comparative study

PURPOSE

The aim of this study is to assess the effectiveness of maxillary cortical bone graft chips harvested by bone scraper, covered with platelet-rich fibrin (PRF) in alveolar clefts.

PATIENTS AND METHODS

Seventy-two cleft patients were examined for their eligibility to be part in this comparative study; they were randomly divided into group A, thirty-six patients had received cancellous bone chips from iliac crest; group B, thirty-six had received cortical bone chips harvested from maxilla using a curved bone scraper, covered with PRF. The clinical success over the follow-up period was evaluated on the basis of elimination of the oronasal fistula, radiographic assessment of bone graft volume, achievement of the osseous continuity of the alveolar arch, and the extent of the vertical bone height.

RESULTS

The mean of volume gained in group A was 0.8053 ± 0.9682, while for group B was 0.7397 ± 0.7703. The amount of vertical bone loss between groups was registered, and the chi-square test revealed insignificant differences between study groups (p = 0.547). The result of the frequency of fistula development after grafting in both groups was insignificant (p = 0.074). Also, for the continuity of the maxilla as a one piece, the results were insignificant differences between study groups (p = 0.058).

CONCLUSION

In conclusion of our study, intraoral harvesting of maxillary cortical chips by bone scraper covered with PRF is able to achieve a valid functional and aesthetic support in alveolar cleft patients, meeting the reconstructive goals.

How osteons form: A quantitative hypothesis-testing analysis of cortical pore filling and wall asymmetry

Osteon morphology provides valuable information about the interplay between different processes involved in bone remodelling. The correct quantitative interpretation of these morphological features is challenging due to the complexity of interactions between osteoblast behaviour, and the evolving geometry of cortical pores during pore closing. We present a combined experimental and mathematical modelling study to provide insights into bone formation mechanisms during cortical bone remodelling based on histological cross-sections of quiescent human osteons and hypothesis-testing analyses. We introduce wall thickness asymmetry as a measure of the local asymmetry of bone formation within an osteon and examine the frequency distribution of wall thickness asymmetry in cortical osteons from human iliac crest bone samples from women 16-78 years old. Our measurements show that most osteons possess some degree of asymmetry, and that the average degree of osteon asymmetry in cortical bone evolves with age. We then propose a comprehensive mathematical model of cortical pore filling that includes osteoblast secretory activity, osteoblast elimination, osteoblast embedment as osteocytes, and osteoblast crowding and redistribution along the bone surface. The mathematical model is first calibrated to symmetric osteon data, and then used to test three mechanisms of asymmetric wall formation against osteon data: (i) delays in the onset of infilling around the cement line; (ii) heterogeneous osteoblastogenesis around the bone perimeter; and (iii) heterogeneous osteoblast secretory rate around the bone perimeter. Our results suggest that wall thickness asymmetry due to off-centred Haversian pores within osteons, and that nonuniform lamellar thicknesses within osteons are important morphological features that can indicate the prevalence of specific asymmetry-generating mechanisms. This has significant implications for the study of disruptions of bone formation as it could indicate what biological bone formation processes may become disrupted with age or disease.

Acidic Osteoid Templates the Plywood Structure of Bone Tissue

Bone is created by osteoblasts that secrete osteoid after which an ordered texture emerges, followed by mineralization. Plywood geometries are a hallmark of many trabecular and cortical bones, yet the origin of this texturing in vivo has never been shown. Nevertheless, extensive in vitro work revealed how plywood textures of fibrils can emerge from acidic molecular cholesteric collagen mesophases. This study demonstrates in sheep, which is the preferred model for skeletal orthopaedic research, that the deeper non-fibrillar osteoid is organized in a liquid-crystal cholesteric geometry. This basophilic domain, rich in acidic glycosaminoglycans, exhibits low pH which presumably fosters mesoscale collagen molecule ordering in vivo. The results suggest that the collagen fibril motif of twisted plywood matures slowly through self-assembly thermodynamically driven processes as proposed by the Bouligand theory of biological analogues of liquid crystals. Understanding the steps of collagen patterning in osteoid-maturation processes may shed new light on bone pathologies that emerge from collagen physico-chemical maturation imbalances.

Comprehensively characterizing heterogeneous and transversely isotropic properties of femur cortical bones

Comprehensive characterization of the transversely isotropic mechanical properties of long bones along both the longitudinal and circumferential gradients is crucial for developing accurate mathematical models and studying bone biomechanics. In addition, mechanical testing to derive elastic, plastic, and failure properties of bones is essential for modeling plastic deformation and failure of bones. To achieve these, we machined a total of 336 cortical specimens, including 168 transverse and 168 longitudinal specimens, from four different quadrants of seven different sections of 3 bovine femurs. We conducted three-point bending tests of these specimens at a loading rate of 0.02 mm/s. Young's modulus, yield stress, tangential modulus, and effective plastic strain for each specimen were derived from correction equations based on classical beam theory. Our statistical analysis reveals that the longitudinal gradient has a significant effect on the Young's modulus, yield stress, and tangential modulus of both longitudinal and transverse specimens, whereas the circumferential gradient significantly influences the Young's modulus, yield stress, and tangential modulus of transverse specimens only. The differences in Young's modulus and yield stress between longitudinal specimens from different sections are greater than 40%, whereas those between transverse specimens are approximately 30%. The Young's modulus and yield stress of transverse specimens in the anterior quadrant were 18.81%/15.46% and 18.34%/14.88% higher than those in the posterior and lateral quadrants, respectively. There is no significant interaction between the longitudinal gradient and the circumferential gradient. Considering the transverse isotropy, it is crucial to consider loading direction when investigating the impact of circumferential gradients in the anterior, lateral, medial, and posterior directions. Our findings indicate that the conventional assumption of homogeneity in simulating the cortical bone of long bones may have limitations, and researchers should consider the anatomical position and loading direction of femur specimens for precise prediction of mechanical responses.

Effectiveness and safety of robot-assisted versus fluoroscopy-assisted cortical bone trajectory screw instrumentation in spinal surgery: a systematic review and meta-analysis

Robot-assisted (RA) technology has been shown to be a safe aid in spine surgery, this meta-analysis aims to compare surgical parameters and clinical indexes between robot-assisted cortical bone trajectory (CBT) and fluoroscopy-assisted (FA) cortical bone trajectory in spinal surgery. We searched databases such as PubMed, Web of Science, the Cochrane Library, and the China National Knowledge Infrastructure. The study selection process was guided by the PICOS (Patient/Problem, Intervention, Comparison, Outcome, Study Design) strategy. The risk of bias in non-randomized comparative studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. We performed this meta-analysis using RevMan 5.3 software (Cochrane Collaboration, Copenhagen, Denmark), and the level of statistical significance was set at P < 0.05. Six articles involving 371 patients and 1535 screws were included in this meta-analysis. RA-CBT outperformed FA-CBT in terms of various parameters, such as accuracy of pedicle screw position (both Gertzbein-Robbins scale and Ding scale), avoidance of superior facet joint violation (FJV), and reduction of neurological injury. Our meta-analysis offered a thorough evaluation of the efficacy and safety of RA-CBT in spinal surgery. The findings revealed that RA-CBT produced statistically significant results in terms of pedicle screw position accuracy and superior facet joint violation prevention. In terms of surgical parameters and clinical indexes, future research and clinical practice should investigate the efficacy of RA-CBT further. The study was registered in the PROSPERO (CRD42023466280).

Cortical bone thickness on preoperative CT scans as predictor of bone quality in distal femur fractures: a retrospective study in Caucasians

AIM

Distal femur fractures (DFF) are rare, but associated with high complication rates and mortality, particularly in patients with osteoporosis. To improve preoperative assessment, we analyzed if cortical bone thickness on CT and AP radiographs is associated with clinical parameters of bone quality.

METHODS

Retrospective single-center study of adult patients presenting at a level-one trauma center, with a DFF between 2011 and 2020. Clinical parameters for bone quality, such as age, sex, body mass index (BMI), energy impact level of trauma, and known history of osteoporosis, were assessed. Mean cortical bone thickness (CBTavg) on AP radiograph was determined using a previously published method. Cortical thickness on CT scan was measured at 8 and 14 cm proximal to the articular surface of the lateral condyle.

RESULTS

71 patients (46 females) between 20 and 100 years were included in the study. Cortical thickness determined by CT correlated significantly with CBTavg measurements on AP radiograph (Spearman r = 0.62 to 0.80; p < 0.001). Cortical thickness was inversely correlated with age (Spearman r = - 0.341 to - 0.466; p < 0.001) and significantly associated with trauma impact level and history of osteoporosis (p =  < 0.001). The CT-based values showed a stronger correlation with the clinical parameters than those determined by AP X-ray.

CONCLUSION

Our results showed that cortical thickness of the distal femur correlates with clinical parameters of bone quality and is therefore an excellent tool for assessing what surgical care should be provided. Interestingly, our findings indicate that cortical thickness on CT is more strongly correlated with clinical data than AP radiograph measurements.

Cooling Efficiency of Sleeveless 3D-Printed Surgical Guides with Different Cylinder Designs

Background and Objectives: Surgical guides might impede the flow of coolant to the implant drills during the preparation of the implant bed, potentially contributing to increased temperatures during bone drilling. The objective of this experimental study was to assess the cooling efficiency of various guiding cylinder designs for sleeveless surgical guides used in guided surgery. Materials and Methods: In this experimental study, surgical guides with three different guiding cylinder designs were printed. One group had solid cylinders (control) and two test groups (cylinders with pores and cylinders with windows). Forty customized polyurethane blocks with type III bone characteristics were fitted into the guide and fixed in a vise, and implant bed preparations were completed using a simplified drilling protocol with and without irrigation. An infrared thermographic camera was used to record the temperature changes during drilling at the coronal, middle, and apical areas. ANOVA test and Games-Howell post hoc test were used to determine significant thermal differences among groups. Results: A significant thermal increase was observed at the coronal area in the group without irrigation (39.69 ± 8.82) (p < 0.05). The lowest thermal increase was recorded at the surgical guides with windows (21.451 ± 0.703 °C) compared to solid (25.005 ± 0.586 °C) and porous surgical guides (25.630 ± 1.004) (p < 0.05). In the middle and apical areas, there were no differences between solid and porous cylinders (p > 0.05). Conclusions: 3D-printed sleeveless surgical guides with window openings at the guiding cylinders reduce the temperature elevation at the cortical bone in guided implant surgery.

Effect of gamma irradiation and supercritical carbon dioxide sterilization with Novakill™ or ethanol on the fracture toughness of cortical bone

Sterilization of structural bone allografts is a critical process prior to their clinical use in large cortical bone defects. Gamma irradiation protocols are known to affect tissue integrity in a dose dependent manner. Alternative sterilization treatments, such as supercritical carbon dioxide (SCCO2 ), are gaining popularity due to advantages such as minimal exposure to denaturants, the lack of toxic residues, superior tissue penetration, and minor impacts on mechanical properties including strength and stiffness. The impact of SCCO2 on the fracture toughness of bone tissue, however, remains unknown. Here, we evaluate crack initiation and growth toughness after 2, 6, and 24 h SCCO2 -treatment using Novakill™ and ethanol as additives on ~11 samples per group obtained from a pair of femur diaphyses of a canine. All mechanical testing was performed at ambient air after 24 h soaking in Hanks' balanced salt solution (HBSS). Results show no statistically significant difference in the failure characteristics of the Novakill™-treated groups whereas crack growth toughness after 6 and 24 h of treatment with ethanol significantly increases by 37% (p = .010) and 34% (p = .038), respectively, compared to an untreated control group. In contrast, standard 25 kGy gamma irradiation causes significantly reduced crack growth resistance by 40% (p = .007) compared to untreated bone. FTIR vibrational spectroscopy, conducted after testing, reveals a consistent trend of statistically significant differences (p < .001) with fracture toughness. These trends align with variations in the ratios of enzymatic mature to immature crosslinks in the collagen structure, suggesting a potential association with fracture toughness. Additional Raman spectroscopy after testing shows a similar trend with statistically significant differences (p < .005), which further supports that collagen structural changes occur in the SCF-treated groups with ethanol after 6 and 24 h. Our work reveals the benefits of SCCO2 sterilization compared to gamma irradiation.

Mouse Lumbar Vertebra Uniaxial Compression Testing with Embedding of the Loading Surface

There is increasing awareness that cortical and cancellous bone differ in regulating and responding to pharmaceutical therapies, hormone therapies, and other treatments for age-related bone loss. Three-point bending is a common method used to assess the influence of a treatment on the mid-diaphysis region of long bones, which is rich in cortical bone. Uniaxial compression testing of mouse vertebrae, though capable of assessing bones rich in cancellous bone, is less commonly performed due to technical challenges. Even less commonly performed is the pairing of three-point bending and compression testing to determine how a treatment may influence a long bone's mid-diaphysis region and a vertebral centrum similarly or differently. Here, we describe two procedures to make compression testing of mouse lumbar vertebrae a less challenging method to perform in parallel with three-point bending: first, a procedure to convert a three-point bending machine into a compression testing machine, and second, an embedding method for preparing a mouse lumbar vertebra loading surface.

Effect of inelastic deformation on strain rate-dependent mechanical behaviour of human cortical bone

In this study, the role of inelastic deformation of bone on its strain rate-dependent mechanical behaviour was investigated. For this, human cortical bone samples were cyclically loaded to accumulate inelastic strain and subsequently, mechanical response was investigated under compressive loading at different strain rates. The strain rate behaviour of fatigued samples was compared with non-loaded control samples. Furthermore, cyclic loading-induced microdamage was quantified through histological analysis. The compression test results show that the strength of fatigue-loaded bone reduced significantly at low strain rates but not at high strain rates. The difference in microcrack density was not significant between fatigued and control groups. The results indicate that the mechanism of load transfer varies between low strain rate and high strain rate regimes. The inelastic deformation mechanisms are more prominent at low strain rates but not at high strain rates. This study shed light on the role of inelastic deformation on the rate-dependent behaviour of cortical bone.

Prediction of the critical energy release rate for rat femoral cortical bone structure under different failure conditions

BACKGROUND AND OBJECTIVE

Critical energy release rate is a global fracture parameter that could be measured during the failing process, and its value may change under different failure conditions even in the same bone structure. The aim of this study was to propose an approach that combined the experimental test and finite element analysis to predict the critical energy release rates in the femoral cortical bone structures under compression and three-point bending loads.

METHODS

Three-point bending and compression experiments and the corresponding fracture simulations were performed on the rat femoral cortical bone structures. Different values of energy release rate were repeatedly assigned to the finite element models to perform fracture simulations, and then the load-displacement curves predicted in each simulation were compared with the experimental data to back-calculate the critical energy release rate.

RESULTS

The predicted data were similar to the experimental results when the calibrated energy release rate was suitable. The results showed that the cortical bone structure occurred shear open failure under compression load, and the predicted critical energy release rate was 0.12 N/mm. The same cortical bone structure occurred tensile open failure under three-point bending load, and the predicted critical energy release rate was 0.16 N/mm.

CONCLUSIONS

The critical energy release rates were different under various failure conditions in one cortical bone structure. A comprehensive analysis from the perspectives of material mechanical properties, failure mode, and damage fracture mechanism was conducted to reveal the reasons for the differences in the critical energy release rate in the cortical bone structure, which provided a theoretical basis for the measurement of the critical energy release rate and the accurate fracture simulation.

Cortical Endplate Bone Density Measured by Novel Phantomless Quantitative Computed Tomography May Predict Cage Subsidence more Conveniently and Accurately

OBJECTIVE

Previous studies have shown that bone mineral density (BMD) is a predictor of cage subsidence. Phantom-less quantitative computed tomography (PL-QCT) can measure volumetric bone mineral density (vBMD) of lumbar trabecular and cortical bone. The study of endplate vBMD (EP-vBMD) is important in predicting cage settlement after extreme lateral interbody fusion (XLIF). This study aimed to determine the risk factors for postoperative cage subsidence after XLIF, particularly focusing on the relationship between vBMD measured by automatic PL-QCT and cage subsidence.

METHODS

Patients who underwent XLIF surgery from January 2018 to October 2020 with a minimum of 6 months of follow-up were retrospectively included. Cage subsidence was defined as >2 mm cage sinking on the adjacent endplate in follow-up imaging evaluation. Outcome measures were localized vBMDs included EP-vBMDs with different region of interest (ROI) heights measured by PL-QCT based on a customized muscle-fat algorithm. Shapiro-Wilk test, one-way ANOVA, Mann-Whitney test, Fisher exact test, univariable and multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were executed in this study.

RESULTS

One hundred and thirteen levels of 78 patients were included in the analysis. The mean age was 65 ± 7.9 years for 11 males and 67 females. Cage subsidence occurred on 45 (39.8%) surgical levels. There was no significant difference in demographics, fused levels, or preoperative radiographic parameters. 1.25-mm EP-vBMD (0.991 [0.985,0.997], p = 0.004) and P-TB-vBMD (cage-positioned trabecular volumetric bone mineral density) (0.988 [0.977-0.999], p = 0.026) were cage-subsidence relevant according to univariate analysis. Low 1.25-mm EP-vBMD (0.992 [0.985, 0.999], p = 0.029) was an independent risk factor according to multifactorial analysis.

CONCLUSION

Preoperative low EP-vBMD was an independent risk factor for postoperative cage subsidence after XLIF. EP-vBMD measured by most cortex-occupied ROI may be the optimal vBMD parameter for cage subsidence prediction.

Dietary supplementation with nacre reduces cortical bone loss in aged female mice

Aging is associated with detrimental bone loss leading to fragility fractures in both men and women. Notably, a majority of bone loss with aging is cortical, as well as a large number of fractures are non-vertebral and at the non-hip sites. Nacre is a product of mollusks composed of calcium carbonate embedded in organic components. As our previous study demonstrated the protective effect of nacre supplementation on trabecular bone loss in ovariectomized rats, we sought to evaluate the effect of dietary nacre on bone loss related to aging in female mice which do not suffer true menopause as observed in women. The current study compared the effect of a 90-day long nacre-supplemented diet to that of Standard or CaCO3 diets on both bone mass and strength in 16-month-old C57BL/6 female mice. Multiple approaches were performed to assess the microarchitecture and mechanical properties of long bones, analyze trabecular histomorphometry, and measure bone cell-related gene expressions, and bone turnover markers. In the cortex, dietary nacre improved cortical bone strength in line with lower expression levels of genes reflecting osteoclasts activity compared to Standard or CaCO3 diets (p < 0.05). In the trabeculae, nacre-fed mice were characterized by a bone remodeling process more active than the other groups as shown by greater histomorphometric parameters and osteoblast-related gene expressions (p < 0.05). But these differences were not exhibited at the level of the trabecular microarchitecture at this age. Collectively, these data suggest that dietary nacre should be a potential candidate for reducing aging-associated cortical bone loss in the elderly.

Effect of in vitro ribosylation on the dynamic fracture behavior of mature bovine cortical bone

In this study, the fracture behavior of ribosylated bovine cortical bone is investigated under loading conditions simulating a fall event. Single edge notched specimens, separated into a control group (n = 11) and a ribosylated group (n = 8), were extracted from the mid-diaphysis of a single bovine femur harvested from a mature cow. A seven-day ribosylation process results in the accumulation of Advanced-Glycation End Products (AGEs) cross-links and AGE adducts. Specimens were subjected to symmetric three point bending (opening mode) and an impact velocity of 1.6 m/s using a drop tower. Near-crack displacement fields up to fracture initiation are determined from high-speed images post-processed using digital image correlation. A constrained over-deterministic least squares regression and orthotropic material linear elastic fracture mechanics theory are used to extract the in-plane critical stress intensity factors at fracture initiation (i.e., fracture initiation toughness values). Statistically significant differences were not observed when comparing the in-plane fracture initiation toughness values (p≥0.96) or energy release rate (p=0.90) between the control and seven-day ribosylated groups. The intrinsic variability of bone may require high sample numbers in order to achieve an adequately powered experiment when assessing dynamic fracture behavior. While there are no detectable differences due to the ribosylation treatment investigated, this is likely due to the limited sample sizes utilized.

[Measurement of cortical bone thickness of zygomatic alveolar ridge in adolescents by Cone-beam CT and its correlation with cervical vertebral bone age]

PURPOSE

To measure the cortical bone thickness of zygomatic alveolar ridge in adolescents and explore the correlation between cortical bone thickness and cervical vertebral bone age.

METHODS

Cone-beam CT data of 80 adolescents were collected, including 20 adolescents with cervical vertebral bone ages of Cvs3, Cvs4, Cvs5 and Cvs6, respectively. CBCT images were reconstructed with the maxillary occlusal plane as the reference plane. Cortical bone thickness of different slices in the left maxillary zygomatic alveolar ridge area was measured in the direction parallel to and 60° from the reference plane, and the measured data were statistically analyzed by SPSS 21.0 software package.

RESULTS

When the measurement direction was parallel to the reference plane and at 60°, the cortical bone thickness in the zygomatic alveolar ridge area of Cvs3-Cvs6 adolescents was (0.90±0.09) -(1.72±0.21) mm and (1.35±0.44)-(3.98±1.48) mm, respectively. There was significant difference in cortical bone thickness between Cvs4 and Cvs5 group(P＜0.05). Spearman correlation analysis showed a strong positive correlation(P＜0.01) between cortical bone thickness of zygomatic alveolar ridge and cervical vertebral bone age in adolescents.

CONCLUSIONS

The cortical bone thickness of zygomatic alveolar ridge in adolescents increases with the increase of cervical vertebral bone age, and the cortical bone thickness may increase significantly during Cvs4-Cvs5. In terms of cortical bone thickness, all slices of zygomatic alveolar ridge of CVS3-CVS6 adolescents are suitable for implanting miniscrews, and the anterior slices should be selected for implantation as far as possible for Cvs3 and Cvs4 adolescents.

Chronic hypoparathyroidism is associated with increased cortical bone density evaluated using high-resolution peripheral quantitative computed tomography

PURPOSE

This cross-sectional study aimed to assess bone mineral density (BMD), bone microarchitecture and fracture prevalence in women with chronic postsurgical hypoparathyroidism (hypoPT).

METHODS

Twenty-seven women with postsurgical hypoPT and 44 age-matched healthy women were included. Dual-energy X-ray absorptiometry was used to evaluate areal BMD and vertebral fracture assessment. High-resolution peripheral quantitative computed tomography assessed microarchitecture and volumetric BMD at the distal radius and tibia. Biochemical parameters, including fibroblast growth factor 23, C-terminal cross-linking telopeptide of type I collagen (ICTP), and procollagen type I N-terminal propeptide (P1NP), were also measured. Previous low-impact fractures were assessed and the 10-year fracture risk was estimated using the FRAX tool for the Brazilian population.

RESULTS

No participant had prevalent clinical fractures, and both groups showed low risk for major and hip based on FRAX tool, but two hypoPT patients had moderate to severe morphometric vertebral fractures. Women with hypoPT had increased aBMD in the lumbar spine, femoral neck and total hip (p < 0.05) and higher cortical vBMD in the radius (p = 0.020) and tibia (p < 0.001). Trabecular bone was not affected. Both P1NP and ICTP suggested low bone turnover rates, but no significant correlation was observed between bone density or microstructure and any of the biochemical parameters.

CONCLUSIONS

The prevalence of fragility fractures was low in HypoPT women and compatible with low fracture risk estimated by the FRAX tool. Patients had a higher aBMD and cortical vBMD than those of healthy control women, but the association with decreased bone turnover remains unclear.

Creating a Box-Cavity Defect Model in the Cortical Bone of Rat Femora

Severe bone defects or complex fractures can result in serious complications such as nonunion or insufficient bone healing. Tissue engineering, which involves the application of cells, scaffolds, and cytokines, is considered a promising solution for bone regeneration. Consequently, various animal models that simulate bone defects play a crucial role in exploring the therapeutic potential of tissue engineering for bone healing. In this study, we established a box-shaped cortical bone defect model in the mid-femur of rats, which could serve as an ideal model for assessing the function of biomaterials in promoting bone healing. This box-shaped cortical bone defect was drilled using an oral low-speed handpiece and shaped by a lathe needle. Post-operative micro-CT analysis was immediately conducted to confirm the successful establishment of the box-cavity cortical bone defect. The femurs on the operated side of the rats were then harvested at multiple time points post-surgery (0 days, 2 weeks, 4 weeks, and 6 weeks). The healing process of each sample's defect area was evaluated using micro-CT, hematoxylin and eosin (H&E) staining, and Masson trichrome staining. These results demonstrated a healing pattern consistent with intramembranous ossification, with healing essentially complete by 6 weeks. The categorization of this animal model's healing process provides an effective in vivo method for investigating novel biomaterials and drugs that target intramembranous ossification during bone tissue defect healing.

Cervical kyphosis surgery using a cervical pedicle screw placed with a U-shaped wire that enables observation of the lateral edge of the cortical bone of the spinal canal: A case report and literature review

RATIONALE

A cervical pedicle screw (CPS) serves as an important anchor for cervical surgeries. Its placement requires the development of a highly safe and easy-to-handle method. Considering that the lateral end of the cortical bone of the spinal canal (LE point) is the most crucial for CPS placement, we devised a U-shaped wire capable of identifying LE points under direct vision and reliably confirming the site with C-arm lateral fluoroscopy.

PATIENT CONCERNS

A 65-year-old male, who had been aware of numbness in both hands, mild finger dexterity disorder, and gait disturbance for half a year, visited our hospital due to the progression of his symptoms in the previous 2 months.

DIAGNOSIS

The patient presented with mild muscle weakness and tendon hyperreflexia in the upper and lower extremities on both sides, and magnetic resonance imaging revealed moderate spinal canal stenosis at the C4/5 and 5/6 levels. Based on the local third cervical vertebra (C3)/4 angle of -10 degrees and the C2/7 angle of -15 degrees, the patient was diagnosed with cervical myelopathy with cervical kyphosis. He had a Japanese Orthopaedic Association score for cervical myelopathy of 10.

INTERVENTIONS

We placed CPSs at C3 using a U-shaped wire. After placing an anchor in the range of C3-T1, laminectomy from C4 to C7 was performed. Subsequently, corrective fixation was performed to reduce kyphosis, followed by bone grafting in the range of C3-T1 and complete posterior cervical decompression fixation.

OUTCOMES

The CPSs were placed at C3 without deviation and intra- or postoperative complications. The surgery resulted in improvement in kyphosis with a C2/7 angle of -5 degrees and recovery in spinal cord disorder with a Japanese Orthopedic Association score for cervical myelopathy of 13.

LESSONS

A U-shaped wire, which can be prepared inexpensively and easily, is a useful tool, especially for inexperienced surgeons, for safe CPS placement by capture of LE points accurately.

Altered Osteogenic Differentiation in Mesenchymal Stem Cells Isolated from Compact Bone of Chicken Treated with Varying Doses of Lipopolysaccharides

Persistent inflammation biologically alters signaling molecules and ultimately affects osteogenic differentiation, including in modern-day broilers with unique physiology. Lipopolysaccharides (LPS) are Gram-negative bacterial components that activate cells via transmembrane receptor activation and other molecules. Previous studies have shown several pathways associated with osteogenic inductive ability, but the pathway has yet to be deciphered, and data related to its dose-dependent effect are limited. Primary mesenchymal stem cells (MSCs) were isolated from the bones of day-old broiler chickens, and the current study focused on the dose-dependent variation (3.125 micrograms/mL to 50 micrograms/mL) in osteogenic differentiation and the associated biomarkers in primary MSCs. The doses in this study were determined using a cell viability (MTT) assay. The study revealed that osteogenic differentiation varied with dose, and the cells exposed to higher doses of LPS were viable but lacked differentiating ability. However, this effect became transient with lower doses, and this phenotypic character was observed with differential staining methods like Alizarin Red, Von Kossa, and alkaline phosphatase. The data from this study revealed that LPS at varying doses had a varying effect on osteogenic differentiation via several pathways acting simultaneously during bone development.

Method for Evaluating Cortical Bone Young's Modulus: Numerical Twin Reconstruction, Finite Element Calculation, and Microstructure Analysis

The determination of bone mechanical properties remains crucial, especially to feed up numerical models. An original methodology of inverse analysis has been developed to determine the longitudinal elastic modulus of femoral cortical bone. The method is based on a numerical twin of a specific three-point bending test. It has been designed to be reproducible on each test result. In addition, the biofidelity of the geometric acquisition method has been quantified. As the assessment is performed at the scale of a bone shaft segment, the Young's modulus values obtained (between 9518.29 MPa and 14181.15 MPa) are considered average values for the whole tissue, highlighting some intersubject variability. The material microstructure has also been studied through histological analysis, and bone-to-bone comparisons highlighted discrepancies in quadrants microstructures. Furthermore, significant intrasubject variability exists since differences between the bone's medial-lateral and anterior-posterior quadrants have been observed. Thus, the study of microstructures can largely explain the differences between the elastic modulus values obtained. However, a more in-depth study of bone mineral density would also be necessary and would provide some additional information. This study is currently being setup, alongside an investigation of the local variations of the elastic modulus.

The biomechanical and biological effect of supercooling on cortical bone allograft

BACKGROUND

The need for a storage method capable of preserving the intrinsic properties of bones without using toxic substances has always been raised. Supercooling is a relatively recently introduced preservation method that meets this need. Supercooling refers to the phenomenon of liquid in which the temperature drops below its freezing point without solidifying or crystallizing.

OBJECTIVES

The purpose of this study was to identify the preservation efficiency and applicability of the supercooling technique as a cortical bone allograft storage modality.

METHODS

The biomechanical effects of various storage methods, including deep freezing, cryopreservation, lyophilization, glycerol preservation, and supercooling, were evaluated with the three-point banding test, axial compression test, and electron microscopy. Additionally, cortical bone allografts were applied to the radial bone defect in New Zealand White rabbits to determine the biological effects. The degree of bone union was assessed with postoperative clinical signs, radiography, micro-computed tomography, and biomechanical analysis.

RESULTS

The biomechanical properties of cortical bone grafts preserved using glycerol and supercooling method were found to be comparable to those of normal bone while also significantly stronger than deep-frozen, cryopreserved, and lyophilized bone grafts. Preclinical research performed in rabbit radial defect models revealed that supercooled and glycerol-preserved bone allografts exhibited significantly better bone union than other groups.

CONCLUSIONS

Considering the biomechanical and biological superiority, the supercooling technique could be one of the optimal preservation methods for cortical bone allografts. This study will form the basis for a novel application of supercooling as a bone material preservation technique.

Daily administration of parathyroid hormone slows the progression of basic multicellular units in the cortical bone of the rabbit distal tibia

Basic Multicellular Units (BMUs) conduct bone remodeling, a critical process of tissue turnover which, if imbalanced, can lead to disease, including osteoporosis. Parathyroid hormone (PTH 1-34; Teriparatide) is an osteoanabolic treatment for osteoporosis; however, it elevates the rate of intra-cortical remodeling (activation frequency) leading, at least transiently, to increased porosity. The purpose of this study was to test the hypothesis that PTH not only increases the rate at which cortical BMUs are initiated but also increases their progression (Longitudinal Erosion Rate; LER). Two groups (n = 7 each) of six-month old female New Zealand white rabbits were both administered 30 μg/kg of PTH once daily for a period of two weeks to induce remodeling. Their distal right tibiae were then imaged in vivo by in-line phase contrast micro-CT at the Canadian Light Source synchrotron. Over the following two weeks the first group (PTH) received continued daily PTH while the second withdrawal group (PTHW) was administrated 0.9 % saline. At four weeks all animals were euthanized, their distal tibiae were imaged by conventional micro-CT ex vivo and histomorphometry was performed. Matching micro-CT datasets (in vivo and ex vivo) were co-registered in 3D and LER was measured from 612 BMUs. Counter to our hypothesis, mean LER was lower (p < 0.001) in the PTH group (30.19 ± 3.01 μm/day) versus the PTHW group (37.20 ± 2.77 μm/day). Despite the difference in LER, osteonal mineral apposition rate (On.MAR) did not differ between groups indicating the anabolic effect of PTH was sustained after withdrawal. The slowing of BMU progression by PTH warrants further investigation; slowed resorption combined with elevated bone formation rate, may play an important role in how PTH enhances coupling between resorption and formation within the BMU. Finally, the prolonged anabolic response following withdrawal may have utility in terms of optimizing clinical dosing regimens.

Biomechanical comparison of compact versus standard flute drill bits, and interlocking versus buttress thread self-tapping cortical bone screws in cadaveric equine third metacarpal condyle

OBJECTIVES

To compare (1) performance of compact versus standard flute drill bits, (2) screw insertion properties and (3) pullout variables between interlocking thread (ITS) and buttress thread (BTS) self-tapping screws in third metacarpi.

STUDY DESIGN

In vitro experimental study.

SAMPLE POPULATION

Paired third metacarpi from 11 Thoroughbreds aged 2-4 years.

METHODS

Screws were inserted into the lateral condylar fossae following bone preparation using the respective drill bit for each screw type. Screw pullout was achieved using a mechanical testing system. Density and porosity of bone surrounding screw holes was measured with microcomputed tomography following each pullout test. Drilling, screw insertion and pullout variables were compared between drill bit and screw types using repeated measures ANOVA. Linear regression analyses were used to characterize relationships between bone tissue properties and drill bit and screw outcomes.

RESULTS

Maximum torque power spectral density (PSD) was lower for compact flute drill bits. Insertion torque was 50% higher for ITS. BTS had 33% greater preyield stiffness and 7% greater mean yield force. Bone tissue properties affected measured variables similarly for both screw and drill bit types.

CONCLUSIONS

Lower torque PSD may increase durability of the compact flute drill bit. ITS had greater insertional torque, which may reflect greater bone engagement. BTS had greater resistance to axial pullout forces.

CLINICAL SIGNIFICANCE

Metacarpal bone provides a simple model for comparison of drill bit and screw designs. Use of ITS to repair equine fractures subject to predominantly tensile forces is not justified based on the results of this study.

Cortical bone distribution of the proximal phalanges in great apes: implications for reconstructing manual behaviours

Primate fingers are typically in direct contact with the environment during both locomotion and manipulation, and aspects of external phalangeal morphology are known to reflect differences in hand use. Since bone is a living tissue that can adapt in response to loading through life, the internal bone architecture of the manual phalanges should also reflect differences in manual behaviours. Here, we use the R package Morphomap to analyse high-resolution microCT scans of hominid proximal phalanges of digits 2-5 to determine whether cortical bone structure reflects variation in manual behaviours between bipedal (Homo), knuckle-walking (Gorilla, Pan) and suspensory (Pongo) taxa. We test the hypothesis that relative cortical bone distribution patterns and cross-sectional geometric properties will differ both among extant great apes and across the four digits due to locomotor and postural differences. Results indicate that cortical bone structure reflects the varied hand postures employed by each taxon. The phalangeal cortices of Pongo are significantly thinner and have weaker cross-sectional properties relative to the African apes, yet thick cortical bone under their flexor sheath ridges corresponds with predicted loading during flexed finger grips. Knuckle-walking African apes have even thicker cortical bone under the flexor sheath ridges, as well as in the region proximal to the trochlea, but Pan also has thicker diaphyseal cortices than Gorilla. Humans display a distinct pattern of distodorsal thickening, as well as relatively thin cortices, which may reflect the lack of phalangeal curvature combined with frequent use of flexed fingered hand grips during manipulation. Within each taxon, digits 2-5 have a similar cortical distribution in Pongo, Gorilla and, unexpectedly, Homo, which suggest similar loading of all fingers during habitual locomotion or hand use. In Pan, however, cortical thickness differs between the fingers, potentially reflecting differential loading during knuckle-walking. Inter- and intra-generic variation in phalangeal cortical bone structure reflects differences in manual behaviours, offering a comparative framework for reconstructing hand use in fossil hominins.

Fractal analysis of the mandible cortical bone: correlation among fractal dimension values obtained by two processing methods from periapical radiograph and micro-computed tomography with cone-beam computed tomography

The objectives of the present study were to assess Fractal Dimension (FD) values in the mandible cortical bone obtained from digital periapical radiographs (DPR), high-resolution microtomography (µCT), and cone-beam computed tomography (CBCT), by two processing methods: binarization (FD.b) and grayscale-based method (FD.f) and, finally, to identify the correlation among these values with other micro-architectural parameters. For this, a prospective study was conducted on 18 healthy individuals (mean age 23 ± 2.4 years old) who underwent third molar extraction. Pre-operative CBCT scans were conducted, bone fragments were removed from the retro-molar region, and DPR and µCT were performed on those bone samples. FD.b and FD.f values were calculated using three parasagittal sections for CBCT, one image for DPR, and three sections for µCT. The 3D bone microarchitecture was analyzed in µCT (voxel size: 19 µm). As a result, FD.b mean values of 1.55 ± 0.02 and 1.80 ± 0.01 were obtained for CBCT and µCT, respectively. Furthermore, FD.f mean values of 1.22 ± 0.12 for DPR, 0.99 ± 0.04 for CBCT, and 1.30 ± 0.07 for µCT were obtained. Both FD.b and FD.f values showed a good agreement. FD.f was negatively correlated with the standard deviation of the mean gray value (p = 0.003) for DPR and intra-cortical bone surface (p = 0.02) for µCT. In conclusion, image processing with or without binarization revealed different values for FD, although showing agreement. The grayscale-based method retrieved FD values correlated with the gray levels and the cortical porous network, which means that FD can be a valuable index for mandibular cortical bone evaluation. FD is associated with mineralization and microarchitecture. Nevertheless, there was no correlation between FD values obtained from low- (DPR) and high-resolution (µCT) X-ray modalities with FD obtained from the in vivo CBCT.

General and local predictors of mandibular cortical bone morphology in adult females and males: the seventh survey of the Tromsø Study

OBJECTIVES

To analyze factors predicting mandibular cortical width (MCW) and mandibular cortical index (MCI) in adult females and males.

MATERIAL AND METHODS

Data on 427 females and 335 males aged 40-84 from The Tromsø study: Tromsø7 were used. T-score, age, menopausal status (for females), remaining teeth, and periodontal status were analyzed in linear and logistic regression analyses as predictors of MCW and MCI, respectively.

RESULTS

T-score, age, and the number of remaining teeth significantly predicted MCW in females but not males. Standardized β coefficients were 0.286, -0.231, and 0.131, respectively. The linear regression model explained 24% of MCW variation in females. MCI in females was significantly predicted by T-score, age, and remaining teeth with the Wald values of 9.65, 6.17, and 5.83, respectively. The logistic regression model explained 16.3-23% of the variation in MCI in females. In males, T-score was the only significant predictor of the eroded cortex, and the logistic model explained only 4.3-5.8% of the variation in MCI.

CONCLUSIONS

The T-score demonstrated a stronger relationship with MCW and MCI than other factors in females, which supports the usefulness of those indices for osteoporosis screening. Conversely, the T-score exhibited no association with MCW and remained the only significant predictor of MCI in males, yet to a lesser extent than in females.

CLINICAL RELEVANCE

Understanding factors affecting mandibular cortical morphology is essential for further investigations of MCW and MCI usefulness for osteoporosis screening in females and males.

Effect of breathing patterns on mandibular cortical bone quality in children and establishment of a preliminary screening model

OBJECTIVE

This retrospective study analyzed breathing patterns and age subgroups effect on cortical bone quality of the mandible in growing subjects, aiming to explore the application value of facial skeletal pattern combined with cortical bone density detection in early screening diagnosis of mouth breathing.

METHODS

One hundred twenty-six participants were divided into four groups: mouth breathing group (7-9, 10-12 years old) and nasal breathing group (7-9, 10-12 years old). The mandibular anterior, middle, and posterior cortical bone mineral density (CBMD), cortical bone width (MCW), ANB, and FMA values were measured. Independent T-test and Mann-Whitney U test were used to compare the measured values. Binary logistic regression was employed to analyze the correlation between measured variables and the children's breathing patterns. ROC analysis was used to determine the ability of the cortical bone density measurements in early screening diagnosis of MB.

RESULTS

Mouth breathing had a negative impact on CBMD and MCW of the pre-mandibular (Pog) in subjects aged 7-9 years and also impacted the development of (Pog) and submandibular (Me) sites in subjects aged 10-12 years. Older children in the nasal breathing group have higher CBMD, MCW, and SNB values and lower FMA values. Single-factor and multiple-factor logistic binary regression analysis showed that FMA, MSPogCBMD, MSPogMCW, and ANB are correlated factors for children at risk of mouth breathing.

CONCLUSION

Mouth breathing pattern is closely associated with decreased mandibular CBMD and MCW values in children aged 7-12, where the anterior (Pog) and inferior (Me) sites of anterior mandible are more significantly affected. Furthermore, in combination with facial skeletal pattern, it provides a basis for the early warning diagnosis of mouth breathing.

Effects of different factors on the friction and wear mechanical properties of titanium alloy materials with cortical bones at near service conditions

The artificial joint is one of the most effective methods to treat joint injuries. The service performance of artificial joints is gradually weakened because of the wear of artificial joints in actual service. In order to obtain the potential failure mechanism of the artificial joint in actual service, the study was carried out with the multiple factors that affect the service performance of the artificial joint. The experimental study was carried out on the change rule of mechanical behavior of the contact interface between the artificial joint of titanium alloy and cortical bone. The multi-factor is compression load, contact load, friction velocity, and lubrication environment, respectively. The results indicate that the friction coefficient, wear mass, and wear coefficient of Ti-6A1-4V titanium alloy decreased with the increasing of the compression load. The friction rate and the friction coefficient of Ti-6A1-4V titanium alloy decreased with the increasing of the contact load. The wear mass and friction coefficient of Ti-6A1-4V titanium alloy increased with the increasing of contact load. The lubrication effect is better with the increasing of lubricant concentration. Based on the observation of the SEM, the wear type influenced by compression load and friction rate is mainly abrasive wear and oxidation wear. The wear type influenced by contact load is mainly abrasive wear and adhesive wear. The wear type influenced by lubricants is mainly oxidation wear. When wear mass and wear coefficient are used as the criteria for evaluating friction and wear, the order of influential factors to friction and wear of Ti-6Al-4V titanium alloy plate is friction rate, compression load, contact load, and lubricant concentration. This research can provide a theoretical reference for the optimal manufacture of the artificial joint of titanium alloy and optimal rules of safe service conditions.

Low Circulating Valine Associate With High Risk of Hip Fractures

CONTEXT

Hip fractures constitute a major health concern. An adequate supply of amino acids is crucial to ensure optimal acquisition and remodeling of bone. Circulating amino acid levels have been proposed as markers of bone mineral density, but data on their ability to predict incident fractures are scarce.

OBJECTIVES

To investigate the associations between circulating amino acids and incident fractures.

METHODS

We used UK Biobank (n = 111 257; 901 hip fracture cases) as a discovery cohort and the Umeå Fracture and Osteoporosis (UFO) hip fracture study (hip fracture cases n = 2225; controls n = 2225) for replication. Associations with bone microstructure parameters were tested in a subsample of Osteoporotic Fractures in Men Sweden (n = 449).

RESULTS

Circulating valine was robustly associated with hip fractures in the UK Biobank (HR per SD increase 0.79, 95% CI 0.73-0.84), and this finding was replicated in the UFO study (combined meta-analysis including 3126 incident hip fracture cases, odds ratio per SD increase 0.84, 95% CI 0.80-0.88). Detailed bone microstructure analyses showed that high circulating valine was associated with high cortical bone area and trabecular thickness.

CONCLUSION

Low circulating valine is a robust predictor of incident hip fractures. We propose that circulating valine may add information for hip fracture prediction. Future studies are warranted to determine whether low valine is causally associated with hip fractures.

A Correspondence-Based Network Approach for Groupwise Analysis of Patient-Specific Spatiotemporal Data

Methods for statistically analyzing patient-specific data that vary both spatially and over time are currently either limited to summary statistics or require elaborate surface registration. We propose a new method, called correspondence-based network analysis, which leverages particle-based shape modeling to establish correspondence across a population and preserve patient-specific measurements and predictions through statistical analysis. Herein, we evaluated this method using three published datasets of the hip describing cortical bone thickness of the proximal femur, cartilage contact stress, and dynamic joint space between control and patient cohorts to evaluate activity- and group-based differences, as applicable, using traditional statistical parametric mapping (SPM) and our proposed spatially considerate correspondence-based network analysis approach. The network approach was insensitive to correspondence density, while the traditional application of SPM showed decreasing area of the region of significance with increasing correspondence density. In comparison to SPM, the network approach identified broader and more connected regions of significance for all three datasets. The correspondence-based network analysis approach identified differences between groups and activities without loss of subject and spatial specificity which could improve clinical interpretation of results.

Cortical bone microdamage affects primary stability of orthodontic miniscrew

BACKGROUND

The aim of this study was to investigate the effects of orthodontic miniscrew pitch and thread shape on microdamage in cortical bone. The relationship between the microdamage and primary stability was also examined.

METHODS

Ti6Al4V orthodontic miniscrews and 1.0-mm-thick cortical bone pieces from fresh porcine tibia were prepared. The orthodontic miniscrews had custom-made thread height (H) and pitch (P) size geometries, and were classified into three groups: control geometry; HCPC (HC; thread height = 0.12 mm, PC; pitch size = 0.60 mm), geometry with a narrower pitch; HCPN (HC; thread height = 0.12 mm, PN; pitch size = 0.30 mm), and geometry with a taller thread height; HTPC (HT; thread height = 0.36 mm, PC; pitch size = 0.60 mm). The orthodontic miniscrews were inserted into a pilot hole in the cortical bone, and maximum insertion torque and Periotest value were measured. After insertion, the samples were stained with basic fuchsin. Histological thin sections were obtained and the bone microdamage parameters, i.e., total crack length and total damage area, and insertion state parameters, i.e., orthodontic miniscrew surface length and bone compression area were calculated.

RESULTS

The orthodontic miniscrews with the taller thread height resulted in lower primary stability with minimal bone compression and microdamage; however, the narrower thread pitch led to maximum bone compression and extensive bone microdamage.

CONCLUSIONS

A wider thread pitch reduced microdamage, and decreased thread height resulted in increased bone compression, ultimately resulting in increased primary stability.

Sensitivity of the amide I band to matrix manipulation in bone: a Raman micro-spectroscopy and spatially offset Raman spectroscopy study

The fracture resistance of bone arises from the hierarchical arrangement of minerals, collagen fibrils (i.e., cross-linked triple helices of α1 and α2 collagen I chains), non-collagenous proteins, and water. Raman spectroscopy (RS) is not only sensitive to the relative fractions of these constituents, but also to the secondary structure of bone proteins. To assess the ability of RS to detect differences in the protein structure, we quantified the effect of sequentially autoclaving (AC) human cortical bone at 100 °C (∼34.47 kPa) and then at 120 °C (∼117.21 kPa) on the amide I band using a commercial Raman micro-spectroscopy (μRS) instrument and custom spatially offset RS (SORS) instrument in which rings of collection fiber optics are offset from the central excitation fiber optics within a hand-held, cylindrical probe. Being clinically viable, measurements by SORS involved collecting Raman spectra of cadaveric femur mid-shafts (5 male & 5 female donors) through layers of a tissue mimic. Otherwise, μRS and SORS measurements were acquired directly from each bone. AC-related changes in the helical status of collagen I were assessed using amide I sub-peak ratios (intensity, I, at ∼1670 cm-1 relative to intensities at ∼1610 cm-1 and ∼1640 cm-1). The autoclaving manipulation significantly decreased the selected amide I sub-peak ratios as well as shifted peaks at ∼1605 cm-1 (μRS), ∼1636 cm-1 (SORS) and ∼1667 cm-1 in both μRS and SORS. Compared to μRS, SORS detected more significant differences in the amide I sub-peak ratios when the fiber optic probe was directly applied to bone. SORS also detected AC-related decreases in I1670/I1610 and I1670/I1640 when spectra were acquired through layers of the tissue mimic with a thickness ≤2 mm by the 7 mm offset ring, but not with the 5 mm or 6 mm offset ring. Overall, the SORS instrument was more sensitive than the conventional μRS instrument to pressure- and temperature-related changes in the organic matrix that affect the fracture resistance of bone, but SORS analysis of the amide I band is limited to an overlying thickness layer of 2 mm.

Effects of different running intensities on the micro-level failure strain of rat femoral cortical bone structures: a finite element investigation

BACKGROUND

Running with the appropriate intensity may produce a positive influence on the mechanical properties of cortical bone structure. However, few studies have discussed the effects of different running intensities on the mechanical properties at different levels, especially at the micro-level, because the micromechanical parameters are difficult to measure experimentally.

METHODS

An approach that combines finite element analysis and experimental data was proposed to predict a micromechanical parameter in the rat femoral cortical bone structure, namely, the micro-level failure strain. Based on the previous three-point bending experimental information, fracture simulations were performed on the femur finite element models to predict their failure process under the same bending load, and the micro-level failure strains in tension and compression of these models were back-calculated by fitting the experimental load-displacement curves. Then, the effects of different running intensities on the micro-level failure strain of rat femoral cortical bone structure were investigated.

RESULTS

The micro-level failure strains of the cortical bone structures expressed statistical variations under different running intensities, which indicated that different mechanical stimuli of running had significant influences on the micromechanical properties. The greatest failure strain occurred in the cortical bone structure under low-intensity running, and the lowest failure strain occurred in the structure under high-intensity running.

CONCLUSIONS

Moderate and low-intensity running were effective in enhancing the micromechanical properties, whereas high-intensity running led to the weakening of the micromechanical properties of cortical bone. Based on these, the changing trends in the micromechanical properties were exhibited, and the effects of different running intensities on the fracture performance of rat cortical bone structures could be discussed in combination with the known mechanical parameters at the macro- and nano-levels, which provided the theoretical basis for reducing fracture incidence through running exercise.

Histological and Immunological Evaluation of the Osteogenic Effects of Compact Bone-Delivered Stem Cell on Spongiosis Bone in the Rat Zygomatic Arch Defect Model

BACKGROUND

In stem cell applications, apart from bone marrow and adipose tissue, compact bone is also used as an alternative. However, studies on this subject are limited. In our study, we investigated the effect of stem cell derived from compact bone on rat zygomatic arch defect.

METHODS

Fifteen rats were included in the study. Five rats were killed to obtain stem cells before the experiment. The rats were divided into 2 groups with 5 rats each. In group 1, compact bone-derived stem cell was applied. In group 2, adipose tissue-derived stem cell was applied. Right zygomatic arch defect was created in rats in both groups. Zygomatic bones were decellularized by cryosurgery. Stem cells were transferred to zygomatic bones. The number of stem cells, stem cell differentiation, and superficial markers obtained from the groups were examined. Histologically, cell structure, osteocyte count and osteopontin scores, elemental composition of the groups, percentages of resemblance to intact bone, osteocytes numbers, and cells were examined by electron microscopy of the bones in the groups after killing.

RESULTS

The number of stem cells administered to the groups was 5 × 107 and 3.2 × 107 for group 1 and group 2, respectively (P > 0.05). Histologically, the morphology of the cells in group 1 was found to be healthier than group 2. The number of osteocytes was 97.56 ± 15.4 and 132.93 ± 10.8 in group 1 and group 2, respectively (P < 0.05). The osteopontin score was 3.47 ± 0.73 and 65 ± 0.64 in group 1 and group 2, respectively (P < 0.05). In the electron microscope examination, the morphologies of the cells in group 1 were seen more normal. The Ca/P ratio of the groups was 1.51 and 1.59 in group 1 and group 2, respectively (P > 0.05). Osteocyte counts were 10.7 ± 2.8 and 6.1 ± 1.2 in group 1 and group 2, respectively (P < 0.05). Morphological similarity percentages to normal bone were 88.4% and 79.6% in group 1 and group 2, respectively (P > 0.05).

CONCLUSION

Stem cells obtained from compact bone gave positive results in zygomatic arch defect. This method can also be used as an alternative in stem cell applications.

Bone quality in relation to skeletal maturation in palatal miniscrews insertion sites

INTRODUCTION

This study aimed to investigate the relationship between bone density and quantity at the insertion sites of palatal miniscrews and skeletal maturation-evaluated with the middle phalanx maturation method-in growing patients.

METHODS

Sixty patients were analyzed as having a staged third finger middle phalanx radiograph and a cone-beam computed tomography of the maxilla. On the cone-beam computed tomography, a grid was designed to parallel the midpalatal suture (MPS) and posterior to the nasopalatine foramen, both on the palatal and lower nasal cortical bones. Bone density and thickness were measured at the intersections, and medullary bone density was also calculated.

RESULTS

Of patients in MPS stages 1-3, 67.6% showed a mean palatal cortical thickness of <1 mm, whereas in 78.3% of the patients in stages 4 and 5, it was >1 mm. The nasal cortical thickness showed a similar trend (MPS stages 1-3: 62.16% <1 mm; MPS stages 4 and 5: 65.2% >1 mm). There was a significant difference in the density of the palatal cortical bone between MPS stages 1-3 (1272.05 ± 191.13) and stages 4 and 5 (1572.33 ± 274.89) and in nasal cortical density between MPS stages 1-3 (1428.09 ± 198.97) and stages 4 and 5 (1597.97 ± 267.75) (P <0.001).

CONCLUSIONS

This study revealed a correlation between skeletal maturity and maxillary bone quality. MPS stages 1-3 have lower palatal cortical bone density and thickness but high nasal cortical bone density values. MPS stage 4 and, even more, stage 5 show increasing palatal cortical bone thickness and palatal and nasal cortical bone density values.

Graded levels of Eimeria challenge altered the microstructural architecture and reduced the cortical bone growth of femur of Hy-Line W-36 pullets at early stage of growth (0-6 wk of age)

An experiment was carried out to evaluate the impact of mixed Eimeria challenge on skeletal health of Hy-Line W-36 pullets. A total of 540, 16-day-old pullets were randomly allocated into 5 treatment groups, including a nonchallenged control. A mixed Eimeria species solution containing 50,000 E. maxima, 50,000 E. tenella, and 250,000 E. acervulina oocysts per mL was prepared and challenged to 1 group as a high-dose treatment. The 2-fold serial dilution was done to prepare the medium-high (25,000 E. maxima; 25,000 E. tenella; 125,000 E. acervulina), the medium-low (12,500 E. maxima; 12,500 E. tenella; 62,500 E. acervulina), and the low (6,250 E. maxima; 6,250 E. tenella; 31,250 E. acervulina) dose treatments which were challenged to 3 corresponding groups, respectively. The mineral apposition rate (MAR) was measured from 0 to 14 d post inoculation (DPI) and 14 to 28 DPI using calcein injection. The microstructural architecture of the femur was analyzed using the Skyscan X-ray microtomography (microCT) on 6, 14, and 28 DPI. The results showed that the MAR decreased linearly with an increase in the challenged dose (P < 0.05) during 0 to 14 DPI. The results of microCT revealed that cortical and total BMD, BMC, bone volume (BV), and bone volume as a fraction of tissue volume (BV/TV) of femur decreased both linearly (P < 0.05). Conversely, the total number of pores increased linearly with an increase in challenge dosages on 6 and 14 DPI. Trabecular BMD, BV, BV/TV, trabecular number, and trabecular thickness decreased linearly with an increase in the challenge dosages (P < 0.05) on 6 DPI. Furthermore, Eimeria infection significantly increased the number of osteoclasts and osteoclastic activity (P = 0.001). The result of this study suggests that the mixed Eimeria challenge negatively impacts the quality of skeletal health in a linear or quadratic manner with an increase in the concentration of Eimeria oocysts. The negative impact on long bone development might be due to malabsorption, nutrient deficiency during the infection, along with oxidative stress/inflammation disrupting the balance of osteoblastic and osteoclastic cells and their functions.

Bone Tissue in Magnetic Resonance Imaging: Contribution of New Zero Echo Time Sequences

The introduction of new ultrashort and zero echo time (ZTE) sequences is revolutionizing magnetic resonance imaging (MRI) and optimizing patient management. These sequences acquire signals in tissues with very short T2: mineralized bone, cortical bone, and calcium deposits. They can be added to a classic MRI protocol. ZTE MRI provides computed tomography-like contrast for bone.

Elasticity and material anisotropy of lamellar cortical bone in adult bovine tibia characterized via AFM nanoindentation

The research focuses on the evaluation of the mechanical properties of osteonal cortical bone at the lamellar level. Elastic properties of the mid-diaphysis region of the bovine tibia are investigated via cantilever-based nanoindentation at the submicron length scale utilizing Atomic Force Microscopy, where the force-displacement curves are used for the elastic assessment using the Derjaguin-Muller-Toropov model to calculate indentation modulus. Variations of the modulus and the directional mechanical response of the osteonal bone at different distances from the Haversian canal are investigated. Additionally, the effects of demineralization on the indentation modulus are discussed. It was found that in the axial direction, the first and last untreated thick lamella layers show a significant indentation modulus difference compared to all other layers (4.26 ± 0.4 and 4.6 ± 0.3 GPa vs ∼3.5 GPa). On the other hand, the indentation modulus of transverse thick lamella layers shows a periodic variation between ∼3 ± 0.7 GPa and ∼4 ± 0.3 GPa from near the Haversian canal to near the interstitial bone. A periodic variation in the anisotropy ratio was found. Mineral content was quantified via energy-dispersive X-ray microanalysis at different levels of mineralization and shows a positive correlation with the indentation modulus.

The influence of different shaped osteocyte lacunae on microcrack initiation and propagation

BACKGROUND

The morphology of osteocyte lacunae varies in bones of different ages and bone pathologies. Osteocyte lacunae can cause stress concentration and initiate microcracks. However, the influence of changes in osteocyte lacunar shape on microcrack is unknown. Therefore, the aim of this study was to determine the effects of osteocyte lacunae with different shapes on microcrack initiation and propagation.

METHODS

Osteon models containing osteocyte lacunae with different shapes were established. The progressive damage analysis method, based on computer simulations, was used to study the evolution of microdamage within the osteon, including the processes of intralaminar and interlaminar microdamage.

FINDINGS

Models with larger DoE values can effectively delay or prevent the formation of linear microcracks, which ensures high fracture toughness of cortical bone. It is subjected to stronger mechanical stimulation, making it more sensitive to loads. Models with smaller DoE values increase the load threshold for microdamage generation and reduces its impact on bone mechanical performance, making it less susceptible to microdamage than models with larger DoE values.

INTERPRETATION

These findings enhance the limited knowledge of the influence of the lacunar shape on microdamage and contribute to a better understanding of bone biomechanics.

A human, allogeneic cortical bone screw for distal interphalangeal joint (DIP) arthrodesis: a retrospective cohort study with at least 10 months follow-up

INTRODUCTION

The prime requisites of a good digital arthrodesis are a painless and stable union in a proper position. Arthrodesis of the distal interphalangeal joint of the fingers is not without potential complications including nonunion, malunion, and deep tissue infections. The Shark Screw® is a human, cortical bone allograft for osteosynthesis and an alternative to metal or bioabsorbable devices in orthopedics and trauma surgery. The primary hypothesis is that the fusion and complication rate, using the Shark Screw®, is at least similar to those reported in the literature, using metal or bioabsorbable screws.

MATERIAL AND METHODS

This retrospective cohort study analyzes the fusion and complication rate and the patient satisfaction of distal interphalangeal joint arthrodesis of 27 fingers with the human allogeneic cortical bone screw. Complications, Disabilities of Arm, Shoulder, and Hand Questionnaire (Quick-DASH) score and Michigan Hand Outcomes Questionnaire (MHQ) score, grip and pinch strength and fusion angle were investigated.

RESULTS

The mean follow-up was 23 months. At 6 weeks after surgery, fusion was obtained for all fingers. There was no surgical complication that required revision surgery. An average fusion angle of 13.6° ± 10.7° was measured. VAS pain score decreased significantly from 6.9 before surgery to 0.14 after surgery. The Quick-DASH score decreased from 10.7 to 7.8. The MHQ score improved in all sub-scores.

CONCLUSION

The complication rates, using the Shark Screw® for DIP joint arthrodesis, are lower compared to the results reported in the literature for other surgical techniques. Complications related to the human allograft cortical bone screw itself were not observed. The bone screw is completely remodeled into the host bone and further hardware removal is not necessary.

LEVEL OF EVIDENCE

IV.

Sympathetic Innervation Regulates Osteocyte-Mediated Cortical Bone Resorption during Lactation

Bone undergoes constant remodeling by osteoclast bone resorption coupled with osteoblast bone formation at the bone surface. A third major cell type in the bone is osteocytes, which are embedded in the matrix, are well-connected to the lacunar network, and are believed to act as mechanical sensors. Here, it is reported that sympathetic innervation directly regulates lacunar osteocyte-mediated bone resorption inside cortical bone. It is found that sympathetic activity is elevated in different mouse models of bone loss, including lactation, ovariectomy, and glucocorticoid treatment. Further, during lactation elevated sympathetic outflow induces netrin-1 expression by osteocytes to further promote sympathetic nerve sprouting in the cortical bone endosteum in a feed-forward loop. Depletion of tyrosine hydroxylase-positive (TH+ ) sympathetic nerves ameliorated osteocyte-mediated perilacunar bone resorption in lactating mice. Moreover, norepinephrine activates β-adrenergic receptor 2 (Adrb2) signaling to promote secretion of extracellular vesicles (EVs) containing bone-degrading enzymes for perilacunar bone resorption and inhibit osteoblast differentiation. Importantly, osteocyte-specific deletion of Adrb2 or treatment with a β-blocker results in lower bone resorption in lactating mice. Together, these findings show that the sympathetic nervous system promotes osteocyte-driven bone loss during lactation, likely as an adaptive response to the increased energy and mineral demands of the nursing mother.