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Cohen DJ, Lohmann CH, Scott KM, Olson LC, Boyan BD, Schwartz Z. Osseointegration and Remodeling of Mineralized Bone Graft Are Negatively Impacted by Prior Treatment with Bisphosphonates. J Bone Joint Surg Am 2022; 104:1750-1759. [PMID: 35983995 PMCID: PMC10007861 DOI: 10.2106/jbjs.21.01489] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bisphosphonates limit resorption by inhibiting osteoclast formation and activation. They are removed during preparation of demineralized bone matrix (DBM) particles, but it is not known if osteogenesis and incorporation of mineralized bone allografts from patients treated with oral bisphosphonates are affected in vivo. METHODS Human block allografts from 3 bisphosphonate-treated donors and 3 age and sex-matched control donors who had not received bisphosphonates were obtained (Musculoskeletal Transplant Foundation); one-half from each donor was demineralized. In the first study, 3 × 2-mm mineralized and demineralized cylindrical grafts were implanted bilaterally in the femoral metaphysis of 56 rats. In the second study, samples from each group were pooled, prepared as particles, and implanted bilaterally in the femoral marrow canal of 24 rats. Osseointegration, defined as native bone in contact with allograft, was assessed at 10 weeks by micro-computed tomography (CT) and histomorphometry. RESULTS Micro-CT showed greater bone volume in sites treated with demineralized samples compared with the control mineralized and bisphosphonate-exposed mineralized samples. More new bone was generated along the cortical-endosteal interface compared with mineralized samples. Histology showed significantly less new bone in contact with the mineralized bisphosphonate-exposed allograft (10.4%) compared with mineralized samples that did not receive bisphosphonates (22.8%) and demineralized samples (31.7% and 42.8%). A gap was observed between native bone and allograft in the bisphosphonate-exposed mineralized samples (0.50 mm 2 ). The gap area was significantly greater compared with mineralized samples that did not receive bisphosphonates (0.16 mm 2 ) and demineralized samples (0.10 and 0.03 mm 2 ). CONCLUSIONS Mineralized allografts were osseointegrated, but not remodeled or replaced by living bone, preventing full regeneration of the bone defect. Prior treatment of the donor with bisphosphonates affected osteogenesis, preventing osteointegration and remodeling of the allograft into the regenerating bone. CLINICAL RELEVANCE Clinical use of mineralized allografts from patients who had received bisphosphonate therapy needs to be evaluated; in this animal model, such grafts were not integrated into the host bone or remodeled, and full regeneration of the bone defects was prevented.
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Affiliation(s)
- D Joshua Cohen
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Christoph H Lohmann
- Department of Orthopaedics, Otto-von-Guericke University, Magdeburg, Germany
| | - Kayla M Scott
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Lucas C Olson
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Barbara D Boyan
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Zvi Schwartz
- Department of Biomedical Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia.,Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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2
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Effect of Primary Stabilisation on Osseointegration of Implants With Local and Systemic Zoledronic Acid Application. J Craniofac Surg 2021; 33:1276-1281. [PMID: 34560734 DOI: 10.1097/scs.0000000000008236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/14/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Primary stabilization (PS) is defined as initial tight fit during the surgical placement of an implant. Tight implant placement is quite difficult in cases where bone quality and quantity are insufficient. Zoledronic acid (ZA) is a powerful bisphosphonate that prevents bone resorption. The aim of this study is to investigate the effect of local and systemic ZA application on osseointegration in titanium implants with and without PS. Male Sprague Dawley rats were divided into 2 main groups, with PS, PS + (n = 24), and without primary stabilisation, PS - (n = 24). These main groups were divided into control (n = 8), 2 mg/1 mL local ZA (n = 8) and 0.1 mg/kg systemic ZA (n = 8) groups. All of the subjects were sacrificed after a 4-week recovery period. Bone implant connection (BIC) and thread filling (TF) (%) of the samples was analyzed according to the non-decalcified histological analysis method. In terms of BIC percentages and TF, statistically significant differences were found between the groups with and without PS and between the ZA treatment groups (P < 0.05). The common effect of PS and ZA use on the percentage of BIC was found to be statistically significant (P < 0.05). The common effect of PS and acid type on TF was not statistically significant (P < 0.05). Within the limitations of this study, it may be concluded that systemic and local administration of ZA may increase implant osseointegration.
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Kc K, Bhattarai BP, Shrestha S, Shrestha B, Shrestha M. EFFECT OF LOCALLY DELIVERED BISPHOSPHONATES ON ALVEOLAR BONE: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2021; 21:101580. [PMID: 34479678 DOI: 10.1016/j.jebdp.2021.101580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/23/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the effect of locally applied bisphosphonate drugs on alveolar bone defects caused by periodontitis and marginal bone level after placement of dental implants. MATERIALS AND METHODS Three electronic databases (PubMed/MEDLINE, Web of Science, and Scopus) were searched from January 2010 until May 2020 for randomized controlled clinical trials reporting the effect of locally delivered bisphosphonates on alveolar bone. The risk of bias was assessed and quantitative synthesis was conducted with both fixed and random-effects meta-analyses by using RevMan version 5.3. Subgroup and sensitivity analyses were performed whenever required. RESULTS Among the included studies, the effect of locally delivered bisphosphonates on alveolar bone regeneration in periodontitis was measured by 15 studies and on marginal bone level after installation of dental implants by three studies. Bisphosphonates showed significantly higher intrabony defect depth reduction than placebo/control in vertical bone defects treated with non-surgical approach (MD = 1.69mm; 95% CI, 1.32-2.05; P < 0.00001; I²=93%) or surgical approach (MD = 0.70mm; 95% CI, 0.23-1.16; P = 0.003; I² = 78%) and in class II furcation defects treated with non-surgical approach (MD = 1.61mm; 95% CI, 1.15-2.07; P < 0.00001; I² = 99%) or surgical approach (MD = 0.24mm; 95% CI, 0.05-0.42; P = 0.01; I² = 62%). Clinical attachment loss increased by 1.39mm (95% CI, 0.92-1.85; P < 0.01; I²=93%) and 1mm (95% CI, 0.75-1.26; P < 0.001; I² = 0%) in vertical bone defects after non-surgical and surgical treatments, respectively, and by 1.95mm (95% CI, 1.37-2.53; P < 0.00001; I² = 96%) and 0.84mm (95% CI, 0.58-1.10; P < 0.01, I² = 47%) after non-surgical and surgical treatment in class II furcation defects, respectively. Lesser marginal bone loss during pre-loading (MD = -0.18 mm; 95% CI, -0.24- -0.12; P<0.00001; I²=0%) and 1-year post-loading (MD = -0.33 mm; 95% CI, -0.59-0.07; P = 0.01; I² = 0%) periods was observed when bisphosphonate coated dental implants were used. CONCLUSION Locally delivered bisphosphonates induce bone regeneration in periodontal defects and decrease the rate of marginal bone loss after dental implant therapy.
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Affiliation(s)
- Kumar Kc
- BDS, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Bishwa Prakash Bhattarai
- BDS, MScD, Department of Clinical Dentistry, Walailak University International College of Dentistry, Bangkok, Thailand
| | - Shilu Shrestha
- BDS, MDS, Department of Periodontology, People's Dental College and Hospital, Kathmandu, Nepal.
| | - Bijaya Shrestha
- BPT, MPH, Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
| | - Manash Shrestha
- BDS, MPH, Department of society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
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Văruţ RM, Melinte PR, Pîrvu AS, Gîngu O, Sima G, Oancea CN, Teişanu AC, Drăgoi G, Biţă A, Manolea HO, Mitruţ I, Rogoveanu OC, Romulus IS, Neamţu J. Calcium fructoborate coating of titanium-hydroxyapatite implants by chemisorption deposition improves implant osseointegration in the femur of New Zealand White rabbit experimental model. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:1235-1247. [PMID: 34171072 PMCID: PMC8343473 DOI: 10.47162/rjme.61.4.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The identification of biocomposites that improve cell adhesion and reduce bone integration time is a great challenge for implantology and bone reconstruction. AIM Our aim was to evaluate a new method of chemisorption deposition (CD) for improving the biointegration of hydroxyapatite-coated titanium (HApTi) implants. CD method was used to prepare a calcium fructoborate (CaFb) coating on a HApTi (HApTiCaFb) implant followed by evaluation of histological features related to bone healing at the interface of a bioceramic material in an animal model. METHODS The coating composition was investigated by high-performance thin-layer chromatography/mass spectrometry. The surface morphology of the coating was studied by scanning electron microscopy (SEM), before and after the in vitro study. We implanted two types of bioceramic cylinders, HApTi and HApTiCaFb, in the femur of 10 New Zealand White (NZW) rabbits. RESULTS The release of CaFb from HApTiCaFb occurred rapidly within the first three days after phosphate-buffered saline immersion; there was then a linear release for up to 14 days. SEM analysis showed similar morphology and particle size diameter for both implants. Around the porous HApTiCaFb implant, fibrosis and inflammation were not highlighted. CONCLUSIONS Easily applied using CD method, CaFb coatings promote HApTi implant osseointegration in the femur of NZW rabbits.
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Affiliation(s)
- Renata Maria Văruţ
- Department of Biochemistry, BioBoron Research Institute, S.C. Natural Research S.R.L., Podari, Dolj County, Romania;
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5
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Kauffmann F, Höhne C, Assaf AT, Vollkommer T, Semmusch J, Reitmeier A, Michel Stein J, Heiland M, Smeets R, Rutkowski R. The Influence of Local Pamidronate Application on Alveolar Dimensional Preservation after Tooth Extraction-An Animal Experimental Study. Int J Mol Sci 2020; 21:ijms21103616. [PMID: 32443867 PMCID: PMC7279330 DOI: 10.3390/ijms21103616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/02/2022] Open
Abstract
The aim of this randomized, controlled animal exploratory trial was to investigate the influence of local application of aminobisphosphonate pamidronate during the socket preservation procedure. Mandibular premolars were extracted in five Göttingen minipigs. Two animals underwent socket preservation using BEGO OSS (n = 8 sockets) and three animals using BEGO OSS + Pamifos (15 mg) (n = 12 sockets). After jaw impression, cast models (baseline, eight weeks postoperative) were digitized using an inLab X5 scanner (Dentsply Sirona) and the generated STL data were superimposed and analyzed with GOM Inspect 2018 (GOM, Braunschweig). After 16 weeks, the lower jaws were prepared and examined using standard histological methods. In the test group (BEGO OSS + pamidronate), buccooral dimensional loss was significantly lower, both vestibulary (−0.80 ± 0.57 mm vs. −1.92 ± 0.63 mm; p = 0.00298) and lingually (−1.36 ± 0.58 mm vs. −2.56 ± 0.65 mm; p = 0.00104) compared with the control group (BEGO OSS). The test group showed a significant difference between vestibular and lingual dimensional loss (p = 0.04036). Histology showed cortical and cancellous bone in the alveolar sockets without signs of local inflammation. Adjuvant application of pamidronate during socket preservation reduces alveolar dimensional loss significantly. Further investigations with regard to dose–response relationships, volume effects, side effects, and a verification of the suitability in combination with other bone substitute materials (BSMs) are necessary.
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Affiliation(s)
- Frederic Kauffmann
- Department of Oral and Craniomaxillofacial Surgery, Center for Dental Medicine, University Medical Center Freiburg, 79106 Freiburg, Germany;
| | - Christian Höhne
- Department of Prosthodontics, Julius-Maximilians-University, 97070 Würzburg, Germany;
| | - Alexandre Thomas Assaf
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (A.T.A.); (T.V.); (J.S.); (R.S.)
| | - Tobias Vollkommer
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (A.T.A.); (T.V.); (J.S.); (R.S.)
| | - Jan Semmusch
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (A.T.A.); (T.V.); (J.S.); (R.S.)
| | - Aline Reitmeier
- Department of Laboratory Animal Science, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Jamal Michel Stein
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, University Hospital Aachen (RWTH), 52074 Aachen, Germany;
| | - Max Heiland
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, 14197 Berlin, Germany;
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (A.T.A.); (T.V.); (J.S.); (R.S.)
- Department of Oral and Maxillofacial Surgery, Division of Regenerative Orofacial Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Rico Rutkowski
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (A.T.A.); (T.V.); (J.S.); (R.S.)
- Correspondence: ; Tel.: +49-1522-2887432
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6
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AbuMoussa S, Ruppert DS, Lindsay C, Dahners L, Weinhold P. Local delivery of a zoledronate solution improves osseointegration of titanium implants in a rat distal femur model. J Orthop Res 2018; 36:3294-3298. [PMID: 30117189 DOI: 10.1002/jor.24125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/06/2018] [Indexed: 02/04/2023]
Abstract
This study aimed to determine whether locally applied anti-resorptive agents acetazolamide or zoledronic acid would improve mechanical stability in implant osseointegration when applied as a solution within the medullary canal. Thirty-three rats received titanium-implants bilaterally in their intramedullary femoral canals. Prior to implantation, animals received 0.1 ml saline, 1 mM acetazolamide solution, or 0.7 mM zoledronic acid solution directly into the medullary cavity. The control group only received saline within the medullary canal while the treatment groups only received the respective treatment to which they were randomized. Animals were allowed to heal 4 weeks, at which time they were euthanized and femurs isolated for mechanical and radiographic evaluation. Push-out force to failure increased 152% in the zoledronic acid group relative to the control. There was no significant difference in push-out force with acetazolamide relative to control. Also, zoledronic acid increased metaphyseal bone volume fraction 46% and increased metaphyseal bone-implant contact 58% relative to the control. Recent research exploring local injection of medications to improve implant osseointegration and minimize systemic-effects has failed to quantitatively evaluate implant fixation strength on non-hydroxyapatite coated implants or implants without previous bone compaction. This study demonstrated that a simple injection of zoledronic acid into the medullary canal, rather than coatings or commercial gels, can increase fixation strength of an uncoated titanium-implant. Our findings indicate simple injection of zoledronic acid in saline solution has the potential for improving fixation of uncemented joint implants. Clinical Significance: Intramedullary injection of local bisphosphonate solutions could be implemented to improve osseointegration in cementless arthroplasty. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3294-3298, 2018.
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Affiliation(s)
- Samuel AbuMoussa
- University of North Carolina School of Medicine, CB# 7546, 134 Glaxo Bldg 101A Mason Farm Rd, Chapel Hill 27599, North Carolina.,Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - David S Ruppert
- Department of Biomedical Engineering, UNC/NCSU, Chapel Hill, North Carolina
| | - Christopher Lindsay
- University of North Carolina School of Medicine, CB# 7546, 134 Glaxo Bldg 101A Mason Farm Rd, Chapel Hill 27599, North Carolina.,Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa
| | - Laurence Dahners
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Paul Weinhold
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina
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7
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Qayoom I, Raina DB, Širka A, Tarasevičius Š, Tägil M, Kumar A, Lidgren L. Anabolic and antiresorptive actions of locally delivered bisphosphonates for bone repair: A review. Bone Joint Res 2018; 7:548-560. [PMID: 30464835 PMCID: PMC6215244 DOI: 10.1302/2046-3758.710.bjr-2018-0015.r2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
During the last decades, several research groups have used bisphosphonates for local application to counteract secondary bone resorption after bone grafting, to improve implant fixation or to control bone resorption caused by bone morphogenetic proteins (BMPs). We focused on zoledronate (a bisphosphonate) due to its greater antiresorptive potential over other bisphosphonates. Recently, it has become obvious that the carrier is of importance to modulate the concentration and elution profile of the zoledronic acid locally. Incorporating one fifth of the recommended systemic dose of zoledronate with different apatite matrices and types of bone defects has been shown to enhance bone regeneration significantly in vivo. We expect the local delivery of zoledronate to overcome the limitations and side effects associated with systemic usage; however, we need to know more about the bioavailability and the biological effects. The local use of BMP-2 and zoledronate as a combination has a proven additional effect on bone regeneration. This review focuses primarily on the local use of zoledronate alone, or in combination with bone anabolic factors, in various preclinical models mimicking different orthopaedic conditions. Cite this article: I. Qayoom, D. B. Raina, A. Širka, Š. Tarasevičius, M. Tägil, A. Kumar, L. Lidgren. Anabolic and antiresorptive actions of locally delivered bisphosphonates for bone repair: A review. Bone Joint Res 2018;7:548–560. DOI: 10.1302/2046-3758.710.BJR-2018-0015.R2.
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Affiliation(s)
- I Qayoom
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology, Kanpur, India
| | - D B Raina
- Department of Orthopedics, The Medical Faculty, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - A Širka
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Š Tarasevičius
- Department of Orthopedics and Traumatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - M Tägil
- Department of Orthopedics, The Medical Faculty, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - A Kumar
- Department of Biological Sciences and Bioengineering; Centre for Environmental Sciences and Engineering; Centre for Nanosciences, Indian Institute of Technology Kanpur, Kanpur, India
| | - L Lidgren
- Department of Orthopedics, The Medical Faculty, Clinical Sciences Lund, Lund University, Lund, Sweden
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8
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Alendronate release from calcium phosphate cement for bone regeneration in osteoporotic conditions. Sci Rep 2018; 8:15398. [PMID: 30337567 PMCID: PMC6194021 DOI: 10.1038/s41598-018-33692-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 10/03/2018] [Indexed: 01/14/2023] Open
Abstract
Osteoporosis represents a major health problem in terms of compromising bone strength and increasing the risk of bone fractures. It can be medically treated with bisphosphonates, which act systemically upon oral or venous administration. Further, bone regenerative treatments in osteoporotic conditions present a challenge. Here, we focused on the development of a synthetic bone substitute material with local diminishing effects on osteoporosis. Composites were created using calcium phosphate cement (CPC; 60 wt%) and polylactic-co-glycolic acid (PLGA; 40 wt%), which were loaded with alendronate (ALN). In vitro results showed that ALN-loaded CPC/PLGA composites presented clinically suitable properties, including setting times, appropriate compressive strength, and controlled release of ALN, the latter being dependent on composite degradation. Using a rat femoral condyle bone defect model in osteoporotic animals, ALN-loaded CPC/PLGA composites demonstrated stimulatory effects on bone formation both within and outside the defect region.
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9
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Sharmin F, O'Sullivan M, Malinowski S, Lieberman JR, Khan Y. Large scale segmental bone defect healing through the combined delivery of VEGF and BMP‐2 from biofunctionalized cortical allografts. J Biomed Mater Res B Appl Biomater 2018; 107:1002-1010. [DOI: 10.1002/jbm.b.34193] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/18/2017] [Accepted: 08/22/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Farzana Sharmin
- Department of Materials Science and EngineeringUniversity of Connecticut Storrs Connecticut
- Institute for Regenerative EngineeringUConn Health Farmington Connecticut
| | | | - Seth Malinowski
- Department of Biomedical EngineeringUniversity of Connecticut Storrs Connecticut
| | - Jay R. Lieberman
- Department of Orthopedic SurgeryKeck School of Medicine of the University of Southern California California Los Angeles
| | - Yusuf Khan
- Department of Materials Science and EngineeringUniversity of Connecticut Storrs Connecticut
- Institute for Regenerative EngineeringUConn Health Farmington Connecticut
- Department of Orthopaedic SurgeryUConn Health Farmington Connecticut
- Department of Biomedical EngineeringUniversity of Connecticut Storrs Connecticut
- UConn Musculoskeletal Institute Farmington Connecticut
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10
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Jin ES, Kim JY, Lee B, Min J, Jeon SR, Choi KH, Jeong JH. Biodegradable Screws Containing Bone Morphogenetic Protein-2 in an Osteoporotic Rat Model. J Korean Neurosurg Soc 2018; 61:559-567. [PMID: 30041512 PMCID: PMC6129746 DOI: 10.3340/jkns.2017.0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/09/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effect for biodegradable screws containing bone morphogenetic protein-2 (BMP-2) in an osteoporotic rat model. METHODS Twenty-four female Wistar rat (250-300 g, 12 weeks of age) were randomized into four groups. Three groups underwent bilateral ovariectomy (OVX). Biodegradable screws with or without BMP-2 were inserted in the proximal tibia in two implantation groups. The extracted proximal metaphysis of the tibiae were scanned by exo-vivo micro-computed tomography. Evaluated parameters included bone mineral density (BMD), trabecular bone volume (BV/TV), trabecular number, trabecular thickness, and trabecular separation (Tb.Sp). The tibia samples were pathologically evaluated by staining with by Hematoxylin and Eosin, and trichrome. RESULTS Trabecular formation near screw insertion site was evident only in rats receiving BMP-2 screws. BMD and BV/TV significantly differed between controls and the OVX and OVX with screw groups. However, there were no significant differences between control and OVX with screw BMP groups. Tb.Sp significantly differed between control and OVX and OVX with screw groups (p<0.05), and between the OVX and OVX with screw BMP group (p<0.05), with no statistically significant difference between control and OVX with screw BMP groups. Over the 12 weeks after surgery, bone lamellae in direct contact with the screw developed more extensive and thicker trabecular bone around the implant in the OVX with screw BMP group compared to the OVX with screw group. CONCLUSION Biodegradable screws containing BMP-2 improve nearby bone conditions and enhance ostoeintegration between the implant and the osteoporotic bone.
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Affiliation(s)
- Eun-Sun Jin
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.,Laboratory of Stem Cell Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yeon Kim
- Laboratory of Stem Cell Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bora Lee
- Department of Biostatistic Consulting, Soon Chun Hyang Medical Center, Bucheon, Korea
| | - JoongKee Min
- Laboratory of Stem Cell Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Ryong Jeon
- Laboratory of Stem Cell Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hyo Choi
- Laboratory of Stem Cell Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Je Hoon Jeong
- Laboratory of Stem Cell Therapy, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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11
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Vargas-Franco JW, Castaneda B, Rédiní F, Gómez DF, Heymann D, Lézot F. Paradoxical side effects of bisphosphonates on the skeleton: What do we know and what can we do? J Cell Physiol 2018; 233:5696-5715. [PMID: 29323712 DOI: 10.1002/jcp.26465] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/05/2018] [Indexed: 12/15/2022]
Abstract
Bisphosphonates are considered the most effective drugs for controlling adult and pediatric osteolytic diseases. Although they have been used successfully for many years, several side effects, such as osteonecrosis of the jaw, delayed dental eruption, atypical femoral fracture, and alterations to the bone growth system, have been described. After an overview of nitrogenous bisphosphonate, the purpose of this article is to describe their mechanisms of action and current applications, review the preclinical and clinical evidence of their side effects in the skeleton ("what we know"), and describe current recommendations for preventing and managing these effects ("what we can do"). Finally, promising future directions on how to limit the occurrence of these side effects will be presented.
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Affiliation(s)
- Jorge W Vargas-Franco
- UMR-1238, INSERM, Equipe 1, Faculté de Médecine de l'Université de Nantes, Nantes, France.,Department of Basic Studies, Faculty of Odontology, University of Antioquia, Medellin, Colombia
| | - Beatriz Castaneda
- INSERM, UMR-1138, Equipe 5, Centre de Recherche des Cordeliers, Paris, France
| | - Françoise Rédiní
- UMR-1238, INSERM, Equipe 1, Faculté de Médecine de l'Université de Nantes, Nantes, France
| | - David F Gómez
- Department of Basic Studies, Faculty of Odontology, University of Antioquia, Medellin, Colombia
| | - Dominique Heymann
- INSERM, LEA Sarcoma Research Unit, Department of Oncology and Human Metabolism, Medical School, University of Sheffield, Sheffield, UK.,UMR-1232, Institut de Cancérologie de l'Ouest, Site René Gauducheau, INSERM, Boulevard Professeur Jacques Monod, Saint-Herblain, France
| | - Frédéric Lézot
- UMR-1238, INSERM, Equipe 1, Faculté de Médecine de l'Université de Nantes, Nantes, France
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12
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Does local delivery of bisphosphonates influence the osseointegration of titanium implants? A systematic review. Int J Oral Maxillofac Surg 2017; 46:1429-1436. [DOI: 10.1016/j.ijom.2017.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/21/2017] [Accepted: 04/18/2017] [Indexed: 11/22/2022]
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13
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Özer T, Aktas A, Barıs E, Çelik HH, Vatansever A. Effects of local alendronate administration on bone defect healing. Histomorphometric and radiological evaluation in a rabbit model. Acta Cir Bras 2017; 32:781-795. [PMID: 29019595 DOI: 10.1590/s0102-865020170090000010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/18/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To performed a histomorphometric and radiological study to evaluate the effects of alendronate sodium administered locally in mandibular bone defects created in rabbits. METHODS Two circular defects 5 mm in diameter were created bilaterally in the mandibular corpus of 20 New Zealand rabbits (i.e., four defects per animal). Each defect received one of four treatments: no treatment (EC group), alendronate irrigation (AL group), autogenous bone grafting (AG group), or alendronate irrigation with autogenous bone grafting (AL+AG group). Histomorphometric and radiological assessments were conducted at 4 and 8 weeks after surgery. RESULTS Between-group comparisons of the new bone area, the value of the AL+AG group was significantly lower thanthe remaining three groups at 4 weeks postoperatively. In all groups, the new bone area was significantly larger at 8 weeks than at 4 weeks. The residual graft area at 4 and 8 weeks was significantly higher in the AL+AG group than in the AG group, although it was significantly smaller at 8 weeks than at 4 weeks in both these groups. CONCLUSION The use of alendronate sodium in conjunction with autogenous bone grafting improves the osteoconductive properties of the graft, enhances graft retention in the defect, and improves ossification.
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Affiliation(s)
- Taha Özer
- DDS, PhD, Department of Oral Surgery, Hacettepe University, Turkey. Scientific, intellectual, conception and design of the study; acquisition, analysis and interpretation of data; technical procedures; statistics analysis; manuscript preparation and writing; final approval
| | - Alper Aktas
- DDS, PhD, Associate Professor, Department of Oral Surgery, Hacettepe University, Turkey. Scientific, intellectual, conception and design of the study; technical procedures; critical revision
| | - Emre Barıs
- DDS, PhD, Associate Professor, Department of Oral Pathology, Gazi University, Turkey. Acquisition of data, histopathological examinations, critical revision
| | - Hakan Hamdi Çelik
- MD, PhD, Department of Anatomy, Hacettepe University, Turkey. Acquisition of data, critical revision
| | - Alper Vatansever
- PhD, Department of Anatomy, Balıkesir University, Turkey. Acquisition of data, critical revision
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14
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Tafur D, Cabrera DA, Salavarrieta J, Olarte CM, Pesántez RF. Alternative Fixation in Osteoporotic Fractures. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0211-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Role of local alendronate delivery on the osseointegration of implants: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2017; 46:912-921. [DOI: 10.1016/j.ijom.2017.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/25/2017] [Accepted: 03/09/2017] [Indexed: 01/19/2023]
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16
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Assanah F, McDermott C, Malinowski S, Sharmin F, Kumbar S, Adams DJ, Khan Y. Enhancing the Functionality of Trabecular Allografts Through Polymeric Coating for Factor Loading. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2017. [DOI: 10.1007/s40883-017-0027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Effects of Local and Systemic Zoledronic Acid Application on Titanium Implant Osseointegration. J Craniofac Surg 2017; 28:935-938. [DOI: 10.1097/scs.0000000000003568] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Sharmin F, McDermott C, Lieberman J, Sanjay A, Khan Y. Dual growth factor delivery from biofunctionalized allografts: Sequential VEGF and BMP-2 release to stimulate allograft remodeling. J Orthop Res 2017; 35:1086-1095. [PMID: 27155087 DOI: 10.1002/jor.23287] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 04/29/2016] [Indexed: 02/04/2023]
Abstract
Autografts have been shown to stimulate osteogenesis, osteoclastogenesis, and angiogenesis, and subsequent rapid graft incorporation. Large structural allografts, however, suffer from limited new bone formation and remodeling, both of which are directly associated with clinical failure due to non-unions, late graft fractures, and infections, making it a priority to improve large structural allograft healing. We have previously shown the osteogenic ability of a polymer-coated allograft that delivers bone morphogenetic protein-2 both in vitro and in vivo through both burst release and sustained release kinetics. In this study, we have demonstrated largely sequential delivery of bone morphogenetic protein-2 and vascular endothelial growth factor from the same coated allograft. Release data showed that loading both growth factors onto a polymeric coating with two different techniques resulted in short-term (95% release within 2 weeks) and long-term (95% release within 5 weeks) delivery kinetics. We have also demonstrated how released VEGF, traditionally associated with angiogenesis, can also provide a stimulus for allograft remodeling via resorption. Bone marrow derived mononuclear cells were co-cultured with VEGF released from the coated allograft and showed a statistically significant (p < 0.05) and dose dependent increase in the number of tartrate-resistant acid phosphatase-positive multinucleated osteoclasts. Functionality of these osteoclasts was assessed quantitatively and qualitatively by evaluating resorption pit area from both osteo-assay plates and harvested bone. Data indicated a statistically significant higher resorption area from the cells exposed to VEGF released from the allografts over controls (p < 0.05). These results indicate that by using different loading protocols temporal control can be achieved when delivering multiple growth factors from a polymer-coated allograft. Further, released VEGF can also stimulate osteoclastogenesis that may enhance allograft incorporation, and thus mitigate long-term clinical complications. © 2017 Orthopedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1086-1095, 2017.
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Affiliation(s)
- Farzana Sharmin
- Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut.,Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, Connecticut
| | - Casey McDermott
- Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, Connecticut.,Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| | - Jay Lieberman
- Department of Orthopedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Archana Sanjay
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, Connecticut.,New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut, 06030
| | - Yusuf Khan
- Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut.,Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, Connecticut.,Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut.,Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, Connecticut.,New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, Connecticut, 06030
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19
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Jakobsen T, Bechtold JE, Søballe K, Jensen T, Vestermark MT, Baas J. Local delivery of zoledronate from a poly (d,l-lactide)-coating increases fixation of hydroxy-coated implants. J Orthop Res 2017; 35:974-979. [PMID: 26925986 PMCID: PMC6338069 DOI: 10.1002/jor.23219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/23/2016] [Indexed: 02/04/2023]
Abstract
Initial secure implant fixation predicts long-term survival. Bisphosphonates are anti-resorptive agents. They have been shown to increase implant fixation. We investigated whether local delivery of zoledronate from a poly-d,l-lactide (PDLLA)-coating could improve fixation and osseointegration of hydroxy-apatite coated implants. Cylindrical hydroxy-apatite coated implants were bilaterally inserted press-fit into the proximal tibiae of 10 dogs. On one side the implant was coated with PDLLA containing zoledronate. The PDLLA coating was applied upon the hydroxy-apatite coating. We used the contralateral implant as control. This implant was not coated with a poly-d,l-lactide. Observation period was 12 weeks. We evaluated implant fixation with histomorphometry and biomechanical push-out test. Zoledronate resulted in an approximately threefold increase in all biomechanical parameters when comparing data with their respective controls. We found that zoledronate increased preservation of old lamellar bone and increased formation of new woven bone. This study indicates that local delivery of zoledronate from a PDDLA coating has the potential to increase implant fixation. Studies investigating different doses of zoledronate and longer follow-up are needed. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:974-979, 2017.
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Affiliation(s)
- Thomas Jakobsen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
| | - Joan E Bechtold
- Orthopaedic Biomechanics Laboratory, Minneapolis Medical Research Foundation and University of Minnesota, Minneapolis, Minnesota
| | - Kjeld Søballe
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
| | - Thomas Jensen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
| | - Marianne T Vestermark
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
| | - Jørgen Baas
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Aarhus, Denmark
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20
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Kellesarian SV, Abduljabbar T, Vohra F, Gholamiazizi E, Malmstrom H, Romanos GE, Javed F. Does Local Ibandronate and/or Pamidronate Delivery Enhance Osseointegration? A Systematic Review. J Prosthodont 2016; 27:240-249. [PMID: 27870311 DOI: 10.1111/jopr.12571] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To our knowledge from indexed literature, the present study is the first one to systematically review the influence of local delivery of pamidronate (PAM) and/or ibandronate (IBA) on osseointegration enhancement. The aim of the present systematic review was to assess the efficacy of IBA and/or PAM local delivery (topically or coating on implants surfaces) in promoting osseointegration. MATERIALS AND METHODS To address the focused question, "Does local IBA and/or PAM delivery enhances osseointegration?," indexed databases were searched without time or language restrictions up to and including May 2016 using various combinations of the following keywords: "pamidronate," "ibandronate," "bisphosphonates," "osseointegration," and "topical administration." Letters to the Editor, historic reviews, commentaries, case series, and case reports were excluded. RESULTS Fifteen studies were included. Fourteen studies were performed in animals and 2 were clinical trials. One study reported an experimental model and a clinical trial in the same publication. Results from 12 experimental studies and 2 clinical studies reported improved biomechanical properties and/or osseointegration around implants with PAM and/or IBA. Two experimental studies showed that PAM and/or IBA did not improve osseointegration. CONCLUSIONS On experimental grounds, local IBA and/or PAM delivery seems to enhance osseointegration; however, from a clinical perspective, further randomized control trials are needed to assess the effectiveness of IBA and PAM in promoting osseointegration around dental implants.
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Affiliation(s)
- Sergio Varela Kellesarian
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Tariq Abduljabbar
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Fahim Vohra
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Elham Gholamiazizi
- Department of Engineering, Capital College, Penn State University Harrisburg, Middletown, PA
| | - Hans Malmstrom
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Georgios E Romanos
- Department of Oral Surgery and Implant Dentistry, Dental School, Johann Wolfgang Goethe, University of Frankfurt, Germany.,Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY
| | - Fawad Javed
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
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21
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Günes N, Dundar S, Saybak A, Artas G, Acikan I, Ozercan IH, Atilgan S, Yaman F. Systemic and local zoledronic acid treatment with hydroxyapatite bone graft: A histological and histomorphometric experimental study. Exp Ther Med 2016; 12:2417-2422. [PMID: 27698743 PMCID: PMC5038845 DOI: 10.3892/etm.2016.3685] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/24/2016] [Indexed: 12/30/2022] Open
Abstract
In this study, the aim was to compare the relative efficacy of systemic and local zoledronic acid (ZA) on a hydroxyapatite (HA) bone graft in a rat critical-size calvarial bone defect. In total, 84 female rats were divided into four groups: Empty control (EC) group with no treatment applied; HA group, in which only HA bone graft material was used in the calvarium; and HA plus local ZA (HA+LZA) and HA plus systemic ZA (HA+SZA) groups, in which animals received ZA locally or systemically, respectively, with HA bone graft material in the calvarium. A 5-mm standardised critical-size calvarial bone defect was created with a standard trephine drill and the respective treatment was applied. Rats were sacrificed 7, 14 and 28 days later. The numbers of osteoclasts and osteoblasts, and degree of bone formation were evaluated histopathologically and histomorphometrically. Statistically significant differences were detected between the HA, HA+LZA and HA+SZA groups and the EC group for new bone formation (P<0.05). Osteoblast numbers in the HA+LZA and HA+SZA groups were significantly higher compared with those in the EC and HA groups (P<0.05). No statistically significant difference was detected between the HA+LZA and HA+SZA groups in new bone formation or osteoblast number (P>0.05). Bone formation was significantly higher in the HA group than in the EC group (P<0.05). The numbers of osteoclasts in the HA+LZA and HA+SZA groups were significantly higher than those in the groups EC and HA (P<0.05); however, there was no significant difference between groups HA+LZA and HA+SZA (P>0.05). Within the limitations of this study, systemic or local administration of ZA enhanced new bone formation with a HA bone graft in a rat critical-size calvarial defect model.
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Affiliation(s)
- Nedim Günes
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Dicle University, 21280 Diyarbakır, Turkey
| | - Serkan Dundar
- Department of Periodontology, Faculty of Dentistry, Firat University, 23119 Elazığ, Turkey
| | - Arif Saybak
- Private Practice, Periodontists, 01220 Adana, Turkey
| | - Gökhan Artas
- Department of Medical Pathology, Faculty of Medicine, Firat University, 23119 Elazığ, Turkey
| | - Izzet Acikan
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Dicle University, 21280 Diyarbakır, Turkey
| | - I Hanifi Ozercan
- Department of Medical Pathology, Faculty of Medicine, Firat University, 23119 Elazığ, Turkey
| | - Serhat Atilgan
- Private Practice, Oral and Maxillofacial Surgeon, 27260 Gaziantep, Turkey
| | - Ferhan Yaman
- Department of Oral Maxillofacial Surgery, Faculty of Dentistry, Dicle University, 21280 Diyarbakır, Turkey
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22
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Kim HS, Lee JI, Yang SS, Kim BS, Kim BC, Lee J. The effect of alendronate soaking and ultraviolet treatment on bone-implant interface. Clin Oral Implants Res 2016; 28:1164-1172. [PMID: 27458172 DOI: 10.1111/clr.12933] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Rapid and stable fixation of dental implants is crucial for successful treatment. Herein, we examined whether the simultaneous treatment of titanium implants with ultraviolet (UV) and alendronate (ALN) synergistically improved the bone-to-implant contact. MATERIALS AND METHODS We assessed the in vitro effects of UV radiation-treated (UV+/ALN-), ALN-soaked (UV-/ALN+), and UV radiation/ALN-treated (UV+/ALN+) titanium implants on cell proliferation, cytotoxicity, cell adhesion, and osteoblast differentiation using MG-63 osteoblast-like cells by the assays of MTS, live/dead, scanning electron microscopy (SEM), alkaline phosphatase (ALP) activity, and alizarin red S (AR-S) staining, respectively. Furthermore, in vivo bone formation at the bone-implant interface efficiency determined using a rabbit tibia implantation. Implants were divided into 3 experimental groups (UV+/ALN-, UV-/ALN+, UV+/ALN+) and the non-treated control (UV-/ALN-) group and transplanted into the proximal tibia of rabbits. At 1, 2, 4, and 8 weeks post-operation, bone formation at the bone-implant interface was evaluated by micro-computed tomography and histological analysis. RESULTS MG-63 cells cultured on UV+/ALN+ implants showed significantly higher cell proliferation, ALP activity, and calcium mineralization than those cultured on other implants (P < 0.05). Furthermore, SEM observation showed the highest increase in cell attachment and growth on the UV+/ALN+ implants. In vivo, experimental groups at all time points showed greater peri-implant bone formation than the control group. At 8 weeks post-implantation, in the UV+/ALN+ group, significantly higher bone formation was observed than the UV+/ALN- or UV-/ALN+ group, respectively (P < 0.05). CONCLUSIONS Treatment of titanium surfaces with UV and ALN may synergistically enhance osteoblastic differentiation and mineralization in vitro and enhance bone formation at the bone-implant interface in vivo. These data suggest that UV and ALN treatment may improve the osseointegration of titanium implants.
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Affiliation(s)
- Hyung Soo Kim
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University, Daejeon, Korea
| | - Jae In Lee
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Sun Sik Yang
- Wonkwnag Bone Regeneration Research Institute, Wonkwang University, Iksan, Korea
| | | | - Bong Chul Kim
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University, Daejeon, Korea
| | - Jun Lee
- Department of Oral and Maxillofacial Surgery, Daejeon Dental Hospital, Wonkwang University, Daejeon, Korea
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23
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Pura JA, Bobyn JD, Tanzer M. Implant-delivered Alendronate Causes a Dose-dependent Response on Net Bone Formation Around Porous Titanium Implants in Canines. Clin Orthop Relat Res 2016; 474:1224-33. [PMID: 26831478 PMCID: PMC4814409 DOI: 10.1007/s11999-016-4714-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/14/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bony fixation of cementless orthopaedic implants is not always achieved, particularly in challenging scenarios such as revision surgery, trauma, and tumor reconstruction. An adjunct therapy for improving porous implant fixation could improve the reliability and durability of these reconstructive procedures. QUESTIONS/PURPOSES In this study, we asked whether there is a positive and dose-dependent effect of the local release of the bisphosphonate alendronate from (1) alendronate/hydroxyapatite (HA) porous-coated titanium implants compared with bare metal porous controls; and (2) alendronate/HA on porous-coated titanium implants compared with HA-coated porous controls with respect to extent of bone ingrowth, bone apposition, and periimplant bone formation in a canine model? METHODS Three-dimensional printed porous-coated cylindrical implants coated with three different doses (0.02, 0.06, and 0.18 mg/cm(2)) of alendronate were inserted bilaterally in the intramedullary canal of the proximal femora of 15 adult mongrel dogs (age range, 3-9 years; mean, 5 years) weighing between 36 kg and 60 kg (mean, 43 kg). In each dog, an implant coated with HA and one of three different doses of alendronate was inserted on one side while the contralateral femur had a bare metal porous control implant and an identical control implant with a coating of HA. The dose effect of locally released alendronate on the extent of bone ingrowth, bone apposition, and periimplant bone was assessed by backscattered electron microscopy of three pairs of cross-sections taken from each implant at 12 weeks after surgery. A linear mixed model was used to perform the statistical analyses to account for the correlation in the data resulting from the multiple measures performed on each dog. RESULTS Compared with paired bare metal controls, periimplant bone increased by 92% (p = 0.007), and 114% (p < 0.001) in the femora with the alendronate implants with a dose of 0.06 mg/cm(2), or 0.18 mg/cm(2), respectively. At a dose of 0.02 mg/cm(2), there was no difference (46% change; p = 0.184, with the numbers available). The comparison of the alendronate-dosed implants with their HA-coated controls showed that the intermediate dose of 0.06 mg/cm(2) alendronate had the greatest effect on net bone formation. Bone apposition was enhanced with the 0.06-mg/cm(2) alendronate femoral implants (82%; p = 0.008), although there was no change in bone ingrowth (37% change; p = 0.902, with the numbers available). When compared with the HA-coated control implants, the greatest effect of the alendronate-dosed implants was the increased amount of periimplant bone at the intermediate dose of 0.06-mg/cm(2) (108%, p = 0.009). There was no effect of the low (0.02-mg/cm(2)) and high (0.18-mg/cm(2)) alendronate-dosed implants (4%, and 6%, respectively; p = 0.321, p = 0.502). Overall, all three alendronate-dosed implants revealed little to no effect on bone ingrowth compared with the HA-coated control implants. CONCLUSIONS The local release of alendronate from a three-dimensional printed porous-coated implant from the three doses studied showed an overall improvement in bone apposition and periimplant bone at the intermediate dose compared with bare metal or with HA-coated controls, although the effect was more pronounced compared with bare metal. Long-term studies to show the effects of localized alendronate delivery and mechanical fixation would be the next step for future studies. CLINICAL RELEVANCE Local release of alendronate from a three-dimensional printed porous-coated implant may improve the reliability of cementless fixation of currently available porous-coated bare metal implants.
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Affiliation(s)
- Jenny Ann Pura
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, QC, Canada.
- Montreal General Hospital, 1650 Cedar Avenue, Room C9-136, Montreal, QC, H3G1A4, Canada.
| | - J Dennis Bobyn
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, QC, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Michael Tanzer
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, QC, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
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24
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Jakobsen T, Bechtold JE, Søballe K, Jensen T, Greiner S, Vestermark MT, Baas J. Local delivery of zoledronate from a poly (D,L-lactide)-Coating increases fixation of press-fit implants. J Orthop Res 2016; 34:65-71. [PMID: 26177742 PMCID: PMC6326075 DOI: 10.1002/jor.22979] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 07/08/2015] [Indexed: 02/04/2023]
Abstract
Early secure fixation of total joint replacements is crucial for long-term survival. Antiresorptive agents such as bisphosphonates have been shown to increase implant fixation. We investigated whether local delivery of zoledronate from poly-D, L-lactide (PDLLA)-coated implants could improve implant fixation and osseointegration. Experimental titanium implants were bilaterally inserted press-fit into the proximal tibiae of 10 dogs. On one side the implant was coated with PDLLA containing zoledronate. The contralateral implant was uncoated and used as control. Observation period was 12 weeks. Implant fixation was evaluated with histomorphometry and biomechanical push-out test. We found an approximately twofold increase in all biomechanical parameters when comparing data from the zoledronate group with their respective controls. Histomorphometry showed increased amount of preserved bone and increased bone formation around the zoledronate implants. This study indicates that local delivery of zoledronate from a PDDLA coating has the potential to increase implant fixation.
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Affiliation(s)
- Thomas Jakobsen
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Joan E. Bechtold
- Orthopaedic Biomechanics Laboratory, Minneapolis Medical Research Foundation and University of Minnesota, Minneapolis, Minnesota
| | - Kjeld Søballe
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Jensen
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marianne T. Vestermark
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Baas
- Department of Orthopaedics, Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
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25
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Influence of the local application of sodium alendronate gel on osseointegration of titanium implants. Int J Oral Maxillofac Surg 2015; 44:1423-9. [DOI: 10.1016/j.ijom.2015.05.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 04/01/2015] [Accepted: 05/20/2015] [Indexed: 11/19/2022]
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26
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Kim HC, Song JM, Kim CJ, Yoon SY, Kim IR, Park BS, Shin SH. Combined effect of bisphosphonate and recombinant human bone morphogenetic protein 2 on bone healing of rat calvarial defects. Maxillofac Plast Reconstr Surg 2015; 37:16. [PMID: 26161381 PMCID: PMC4488498 DOI: 10.1186/s40902-015-0015-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/06/2015] [Indexed: 11/11/2022] Open
Abstract
Background This study aimed to investigate new bone formation using recombinant human bone morphogenetic protein 2 (rhBMP-2) and locally applied bisphosphonate in rat calvarial defects. Methods Thirty-six rats were studied. Two circular 5 mm diameter bony defect were formed in the calvaria using a trephine bur. The bony defect were grafted with Bio-Oss® only (group 1, n = 9), Bio-Oss® wetted with rhBMP-2 (group 2, n = 9), Bio-Oss® wetted with rhBMP-2 and 1 mM alendronate (group 3, n = 9) and Bio-Oss® wetted with rhBMP-2 and 10 mM alendronate (group 4, n = 9). In each group, three animals were euthanized at 2, 4 and 8 weeks after surgery, respectively. The specimens were then analyzed by histology, histomorphometry and immunohistochemistry analysis. Results There were significant decrease of bone formation area (p < 0.05) between group 4 and group 2, 3. Group 3 showed increase of new bone formation compared to group 2. In immunohistochemistry, collagen type I and osteoprotegerin (OPG) didn’t show any difference. However, receptor activator of nuclear factor κB ligand (RANKL) decreased with time dependent except group 4. Conclusion Low concentration bisphosphonate and rhBMP-2 have synergic effect on bone regeneration and this is result from the decreased activity of RANKL of osteoblast.
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Affiliation(s)
- Ho-Chul Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, 626-787 Yangsan, Mulgeum-eup Korea
| | - Jae-Min Song
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, 626-787 Yangsan, Mulgeum-eup Korea.,Biomedical Research Institute of Pusan National University, Yangsan, Korea
| | - Chang-Joo Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, 626-787 Yangsan, Mulgeum-eup Korea
| | - Sang-Yong Yoon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, 626-787 Yangsan, Mulgeum-eup Korea.,Department of Oral and Maxillofacial Surgery, Good Gang-An Hospital, Busan, Korea
| | - In-Ryoung Kim
- Department of Oral Anatomy and Cell Biology, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Bong-Soo Park
- Department of Oral Anatomy and Cell Biology, School of Dentistry, Pusan National University, Yangsan, Korea
| | - Sang-Hun Shin
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University, 626-787 Yangsan, Mulgeum-eup Korea
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Sharmin F, Adams D, Pensak M, Dukas A, Lieberman J, Khan Y. Biofunctionalizing devitalized bone allografts through polymer-mediated short and long term growth factor delivery. J Biomed Mater Res A 2015; 103:2847-54. [DOI: 10.1002/jbm.a.35435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/06/2015] [Accepted: 02/11/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Farzana Sharmin
- Department of Materials Science and Engineering; University of Connecticut; Storrs Connecticut
| | - Douglas Adams
- Department of Orthopaedic Surgery; University of Connecticut Health Center; Farmington Connecticut
| | - Michael Pensak
- Department of Orthopaedic Surgery; University of Connecticut Health Center; Farmington Connecticut
| | - Alexander Dukas
- Department of Orthopaedic Surgery; University of Connecticut Health Center; Farmington Connecticut
| | - Jay Lieberman
- Department of Orthopaedic Surgery; Keck School of Medicine of the University of Southern California; Los Angeles CA
| | - Yusuf Khan
- Department of Materials Science and Engineering; University of Connecticut; Storrs Connecticut
- Department of Orthopaedic Surgery; University of Connecticut Health Center; Farmington Connecticut
- Institute for Regenerative Engineering; University of Connecticut Health Center; Farmington Connecticut
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Su J, Feng M, Han W, Zhao H. The effects of bisphosphonate on the remodeling of different irregular bones in mice. J Oral Pathol Med 2014; 44:638-48. [PMID: 25370709 DOI: 10.1111/jop.12281] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to compare the effects of bisphosphonate on the remodeling of irregular bones (the jaw and ilium) in mice after trauma. METHODS To verify the feasibility of modeling osteonecrosis, 20 mice were injected intraperitoneally with zoledronate and dexamethasone (ZOL&DEX group), dexamethasone (DEX group), or phosphate-buffered saline (PBS) [control (CTR) group]. Mice then underwent extraction of the right maxillary first molar and creation of an artificial bony cavity in the ilium. Bone sections were stained with H&E for morphological studies. To further compare differences between the maxilla and the ilium caused by similar traumas, 80 mice were injected intraperitoneally with ZOL&DEX or PBS. Pathological progression at the injury sites was assessed at 1 day and at 1, 3, and 8 weeks after trauma using micro-computed tomography (CT), H&E and immunohistochemistry analyses, high-performance liquid chromatography-mass spectrometry, and enzyme-linked immunosorbent assay. RESULTS Only the ZOL&DEX model group effectively developed osteonecrosis. Bony sequestra, osseous sclerosis, unhealed mucosa, and radiopaque alveolar bone were found in the maxilla. In the ilium, there was a lower frequency of osteonecrotic disease and osseous sclerosis, and less suppression of bone remodeling than in the maxilla following long-term bisphosphonate administration. Zoledronate levels were higher in the maxilla. ZOL&DEX treatment suppressed the levels of RANKL and IL-17, but induced an upregulation of osteoprotegerin and FAM20C in both bones. CONCLUSION Accumulation of bisphosphonate may increase the incidence of osteonecrosis. The RANKL/OPG pathway and IL-17 and FAM20C cytokines play key roles in the progression of pathologically abnormal bone remodeling.
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Affiliation(s)
- Jiansheng Su
- Laboratory of Oral Biomedical Science and Translational Medicine, School of Stomatology, Tongji University, Shanghai, China
| | - Mu Feng
- Laboratory of Oral Biomedical Science and Translational Medicine, School of Stomatology, Tongji University, Shanghai, China
| | - Wenfei Han
- Laboratory of Oral Biomedical Science and Translational Medicine, School of Stomatology, Tongji University, Shanghai, China
| | - Hang Zhao
- Laboratory of Oral Biomedical Science and Translational Medicine, School of Stomatology, Tongji University, Shanghai, China
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Arnoldi J, Alves A, Procter P. Early tissue responses to zoledronate, locally delivered by bone screw, into a compromised cancellous bone site: a pilot study. BMC Musculoskelet Disord 2014; 15:97. [PMID: 24656151 PMCID: PMC3994401 DOI: 10.1186/1471-2474-15-97] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 03/12/2014] [Indexed: 11/30/2022] Open
Abstract
Background In fracture treatment, adequate fixation of implants is crucial to long-term clinical performance. Bisphosphonates (BP), potent inhibitors of osteoclastic bone resorption, are known to increase peri-implant bone mass and accelerate primary fixation. However, adverse effects are associated with systemic use of BPs. Thus, Zoledronic acid (ZOL) a potent BP was loaded on bone screws and evaluated in a local delivery model. Whilst mid- to long-term effects are already reported, early cellular events occurring at the implant/bone interface are not well described. The present study investigated early tissue responses to ZOL locally delivered, by bone screw, into a compromised cancellous bone site. Methods ZOL was immobilized on fibrinogen coated titanium screws. Using a bilateral approach, ZOL loaded test and non-loaded control screws were implanted into femoral condyle bone defects, created by an overdrilling technique. Histological analyses of the local tissue effects such as new bone formation and osteointegration were performed at days 1, 5 and 10. Results Histological evaluation of the five day ZOL group, demonstrated a higher osseous differentiation trend. At ten days an early influx of mesenchymal and osteoprogenitor cells was seen and a higher level of cellular proliferation and differentiation (p < 5%). In the ZOL group bone-to-screw contact and bone volume values within the defect tended to increase. Local drug release did not induce any adverse cellular effects. Conclusion This study indicates that local ZOL delivery into a compromised cancellous bone site actively supports peri-implant osteogenesis, positively affecting mesenchymal cells, at earlier time points than previously reported in the literature.
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Abstract
BACKGROUND Fixation of cementless orthopaedic implants is not always achieved, particularly in challenging scenarios such as revision surgery, trauma, and tumor reconstruction. An adjunct therapy for improving implant fixation would improve the reliability and durability of certain reconstructive procedures. QUESTIONS/PURPOSES The purpose of this study was to determine the effect of local elution of the bisphosphonate alendronic acid on bone formation around porous titanium implants in an animal model. METHODS Porous-coated cylindrical rods were coated with either 0.2 mg or 1.0 mg alendronic acid before bilateral surgical implantation into the femoral intramedullary canals of 10 experimental dogs. Twelve weeks after surgery, the femora were harvested and scanned with micro-CT to quantify the percentage volume of bone within the immediate periimplant space. Four femora from two dogs were also processed for undecalcified thin-section histology and analysis with backscattered scanning electron microscopy. Three histologic sections from each of these four femora were anatomically matched with transverse micro-CT sections to enable direct comparison of the area fraction of bone within the periimplant space. RESULTS Compared with paired controls, micro-CT analysis showed that local elution of alendronic acid increased periimplant bone at both doses of 0.2 mg (+52%, p = 0.01) and 1.0 mg (+152%, p = 0.004) with 1.0 mg resulting in a 2.9-fold greater mean relative increase compared with 0.2 mg (p = 0.002). Micro-CT measurements of periimplant bone formation correlated very strongly with the backscattered scanning electron microscopy measurements (R = 0.965, p < 0.001). CONCLUSIONS Local elution of alendronic acid causes a dose-dependent net increase in periimplant bone formation in an animal model. CLINICAL RELEVANCE This concept has potential to improve the biologic fixation of porous reconstructive implants.
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Toker H, Ozdemir H, Ozer H, Eren K. A comparative evaluation of the systemic and local alendronate treatment in synthetic bone graft: a histologic and histomorphometric study in a rat calvarial defect model. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:S146-52. [DOI: 10.1016/j.oooo.2011.09.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 08/25/2011] [Accepted: 09/11/2011] [Indexed: 10/28/2022]
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Koo KH, Lee JH, Chang BS, Lee CK. Effects of alendronate on lumbar posterolateral fusion using hydroxyapatite in rabbits. Artif Organs 2012; 36:1047-55. [PMID: 22963016 DOI: 10.1111/j.1525-1594.2012.01509.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
There are controversies regarding the effect of alendronate on spine fusion. In order to study the effects of alendronate on fusion with porous hydroxyapatite, a total of 47 rabbits underwent posterolateral lumbar fusion. The rabbits received saline (control group), alendronate 0.5 mg/kg/week (low-dose group), or alendronate 1 mg/kg/week (high-dose group) per oral beginning 2 weeks before surgery. All animals were euthanized 12 weeks after surgery, and the extent of fusion was assessed by radiographs, manual palpation, computed tomography (CT) scan, mechanical testing, and histologic examination. The fusion rates by manual palpation, radiography, and CT scan were similar in all groups. There was no significant difference in pixel optic density from the CT scan. Biomechanical testing showed the tensile strength of the control group was higher than that of the treatment group including the low- and high-dose group. In histologic examination, the fusion masses of control animals were characterized by a higher predominance of well-incorporated, trabeculated bone with a prominent marrow element. The treatment group showed a higher proportion of woven bone structures and thicker bony trabeculae. There was no significant difference in the fusion rate, but the tensile strength of treatment group was significantly lower. Histologic examination showed that alendronate inhibited bone resorption and remodeling.
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Affiliation(s)
- Ki Hyoung Koo
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
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Jakobsen T, Baas J, Bechtold JE, Elmengaard B, Søballe K. The effect on implant fixation of soaking tricalcium phosphate granules in bisphosphonate. Open Orthop J 2012; 6:371-5. [PMID: 22962566 PMCID: PMC3434449 DOI: 10.2174/1874325001206010371] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/30/2012] [Accepted: 06/18/2012] [Indexed: 11/25/2022] Open
Abstract
The use of bone grafting is a well-established way to enhance initial implant fixation in situations with reduced bone stock. Ceramic bone substitutes are inferior alternatives to autogenous or allogeneic bone graft. Improvement of bone graft substitutes is needed. We investigated whether biomechanical implant fixation and osseointegration of experimental implant grafted with β-TCP granules (Conduit) could be improved by soaking the β-TCP granules in bisphosphonate (zoledronate). In 10 dogs, a pair of titanium coated implants surrounded by a 2.5 mm gap was inserted into the proximal part of each tibia. The gap was grafted with β-TCP granules either soaked with zoledronate or saline. At 12 weeks, the implants were evaluated with biomechanical push-out test and histomorphometrical analysis. We found that bisphosphonate increased one of the three biomechanical parameters, but found no difference in the amount of new bone or β-TCP granules between the two treatment groups. This study indicates that local treatment of β-TCP granules with zoledronate not only has the potential to increase implant fixation but also calls for further experimental research in order to optimize the dose of zoledronate.
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Affiliation(s)
- Thomas Jakobsen
- Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark
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Impregnation of bone chips with alendronate and cefazolin, combined with demineralized bone matrix: a bone chamber study in goats. BMC Musculoskelet Disord 2012; 13:44. [PMID: 22443362 PMCID: PMC3338367 DOI: 10.1186/1471-2474-13-44] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 03/24/2012] [Indexed: 11/26/2022] Open
Abstract
Background Bone grafts from bone banks might be mixed with bisphosphonates to inhibit the osteoclastic response. This inhibition prevents the osteoclasts to resorb the allograft bone before new bone has been formed by the osteoblasts, which might prevent instability. Since bisphosphonates may not only inhibit osteoclasts, but also osteoblasts and thus bone formation, we studied different bisphosphonate concentrations combined with allograft bone. We investigated whether locally applied alendronate has an optimum dose with respect to bone resorption and formation. Further, we questioned whether the addition of demineralized bone matrix (DBM), would stimulate bone formation. Finally, we studied the effect of high levels of antibiotics on bone allograft healing, since mixing allograft bone with antibiotics might reduce the infection risk. Methods 25 goats received eight bone conduction chambers in the cortical bone of the proximal medial tibia. Five concentrations of alendronate (0, 0.5 mg/mL, 1 mg/mL, 2 mg/mL, and 10 mg/mL) were tested in combination with allograft bone and supplemented with cefazolin (200 μg/mL). Allograft not supplemented with alendronate and cefazolin served as control. In addition, allograft mixed with demineralized bone matrix, with and without alendronate, was tested. After 12 weeks, graft bone area and new bone area were determined with manual point counting. Results Graft resorption decreased significantly (p < 0.001) with increasing alendronate concentration. The area of new bone in the 1 mg/mL alendronate group was significantly (p = 0.002) higher when compared to the 10 mg/mL group. No differences could be observed between the group without alendronate, but with demineralized bone, and the control groups. Conclusions A dose-response relationship for local application of alendronate has been shown in this study. Most new bone was present at 1 mg/mL alendronate. Local application of cefazolin had no effect on bone remodelling.
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Back DA, Pauly S, Rommel L, Haas NP, Schmidmaier G, Wildemann B, Greiner SH. Effect of local zoledronate on implant osseointegration in a rat model. BMC Musculoskelet Disord 2012; 13:42. [PMID: 22439827 PMCID: PMC3323428 DOI: 10.1186/1471-2474-13-42] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 03/22/2012] [Indexed: 12/04/2022] Open
Abstract
Background An implant coating with poly(D, L-lactide) (PDLLA) releasing incorporated Zoledronic acid (ZOL) has already proven to positively effect osteoblasts, to inhibit osteoclasts and to accelerate fracture healing. Aim of this study was to investigate the release kinetics of the chosen coating and the effect of different concentrations of ZOL locally released from this coating on the osseointegration of implants. Methods For release kinetics the release of C14-labled ZOL out of the coating was monitored over a period of six weeks in vitro. For testing the osseointegration, titanium Kirschner wires were implanted into the medullary canal of right femurs of 100 Sprague Dawley rats. The animals were divided into five groups receiving implants either uncoated or coated with PDLLA, PDLLA/ZOL low (1.2% w/w) or PDLLA/ZOL high (2% w/w). Additionally, a group with uncoated implants received ZOL intravenously (i.v.). After 56 days animals were sacrificed, femurs dissected and either strength of fixation or histological bone/implant contacts and newly formed bone around the implants were determined. Results Release kinetics revealed an initial peak in the release of C14-ZOL with a slight further progression over the following weeks. There was no significant enhancement of osseointegration for both groups who received ZOL-coated implants or ZOL i.v. compared to the controls in biomechanical or histological analyses, except for a significant raise in strength of fixation of ZOL i.v. versus PDLLA. Conclusions Even though the investigated local ZOL application did not enhance the osseointegration of the implant, the findings might support its application in fracture treatment, since fracture stabilization devices are often explanted after consolidation.
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Affiliation(s)
- David A Back
- Department of Orthopedics and Traumatology, German Armed Forces Hospital Berlin, Berlin, Germany
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Kadow-Romacker A, Greiner S, Schmidmaier G, Wildemann B. Effect of β-tricalcium phosphate coated with zoledronic acid on human osteoblasts and human osteoclasts in vitro. J Biomater Appl 2011; 27:577-85. [DOI: 10.1177/0885328211415722] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The combination of a bone graft material with bisphosphonates (BPs) might be advantageous for an optimal balance of material resorption and stimulation of bone formation. This study investigated the effect of β-tricalcium phosphate (β-TCP) bone grafts coated with zoledronic acid (ZOL) on osteoblast-like cells and osteoclast-like cells (OLC). As a drug carrier, the polymer poly(D,L-lactide) was used and three different concentrations of ZOL were tested. β-TCP coated with ZOL stimulated the production of osteocalcin (OC), osteoprotegerin, and sRANKL in osteoblast-like cells. The polymer coating alone caused a significant increase in collagen type 1 and OC production. OLC viability was inhibited and the tartrate-resistant acidic phosphatase isoform-5b was significantly decreased after cultivation on polymer-coated β-TCP for 12 days. The three different concentrations of ZOL decreased cell viability and no TRAPiso-5b was detectable, indicating a strong reduction of the TRAPiso-5b after 12 days in culture. After 21 days in culture, only the higher ZOL concentrations significantly reduced cell viability and TRAPiso-5b. The results of this study show that coating of β-TCP with ZOL has stimulating effects on osteoblast-like cells. Additionally, an inhibition of osteoclasts was seen. The combination of this bone grafting material with BPs might, therefore, be effective in the treatment of large bone defects.
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Affiliation(s)
- A Kadow-Romacker
- Berlin–Brandenburg Center for Regenerative Therapies, Julius Wolff Institut, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - S Greiner
- Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - G Schmidmaier
- Department for Orthopedic and Trauma Surgery, University Clinic of Heidelberg, Heidelberg, Germany
| | - B Wildemann
- Berlin–Brandenburg Center for Regenerative Therapies, Julius Wolff Institut, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Mardas N, Schwarz F, Petrie A, Hakimi AR, Donos N. The effect of SLActive surface in guided bone formation in osteoporotic-like conditions. Clin Oral Implants Res 2011; 22:406-15. [PMID: 21303420 DOI: 10.1111/j.1600-0501.2010.02094.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate new bone formation under etched titanium (SLA) and modified-etched hydrophilic titanium (modSLA) domes placed on the calvarium of healthy, osteoporotic and osteoporotic treated with bisphosphonates rabbits. METHODS Experimental osteoporosis was induced by ovariectomy (OV) and calcium-deficient diet in 24 New Zealand female rabbits. Twelve OV rabbits were treated with weekly dozes of alendronate (Fosamax(®)) (B) while 12 OV rabbits received no treatment (O). Another 12 rabbits were sham operated and used as healthy controls (C). At 6 weeks following OV, one modSLA and one SLA titanium dome were placed in the parietal bones of each rabbit. The animals were sacrificed at 30 and 120 days following the dome placement. Various histomorphometric measurements were performed in the most central of the undecalcified sections produced. RESULTS After 30 days of healing, in the C group, the total bone (TB) area was 37.6% and 37.0% under the modSLA and SLA domes, respectively. In the O group, the TB was 35.7% and 24.8%. In the B group, TB was 37.0% and 32.1%, respectively. After 120 days of healing, in the C group TB was 40.1% and 36.4%, respectively. In the O group, TB was 29.6% and 27.9%, respectively. In the B group, TB was 49.7% and 42.5%, respectively. Hierarchical analysis of variance showed that the type of titanium dome significantly influenced new bone and the amount of new bone being in contact with inner surface of the dome (BIC) independently of the observation period and group (P<0.05). The administration of bisphosphonates influenced the BIC (P<0.05). CONCLUSION The use of modSLA surface may promote bone healing and osseointegration in osteoporotic rabbits, whereas administration of bisphosphonates may compromise the osseointegration of the newly formed bone at the early healing period.
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Affiliation(s)
- Nikos Mardas
- Periodontology Unit, Department of Clinical Research, Eastman Dental Institute, University College London, London, UK.
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McKenzie K, Dennis Bobyn J, Roberts J, Karabasz D, Tanzer M. Bisphosphonate remains highly localized after elution from porous implants. Clin Orthop Relat Res 2011; 469:514-22. [PMID: 20809167 PMCID: PMC3018218 DOI: 10.1007/s11999-010-1527-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Local elution of zoledronic acid from a porous implant reportedly enhances periimplant bone formation and implant fixation. However, there is no information in the literature on the extent to which eluted bisphosphonate remains localized around the implant or becomes systemically distributed. QUESTIONS/PURPOSES We ascertained to what extent eluted zoledronic acid remains local and whether there is systemic exposure after local elution from porous implants. METHODS A hydroxyapatite-coated porous tantalum implant dosed with 100 μg (14)C-labeled zoledronic acid was implanted into the left femoral intramedullary canal of six dogs. Bone samples near to and distant from the implant were harvested from three dogs at 6 weeks and three dogs at 52 weeks. The concentration of radiolabeled bisphosphonate in each sample was quantified using liquid scintillation spectrophotometry and its distribution in periimplant bone was revealed by exposing histologic sections to autoradiography film. RESULTS In all six dogs, the concentration of zoledronic acid in immediate periimplant bone was two orders of magnitude higher than in any other sampled tissue, averaging 732.6 ng/g at 6 weeks and 377.2 ng/g at 52 weeks. Minute amounts of zoledronic acid (≤ 7.2 ng/g) were detected throughout the skeleton, indicating some escape into the circulation after local elution. Autoradiographs revealed the greatest concentration of zoledronic acid on and within the implant, with rapid decrease short distances away and no uptake within the femoral cortex. CONCLUSIONS Zoledronic acid eluted from an implant remains mainly localized with minimal systemic distribution. CLINICAL RELEVANCE Local bisphosphonate elution reduces the risk of systemic side effects and skeletal bisphosphonate exposure.
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Affiliation(s)
- Kimberly McKenzie
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Canada
| | - J. Dennis Bobyn
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Canada ,Division of Orthopaedics, McGill University, 1650 Cedar Avenue, Rm LS1-409, Montreal, QC H3G1A4 Canada
| | - Jacintha Roberts
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Canada
| | - Dorota Karabasz
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Canada
| | - Michael Tanzer
- Jo Miller Orthopaedic Research Laboratory, Montreal General Hospital, Montreal, Canada
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Zhu FB, Cai XZ, Yan SG, Zhu HX, Li R. The effects of local and systemic alendronate delivery on wear debris-induced osteolysis in vivo. J Orthop Res 2010; 28:893-9. [PMID: 20058267 DOI: 10.1002/jor.21062] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We investigated the effects of locally and systemically administered alendronate on wear debris-induced osteolysis in vivo. Endotoxin-free titanium particles were injected into rabbit femurs, prior to insertion of a nonweight-bearing polymethylmethacrylate plug into the distal femur canal. Then the particles were repeatedly injected into the knee 2, 4, and 6 weeks after the implantation. Alendronate was incorporated at three different concentrations (0.1, 0.5, and 1.0 wt %) into bone cement for local delivery. For systemic delivery, alendronate was subcutaneously injected (1.0 mg/kg/week) 1 week after the implantation and then once a week until sacrifice. Eight weeks postoperatively, there was significant evidence of osteolysis surrounding the plug in the control group compared with markedly blocked osteolysis in the 0.5 wt % and the 1.0 wt % groups, and the systemic group. There was a concentration-dependent effect of alendronate-loaded bone cement on the improvement of peri-prosthetic bone stock. Notably, no significant differences were found between the 0.5 wt % and the systemic group in peri-prosthetic bone stock and implant fixation. Collectively, although the biological efficacy after the systemic delivery of alendronate was slightly higher than that in the local treatment groups, alendronate-loaded bone cement may be therapeutically effective in inhibiting titanium particle-induced osteolysis in vivo.
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Affiliation(s)
- Fang-Bing Zhu
- Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, People's Republic of China
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Sadat-Shojai M, Atai M, Nodehi A, Khanlar LN. Hydroxyapatite nanorods as novel fillers for improving the properties of dental adhesives: Synthesis and application. Dent Mater 2010; 26:471-82. [DOI: 10.1016/j.dental.2010.01.005] [Citation(s) in RCA: 190] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 10/03/2009] [Accepted: 01/09/2010] [Indexed: 11/28/2022]
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Li Y, Feng G, Gao Y, Luo E, Liu X, Hu J. Strontium ranelate treatment enhances hydroxyapatite-coated titanium screws fixation in osteoporotic rats. J Orthop Res 2010; 28:578-82. [PMID: 20014319 DOI: 10.1002/jor.21050] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Increased bone turnover with excessive bone resorption and decreased bone formation is known to impair implant fixation. Strontium ranelate is well known as an effective antiosteoporotic agent by its dual effect of antiresorbing and bone-forming activity. This study was designed to evaluate the effect of systemic strontium ranelate (SR) treatment on fixation of hydroxyapatite (HA)-coated titanium screws in ovariectomized (OVX) rats. Twelve weeks after being OVX (n=30) or sham (n=10) operated, 40 female Sprague-Dawley rats received unilateral implants in the proximal tibiae. The OVX rats were randomly divided into the following groups: OVX, OVX+SRL ("L" refers to low SR dose of 500 mg/kg/day), OVX+SRH ("H" refers to high SR dose of 1000 mg/kg/day).Twelve weeks after treatment, bone blocks with implants were evaluated with micro-CT and biomechanical push-out tests. Compared to OVX animals, SR treatment increased the bone volume ratio by 51.5% and 1.1-fold, the percentage osteointegration by 1.0-fold and 1.9-fold in micro-CT evaluation, and the maximal force by 1.9-fold and 3.3-fold in biomechanical push-out test, for the low and high dose of SR, respectively. Significant correlation between micro-CT and biomechanical properties demonstrated that trabecular parameters played an important role in predicting the biomechanical properties of implant fixation. Our findings suggest that SR treatment can dose-dependently improve HA-coated screw fixation in OVX rats and facilitate the stability of the implant in the osteoporotic bone.
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Affiliation(s)
- Yunfeng Li
- The State Key Laboratory of Oral Diseases and Department of Oral and Maxillofacial Surgery, Sichuan University West China College of Stomatology, 14 Section 3 Ren Min Nan Lu, Chengdu, 610041, People's Republic of China
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Jakobsen T, Baas J, Bechtold JE, Elmengaard B, Søballe K. The effect of soaking allograft in bisphosphonate: a pilot dose-response study. Clin Orthop Relat Res 2010; 468:867-74. [PMID: 19763718 PMCID: PMC2816745 DOI: 10.1007/s11999-009-1099-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Accepted: 08/31/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Long-term survival of uncemented total joint replacements relies on osseointegration. With reduced bone stock impacted morselized allograft enhances early implant fixation but is subject to resorption. PURPOSE We therefore asked whether soaking morselized allograft in different concentrations of bisphosphonate before impaction would enhance fixation. METHODS In each of 10 dogs, we implanted four unloaded titanium implants surrounded by a 2.5-mm gap into the proximal humerus, two implants in each humerus. The gap was filled with impacted morselized allograft soaked in saline or a low-, middle-, or high-dose bisphosphonate solution (0.005, 0.05, or 0.5 mg zoledronate/mL). At 4 weeks, the implants were evaluated by histomorphometric analysis and mechanical pushout test. RESULTS The low dose of zoledronate increased new bone formation in the allograft but the high dose decreased new bone formation. The high dose of zoledronate resulted in the greatest inhibition of allograft resorption, whereas the low dose of zoledronate resulted in the lowest inhibition of allograft resorption. Implants surrounded allograft soaked in the low dose of zoledronate or saline had better fixation for all three mechanical parameters compared with implants surrounded by allograft soaked in the middle or high dose of zoledronate. CONCLUSIONS These data suggest bisphosphonate may enhance osseointegration of allografted implants and emphasize the need for preclinical testing of antiresorptive therapies.
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Affiliation(s)
- Thomas Jakobsen
- Orthopaedic Research Laboratory, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark
| | - Jørgen Baas
- Orthopaedic Research Laboratory, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark
| | - Joan E. Bechtold
- Orthopaedic Biomechanics Laboratory, Midwest Research Foundation, Minneapolis, MN USA
| | - Brian Elmengaard
- Orthopaedic Research Laboratory, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark
| | - Kjeld Søballe
- Orthopaedic Research Laboratory, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark
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Bobyn JD, McKenzie K, Karabasz D, Krygier JJ, Tanzer M. Locally delivered bisphosphonate for enhancement of bone formation and implant fixation. J Bone Joint Surg Am 2009; 91 Suppl 6:23-31. [PMID: 19884409 DOI: 10.2106/jbjs.i.00518] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Agholme F, Aspenberg P. Experimental results of combining bisphosphonates with allograft in a rat model. ACTA ACUST UNITED AC 2009; 91:670-5. [DOI: 10.1302/0301-620x.91b5.21867] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Soaking bone grafts in a bisphosphonate solution before implantation can prevent their resorption and increase the local bone density in rats and humans. However, recent studies suggest that pre-treatment of allografts with bisphosphonate can prevent bone ingrowth into impaction grafts. We tested the hypothesis that excessive amounts of bisphosphonate would also cause a negative response in less dense grafts. We used a model where non-impacted metaphyseal bone grafts were randomised into three groups with either no bisphosphonate, alendronate followed by rinsing, and alendronate without subsequent rinsing, and inserted into bone chambers in rats. The specimens were evaluated histologically at one week, and by histomorphometry and radiology at four weeks. At four weeks, both bisphosphonate groups showed an increase in the total bone content, increased newly formed bone, and higher radiodensity than the controls. In spite of being implanted in a chamber with a limited opportunity to diffuse, even an excessive amount of bisphosphonate improved the outcome. We suggest that the negative results seen by others could be due to the combination of densely compacted bone and a bisphosphonate. We suggest that bisphosphonates are likely to have a negative influence where resorption is a prerequisite to create space for new bone ingrowth.
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Affiliation(s)
- F. Agholme
- Section for Orthopaedics and Sports Medicine, Department of Clinical and Experimental Medicine, Linköping University, SE-58185 Linköping, Sweden
| | - P. Aspenberg
- Section for Orthopaedics and Sports Medicine, Department of Clinical and Experimental Medicine, Linköping University, SE-58185 Linköping, Sweden
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