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Hsieh MK, Wang CY, Kao FC, Su HT, Chen MF, Tsai TT, Lai PL. Local application of zoledronate inhibits early bone resorption and promotes bone formation. JBMR Plus 2024; 8:ziae031. [PMID: 38606146 PMCID: PMC11008729 DOI: 10.1093/jbmrpl/ziae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 02/14/2024] [Accepted: 03/03/2024] [Indexed: 04/13/2024] Open
Abstract
Nonunion resulting from early bone resorption is common after bone transplantation surgery. In these patients, instability or osteoporosis causes hyperactive catabolism relative to anabolism, leading to graft resorption instead of fusion. Systemic zoledronate administration inhibits osteoclastogenesis and is widely used to prevent osteoporosis; however, evidence on local zoledronate application is controversial due to osteoblast cytotoxicity, uncontrolled dosing regimens, and local release methods. We investigated the effects of zolendronate on osteoclastogenesis and osteogenesis and explored the corresponding signaling pathways. In vitro cytotoxicity and differentiation of MC3T3E1 cells, rat bone marrow stromal cells (BMSCs) and preosteoclasts (RAW264.7 cells) were evaluated with different zolendronate concentrations. In vivo bone regeneration ability was tested by transplanting different concentrations of zolendronate with β-tricalcium phosphate (TCP) bone substitute into rat femoral critical-sized bone defects. In vitro, zolendronate concentrations below 2.5 × 10-7 M did not compromise viability in the three cell lines and did not promote osteogenic differentiation in MC3T3E1 cells and BMSCs. In RAW264.7 cells, zoledronate inhibited extracellular regulated protein kinases and c-Jun n-terminal kinase signaling, downregulating c-Fos and NFATc1 expression, with reduced expression of fusion-related dendritic cell‑specific transmembrane protein and osteoclast-specific Ctsk and tartrate-resistant acid phosphatase (. In vivo, histological staining revealed increased osteoid formation and neovascularization and reduced fibrotic tissue with 500 μM and 2000 μM zolendronate. More osteoclasts were found in the normal saline group after 6 weeks, and sequential osteoclast formation occurred after zoledronate treatment, indicating inhibition of bone resorption during early callus formation without inhibition of late-stage bone remodeling. In vivo, soaking β-TCP artificial bone with 500 μM or 2000 μM zoledronate is a promising approach for bone regeneration, with potential applications in bone transplantation.
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Affiliation(s)
- Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital, Linkou, Taiwan and College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chi-Yun Wang
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
- International Ph.D. Program in Innovative Technology of Biomedical Engineering and Medical Devices, Ming Chi University of Technology, Taishan Dist, New Taipei City 243303, Taiwan
| | - Fu-Cheng Kao
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital, Linkou, Taiwan and College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Hui-Ting Su
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital, Linkou, Taiwan and College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Mei-Feng Chen
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital, Linkou, Taiwan and College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital, Linkou, Taiwan and College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital, Linkou, Taiwan and College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
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Zhang J, Bai H, Bai M, Wang X, Li Z, Xue H, Wang J, Cui Y, Wang H, Wang Y, Zhou R, Zhu X, Xu M, Zhao X, Liu H. Bisphosphonate-incorporated coatings for orthopedic implants functionalization. Mater Today Bio 2023; 22:100737. [PMID: 37576870 PMCID: PMC10413202 DOI: 10.1016/j.mtbio.2023.100737] [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: 03/20/2023] [Revised: 06/06/2023] [Accepted: 07/19/2023] [Indexed: 08/15/2023] Open
Abstract
Bisphosphonates (BPs), the stable analogs of pyrophosphate, are well-known inhibitors of osteoclastogenesis to prevent osteoporotic bone loss and improve implant osseointegration in patients suffering from osteoporosis. Compared to systemic administration, BPs-incorporated coatings enable the direct delivery of BPs to the local area, which will precisely enhance osseointegration and bone repair without the systemic side effects. However, an elaborate and comprehensive review of BP coatings of implants is lacking. Herein, the cellular level (e.g., osteoclasts, osteocytes, osteoblasts, osteoclast precursors, and bone mesenchymal stem cells) and molecular biological regulatory mechanism of BPs in regulating bone homeostasis are overviewed systematically. Moreover, the currently available methods (e.g., chemical reaction, porous carriers, and organic material films) of BP coatings construction are outlined and summarized in detail. As one of the key directions, the latest advances of BP-coated implants to enhance bone repair and osseointegration in basic experiments and clinical trials are presented and critically evaluated. Finally, the challenges and prospects of BP coatings are also purposed, and it will open a new chapter in clinical translation for BP-coated implants.
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Affiliation(s)
- Jiaxin Zhang
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - Haotian Bai
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - Miao Bai
- Department of Ocular Fundus Disease, Ophthalmology Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - Xiaonan Wang
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - ZuHao Li
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - Haowen Xue
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - Jincheng Wang
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - Yutao Cui
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - Hui Wang
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - Yanbing Wang
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - Rongqi Zhou
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - Xiujie Zhu
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - Mingwei Xu
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - Xin Zhao
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
| | - He Liu
- Orthopedic Institute of Jilin Province, Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, PR China
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Saginova D, Tashmetov E, Kamyshanskiy Y, Tuleubayev B, Rimashevskiy D. Evaluation of Bone Regenerative Capacity in Rabbit Femoral Defect Using Thermally Disinfected Bone Human Femoral Head Combined with Platelet-Rich Plasma, Recombinant Human Bone Morphogenetic Protein 2, and Zoledronic Acid. Biomedicines 2023; 11:1729. [PMID: 37371824 DOI: 10.3390/biomedicines11061729] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
This research aimed to assess the effect of bone allograft combined with platelet-rich plasma (PRP), recombinant human bone morphogenetic protein-2 (rhBMP-2), and zoledronic acid (Zol) on bone formation. A total of 96 rabbits were used, and femoral bone defects (5 mm) were created. The rabbits were divided into four groups: (1) bone allograft with PRP (AG + PRP), (2) bone allograft with rhBMP-2 5 μg (AG + BMP-2), (3) bone allograft with Zol 5 μg (AG + Zol), and (4) bone allograft (AG). A histopathological examination was performed to evaluate bone defect healing after 14, 30, and 60 days. The new bone formation and neovascularization inside the bone allograft was significantly greater in the AG + PRP group compared to AG and AG + Zol groups after 14 and 30 days (p < 0.001). The use of bone allograft with rhBMP-2 induced higher bone formation compared to AG and AG + Zol groups on days 14 and 30 (p < 0.001), but excessive osteoclast activity was observed on day 60. The local co-administration of Zol with a heat-treated allograft inhibits allograft resorption as well as new bone formation at all periods. In conclusion, this study demonstrated that PRP and rhBMP-2, combined with a Marburg bone allograft, can significantly promote bone formation in the early stage of bone defect healing.
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Affiliation(s)
- Dina Saginova
- Center for Applied Scientific Research, National Scientific Center of Traumatology and Orthopaedics Named after Academician N.D. Batpenov, Astana 010000, Kazakhstan
| | - Elyarbek Tashmetov
- Department of Surgical Diseases, Karaganda Medical University, Karaganda 100000, Kazakhstan
| | - Yevgeniy Kamyshanskiy
- Pathology Unit of the University Clinic, Karaganda Medical University, Karaganda 100000, Kazakhstan
| | - Berik Tuleubayev
- Department of Surgical Diseases, Karaganda Medical University, Karaganda 100000, Kazakhstan
| | - Denis Rimashevskiy
- Department of Traumatology and Orthopaedics, Peoples' Friendship University of Russia, Moscow 101000, Russia
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Saginova D, Tashmetov E, Kamyshanskiy Y, Koshanova A, Arutyunyan M, Rustambek I. The histological assessment of new bone formation with zolendronic acid loaded bone allograft in rabbit femoral bone defect. J Med Life 2023; 16:616-622. [PMID: 37305828 PMCID: PMC10251371 DOI: 10.25122/jml-2022-0314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/24/2023] [Indexed: 06/13/2023] Open
Abstract
The aim of this experimental study was to evaluate the effect of zolendronic acid (ZOL) combined with bone allograft prepared using the Marburg Bone Bank System on bone formation in the implant remodeling zone. Femoral bone defects with a diameter of 5 mm and a depth of 10 mm were created in 32 rabbits. Animals were divided into 2 similar groups: Group 1 (control), where defects were filled with bone allograft, and Group 2, where allograft was combined with ZOL. Eight animals from each group were sacrificed at 14- and 60-days post-surgery and bone defect healing was assessed using histopathological and histomorphometric analyses after 14 and 60 days. The results showed that new bone formation within the bone allograft was significantly greater in the control group than in the ZOL-treated group after 14 and 60 days (p<0.05). In conclusion, local co-administration of ZOL on heat-treated allograft inhibits allograft resorption and new bone formation in the bone defect.
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Affiliation(s)
- Dina Saginova
- Center for Applied Scientific Research, National Scientific Center of Traumatology and Orthopaedics named after academician N.D.Batpenov, Nur-Sultan, Kazakhstan
| | - Elyarbek Tashmetov
- Department of Surgical Diseases, Karaganda Medical University, Karaganda, Kazakhstan
| | - Yevgeniy Kamyshanskiy
- Institute of Pathology of the University Clinic, Karaganda Medical University, Karaganda, Kazakhstan
| | - Amina Koshanova
- Department of Surgical Diseases, Karaganda Medical University, Karaganda, Kazakhstan
| | - Marietta Arutyunyan
- Department of Surgical Diseases, Karaganda Medical University, Karaganda, Kazakhstan
| | - Ibrahim Rustambek
- Department of Surgical Diseases, Karaganda Medical University, Karaganda, Kazakhstan
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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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Damron TA. CORR Insights®: Does Local Zoledronate Applied to Pasteurized Bone Autografts Improve the Likelihood of Union of Graft-Host Junctions after Limb-sparing Surgery? Clin Orthop Relat Res 2022; 480:121-123. [PMID: 34570741 PMCID: PMC8673994 DOI: 10.1097/corr.0000000000001984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/31/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Timothy A Damron
- Vice Chair and David G. Murray Professor, Department of Orthopedic Surgery, Upstate Medical University, Upstate Bone and Joint Center, East Syracuse, NY, USA
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Kiatisevi P, Sukanthanak B, Piakong P, Kittithamvongs P. Does Local Zoledronate Applied to Pasteurized Bone Autografts Improve the Likelihood of Union of Graft-Host Junctions after Limb-sparing Surgery? Clin Orthop Relat Res 2022; 480:109-120. [PMID: 34406138 PMCID: PMC8673975 DOI: 10.1097/corr.0000000000001942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/20/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pasteurized bone autograft is a recycling biological reconstruction method for limb-sparing surgery when an allograft or other reconstruction technique is unavailable. Since the application of a local bisphosphonate to morselized allografts can reduce graft resorption and enhance bone formation without systemic complications, adding the local bisphosphonate to pasteurized bone autografts should reduce the graft resorption and improve the graft incorporation to host bone. However, no study that we know of has described the outcomes of local bisphosphonate application to massive allografts or pasteurized bone autografts. Thus, this study compared the outcomes of pasteurized bone autografts with and without local zoledronate. QUESTIONS/PURPOSES (1) What is the survival of pasteurized bone autografts and what complications lead to graft removal? (2) Does treatment of pasteurized bone autografts with zoledronate alter the survival of pasteurized bone autografts compared with grafts without treatment? (3) Does the local application of zoledronate reduce the proportion of patients with fractures because of metaphyseal graft resorption? (4) Does local application of zoledronate improve union at the graft-host bone junction compared with untreated grafts? METHODS Between July 2011 and December 2019, we performed 538 musculoskeletal bone tumor resections. Of these, 101 patients underwent reconstruction with pasteurized bone autografts. Other reconstructions included tumor prostheses (150 patients), allografts (70 patients), reconstruction using a bone cement-plate construct (62 patients), and resection only (155 patients). We generally used pasteurized bone autograft when tumors showed an osteoblastic pattern, had less than one-third cortical destruction, and less than half of metaphyseal bone destruction. Six percent (6 of 101) were lost to follow-up, 6% (6 of 101) had incomplete clinical data, and 16% (16 of 101) had a follow-up period less than 2 years without an event, leaving 73 patients for evaluation. The median (interquartile range) age of the patients was 18 years (15 to 26). Ninety-seven percent (71 of 73) had a diagnosis of bone sarcoma. The median follow-up time was 46 months (33 to 75). From 2011 to 2014, 21 pasteurized bone autografts were prepared without local zoledronate, and from 2014 to 2019, 52 pasteurized bone autografts were prepared with local zoledronate because we thought it might improve union and reduce resorption of the graft. From our tumor registry database, we obtained age, sex, use of chemotherapy, graft length and location, pasteurized bone graft type, fixation methods, the use of local zoledronate, osteotomy gap, complications, proportion of grafts that united by 2 years, and local recurrences. Curves for graft survival were determined using the Kaplan-Meier method with the endpoint of autograft removal and metaphyseal fracture from graft resorption. The probabilities of graft removal were estimated by cumulative incidences using the competing risk analysis, where death was considered as the competing event. Intergroup differences in survival and multivariable analyses were performed using the log-rank test and a Cox regression analysis. A logistic regression model was used to evaluate the association between graft-host osseous union by 2 years and other baseline factors. Union was defined when a callus was seen to bridge the osteotomy line for at least three cortices in both the AP and mediolateral planes. RESULTS The 5-year survival rate of all 73 pasteurized grafts was 85% (95% confidence interval 74% to 92%). With the numbers available, we found no difference in the 5-year survival rates between grafts with and without local zoledronate (90% [95% CI 78% to 96%] versus 74% [95% CI 48% to 89%]; p = 0.30). Eleven percent (8 of 73) of patients had metaphyseal fractures because of graft resorption, primarily associated with osteoarticular grafts (5-year fracture-free survival 56% [95% CI 20 to 80]) rather than pasteurized graft-prosthesis composites (94% [95% CI 78% to 98%]) and intercalary grafts (91% [95% CI 50 to 99]; p = 0.001); there was no association with the use of local zoledronate (13%; 7 of 52) compared with those without local zoledronate (5%; 1 of 21) (odds ratio 3.1 [95% CI 0.4 to 27]; p = 0.43). Of the 84 graft-host bone junctions, 85% (71) of the grafts unified within 2 years, 7% (6) unified after 2 years, and 8% (7) of grafts showed nonunion. Union within 2 years was associated with fixation using plate compared with those with stem and with both stem and plate (odds ratio 6.6 [95% CI 1.4 to 31]; p = 0.02) and grafts treated with local zoledronate compared with those without treatment (OR 5.9 [95% CI 1.3 to 28]; p = 0.02). CONCLUSION The application of local zoledronate to pasteurized bone autografts for limb-sparing surgery improved the likelihood of graft union compared with untreated grafts, especially when the osteotomy junctions were fixed using plate osteosynthesis, but it did not appear to alter the proportion of patients who experience metaphyseal fracture of the grafts because of graft resorption. Although this is a small study, it suggests that the treatment of pasteurized bone autografts and perhaps bone allografts should be studied further to determine whether bisphosphonates or other adjuncts can improve the union time and return to function in patients undergoing bone tumor resections using these reconstruction types. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Piya Kiatisevi
- Orthopaedic Oncology Unit, Institute of Orthopaedics, Lerdsin Hospital, Bangkok, Thailand
| | - Bhasanan Sukanthanak
- Orthopaedic Oncology Unit, Institute of Orthopaedics, Lerdsin Hospital, Bangkok, Thailand
| | - Pongsiri Piakong
- Orthopaedic Oncology Unit, Institute of Orthopaedics, Lerdsin Hospital, Bangkok, Thailand
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Ma HY, Ma N, Liu YF, Wan YQ, Liu GQ, Liu GB, Meng HY, Li H, Wang X, Li CB, Peng J. Core Decompression with Local Administration of Zoledronate and Enriched Bone Marrow Mononuclear Cells for Treatment of Non-Traumatic Osteonecrosis of Femoral Head. Orthop Surg 2021; 13:1843-1852. [PMID: 34664417 PMCID: PMC8523758 DOI: 10.1111/os.13100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/09/2021] [Accepted: 05/17/2021] [Indexed: 01/04/2023] Open
Abstract
Objective To investigate the efficacy and safety of core decompression (CD) with local administration of zoledronate and enriched bone marrow mononuclear cells (BMMCS) for the treatment of non‐traumatic osteonecrosis of femoral head (ONFH). Methods A total of 17 patients (30 hips) diagnosed with stage II and III ONFH according to the 2019 revised Association for Research on Osseous Circulation (ARCO) staging criteria from 2012 to 2014 were retrospectively reviewed. The patients received the following therapy: the BMMCs and zoledronate were injected into the necrotic zone, respectively, along with CD. The mean age of the patients was 36.8 years; 14 were men and three were women. All patients included had non‐traumatic ONFH and a minimum follow‐up of 5 years, which ended when total hip arthroplasty (THA) was performed. Imaging modalities, including plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) were taken pre‐ and postoperatively. Harris hip score (HHS) was used to evaluate the functional outcomes of femoral head necrosis. Kaplan–Meier analysis was adopted to determine the probability of survivorship with THA as the end point in this series of patients. The correlation between radiological progression or THA and related risk factors were further analyzed. All complications were recorded. Results With THA as the follow‐up endpoint, All patients were followed up for an average of 69.1 ± 20.5 months (range, 18–95 months). Preoperative imaging found six hips (20%) at ARCO stage II, 14 hips (46.7%) at stage IIIA, 10 hips (33.3%) at stage IIIB. Fourteen hips (46.7%) shown progression radiologically, while six hips (20%) underwent TKA among these patients with hip preservation. The cumulative survival was 80% (95% CI, 0.608–905) at 5 years with THA as the end point. HHS improved from 63.3 ± 8.7 preoperatively to 74.6 ± 20.6 postoperatively (P = 0.000). Radiological progression was found to be associated with ARCO stage, Japanese Investigation Committee (JIC) type, and corticosteroid exposure (P = 0.047; P = 0.012; P = 0.031). However, no correlation was found between conversion to THA and the known risk factors. No major complication was reported, with only four patients complaining about general weakness and muscle soreness, and all disappeared within 2–3 days. Conclusions The novel treatment modality could relieve pain, delay the progression of collapse, which might be an effective and safe method for hip preservation of early and mid‐term ONFH. However, the effect of this method may be related to ARCO stage, JIC type, and corticosteroid exposure.
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Affiliation(s)
- Hai-Yang Ma
- Institute of Orthopaedics/Beijing Key Laboratory of Regenerative Medicine in Orthopedics/Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Ning Ma
- Institute of Orthopaedics/Beijing Key Laboratory of Regenerative Medicine in Orthopedics/Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Yu-Feng Liu
- Institute of Orthopaedics/Beijing Key Laboratory of Regenerative Medicine in Orthopedics/Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Yi-Qun Wan
- Institute of Orthopaedics/Beijing Key Laboratory of Regenerative Medicine in Orthopedics/Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Gui-Qi Liu
- Institute of Orthopaedics/Beijing Key Laboratory of Regenerative Medicine in Orthopedics/Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Guang-Bo Liu
- Institute of Orthopaedics/Beijing Key Laboratory of Regenerative Medicine in Orthopedics/Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Hao-Ye Meng
- Institute of Orthopaedics/Beijing Key Laboratory of Regenerative Medicine in Orthopedics/Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Huo Li
- Institute of Orthopaedics/Beijing Key Laboratory of Regenerative Medicine in Orthopedics/Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Xin Wang
- Institute of Orthopaedics/Beijing Key Laboratory of Regenerative Medicine in Orthopedics/Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Chun-Bao Li
- Institute of Orthopaedics/Beijing Key Laboratory of Regenerative Medicine in Orthopedics/Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
| | - Jiang Peng
- Institute of Orthopaedics/Beijing Key Laboratory of Regenerative Medicine in Orthopedics/Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, China
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Cleemann R, Sorensen M, West A, Soballe K, Bechtold JE, Baas J. Augmentation of implant surfaces with BMP-2 in a revision setting : effects of local and systemic bisphosphonate. Bone Joint Res 2021; 10:488-497. [PMID: 34346256 PMCID: PMC8414437 DOI: 10.1302/2046-3758.108.bjr-2020-0280.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS We wanted to evaluate the effects of a bone anabolic agent (bone morphogenetic protein 2 (BMP-2)) on an anti-catabolic background (systemic or local zoledronate) on fixation of allografted revision implants. METHODS An established allografted revision protocol was implemented bilaterally into the stifle joints of 24 canines. At revision surgery, each animal received one BMP-2 (5 µg) functionalized implant, and one raw implant. One group (12 animals) received bone graft impregnated with zoledronate (0.005 mg/ml) before impaction. The other group (12 animals) received untreated bone graft and systemic zoledronate (0.1 mg/kg) ten and 20 days after revision surgery. Animals were observed for an additional four weeks before euthanasia. RESULTS No difference was detected on mechanical implant fixation (load to failure, stiffness, energy) between local or systemic zoledronate. Addition of BMP-2 had no effect on implant fixation. In the histomorphometric evaluation, implants with local zoledronate had more area of new bone on the implant surface (53%, p = 0.025) and higher volume of allograft (65%, p = 0.007), whereas implants in animals with systemic zoledronate had the highest volume of new bone (34%, p = 0.003). Systemic zoledronate with BMP-2 decreased volume of allograft by 47% (p = 0.017). CONCLUSION Local and systemic zoledronate treatment protects bone at different stages of maturity; local zoledronate protects the allograft from resorption and systemic zoledronate protects newly formed bone from resorption. BMP-2 in the dose evaluated with experimental revision implants was not beneficial, since it significantly increased allograft resorption without a significant compensating anabolic effect. Cite this article: Bone Joint Res 2021;10(8):488-497.
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Affiliation(s)
- Rasmus Cleemann
- Orthopedics, Zealand University Hospital Koge, Køge, Denmark.,Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Orthopedics, Elective Surgery Center - Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Mette Sorensen
- Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Orthopedics, Aalborg University Hospital, Aalborg, Denmark
| | - Andreas West
- Orthopedics, Regionshospitalet Horsens, Horsens, Denmark
| | - Kjeld Soballe
- Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Orthopedics, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Joan E Bechtold
- Department of Orthopedic Surgery, Hennepin Healthcare Research Institute, Minneapolis Medical Research Foundation, Orthopedic Biomechanics Laboratory, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jorgen Baas
- Orthopedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark.,Orthopedics, Aarhus University Hospital Skejby, Aarhus, Denmark
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10
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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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11
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The effect of two locally administered anti-resorptive agents on bone regeneration in a rat fibula model: Alendronate and 15-deoxy-Δ12,14-prostaglandin J2. J Craniomaxillofac Surg 2019; 47:1758-1766. [DOI: 10.1016/j.jcms.2018.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/29/2018] [Accepted: 04/19/2018] [Indexed: 11/17/2022] Open
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12
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Strickland A, Cavanaugh D, Leatherwood WH, Raynor J, Brown A, Weinhold PS. Effect of local zoledronic acid administration in a rat model of posterolateral spinal fusion. J Orthop 2019; 17:101-105. [PMID: 31879484 DOI: 10.1016/j.jor.2019.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 08/12/2019] [Indexed: 11/19/2022] Open
Abstract
Study design Randomized animal model study. Purpose Posterolateral spinal fusion represents a common surgical procedure in the United States. The effect of bisphosphonate administration in these patients is poorly understood. The purpose of this study is to determine whether local administration of bisphosphonate by soaking bone autograft would affect the apparent bone density or structural properties of the fusion mass in a rat model of posterolateral spinal fusion. Methods 36 Spring Dawley rats underwent L4-5 posterolateral spinal fusion with bone autograft. These rats were divided into three groups, two experimental groups and one control group. Each of the experimental groups underwent spinal fusion with morselized vertebral cortical and cancellous autograft soaked in zoledronic acid solution; one group 20 mcg/mL, another 200 mcg/mL. The control group underwent L4-5 spinal fusion with cancellous allograft soaked with saline. At 8 weeks, the rats were euthanized for analysis. Evaluations consisted of micro-CT scanning, four-point bending biomechanical testing, histology, and radiographs. Results Both of the experimental groups showed statistically significant increase in apparent bone density and bone volume fraction at the fusion mass. Biomechanical measures revealed a trend for improvement in the experimental groups, but these did not reach statistical significance. Conclusions This data suggest that locally administered bisphosphonate medications result in increased apparent bone density and bone volume fraction at the fusion mass in posterolateral spinal fusion, and that there appear to be no deleterious consequences with regards to the stiffness or maximum load to failure of the fusion mass under flexion bending evaluation.
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Affiliation(s)
- Ashley Strickland
- University of North Carolina School of Medicine, 134 Glaxo Bldg., 101A Mason Farm Rd., Chapel Hill, NC, 27599, USA
| | - Daniel Cavanaugh
- University of North Carolina School of Medicine, 134 Glaxo Bldg., 101A Mason Farm Rd., Chapel Hill, NC, 27599, USA
| | - William H Leatherwood
- University of North Carolina School of Medicine, 134 Glaxo Bldg., 101A Mason Farm Rd., Chapel Hill, NC, 27599, USA
| | - James Raynor
- University of North Carolina School of Medicine, 134 Glaxo Bldg., 101A Mason Farm Rd., Chapel Hill, NC, 27599, USA
| | - Alexander Brown
- University of North Carolina School of Medicine, 134 Glaxo Bldg., 101A Mason Farm Rd., Chapel Hill, NC, 27599, USA
| | - Paul S Weinhold
- University of North Carolina School of Medicine, 134 Glaxo Bldg., 101A Mason Farm Rd., Chapel Hill, NC, 27599, USA
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13
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Effects of local application of alendronate on early healing of extraction socket in dogs. Clin Oral Investig 2019; 24:1579-1589. [PMID: 31346723 DOI: 10.1007/s00784-019-03031-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/16/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of the present study was to assess the effects of alendronate (ALN) on bone remodeling following tooth extraction in a dog model. MATERIAL AND METHODS For the study, fifteen male Beagles dogs of approximately 12 months of age were used. Mesial roots of four mandibular premolars were endodontically treated, and the distal roots were removed. ALN concentrations of 0.5, 1, and 2 mg/mL were topically applied for 15 min, while a sterile saline was used as a negative control. After the healing period of 1, 2, and 8 weeks, the samples were analyzed by micro-CT and histology. RESULTS Treatment with ALN increased vertical distance between the lingual and the buccal crestal bones. While the ALN-treated sockets had preserved more lingual bone areas, control sockets showed better preservation of the buccal bone areas. ALN treatment resulted in more osteoid formation within the extraction sockets compared with the control. Higher bone volume was found in ALN groups than in the control at 2-week and 8-week healing periods, reaching the significant difference only for the extraction sockets pooled for the ALN treatment. CONCLUSIONS Although ALN treatment could not prevent buccal bone resorption following tooth extraction in dogs, it proved beneficial for the preservation of the lingual bone and formation of new bone within the socket. There was no clear relation between the ALN dosages and the alterations within the extraction sockets. CLINICAL RELEVANCE ALN affects bone remodeling of the extraction socket. The optimal concentration remains to be determined in future studies.
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14
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Belfrage O, Tägil M, Sundberg M, Kesteris U, Flivik G. Locally administered bisphosphonate in hip stem revisions using the bone impaction grafting technique: a randomised, placebo-controlled study with DXA and five-year RSA follow-up. Hip Int 2019; 29:26-34. [PMID: 29932001 DOI: 10.1177/1120700018781809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND: Bisphosphonates have previously been shown to increase the density of impacted graft bone. In the present study we hypothesise that bisphosphonates also reduce early stem subsidence. We examined the effect of locally applied bisphosphonate to allografts on prosthetic micromotion and bone density in femoral stem revision with impaction grafting. METHODS: 37 patients were randomised to either clodronate or saline as local adjunct to the morsellised allograft bone. 24 patients were finally analysed per protocol and evaluated by dual-energy x-ray absorptiometry (DXA) during the first year and with radiostereometric analysis (RSA) for 5 years. RESULTS: There were no significant differences neither in bone density, nor in migratory behaviour between the groups. The femoral stems had subsided 3.6 mm in both groups (p = 0.99) at 5 years and there was no difference as measured over time with mixed models analysis. The clinical outcome was good in both groups. CONCLUSION: Clodronate as a local addendum to allograft bone in hip revision did not increase bone density or reduce micromotion of the implant.
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Affiliation(s)
- Ola Belfrage
- 1 Orthopaedics, Skåne University Hospital, Lund, Sweden.,2 Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Magnus Tägil
- 1 Orthopaedics, Skåne University Hospital, Lund, Sweden.,2 Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Martin Sundberg
- 1 Orthopaedics, Skåne University Hospital, Lund, Sweden.,2 Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Uldis Kesteris
- 1 Orthopaedics, Skåne University Hospital, Lund, Sweden.,2 Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Gunnar Flivik
- 1 Orthopaedics, Skåne University Hospital, Lund, Sweden.,2 Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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15
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Khojasteh A, Dehghan MM, Nazeman P. Immediate implant placement following 1-year treatment with oral versus intravenous bisphosphonates: a histomorphometric canine study on peri-implant bone. Clin Oral Investig 2018; 23:1803-1809. [PMID: 30187256 DOI: 10.1007/s00784-018-2579-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/16/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Bisphosphonates (BPs) are anti-resorptive medications with inhibitory effects on osteoclasts which decrease bone turnover. The present study aimed to assess the early effects of BPs on peri-implant bone. MATERIALS AND METHODS Twelve female mongrel dogs were assigned to one control and two experimental groups as follows: 12 months of oral alendronate (ALN, 3.5 mg/kg/week) or intravenous (IV) pamidronate (PAM, 1 mg/kg/week) for experimental groups. Following 8 weeks after implant insertion, the specimens were sacrificed, histological evaluation was performed, and C-terminal telopeptide of collagen I (CTx) analysis was performed on serums. RESULTS PAM demonstrated the greatest marginal bone level (MBL), 2.64 ± 0.48, followed by ALN and control, 2.5 ± 0.4 and 0.66 ± 0.5 respectively. The least bone-implant contact was observed in PAM group (%39 ± 0.03) while it was significantly greater in the control group (p < 0.05). PAM and ALN demonstrated < 10 CTx levels versus > 300 in controls. CONCLUSION It is assumed that long-term oral or IV BP therapy decreases marginal bone resorption and osseointegration. These changes were more accentuated in IV BP administration. CTx does not seem to be a precise predictor for bisphosphonate-related osteonecrosis of the jaw. CLINICAL RELEVANCE BPs impair peri-implant bone remodeling and this phenomena may be effective for reducing resorption at esthetic zone implants; however, decrease in osseointegration may be a concern for implant treatment in patients receiving BPs.
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Affiliation(s)
- Arash Khojasteh
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Daneshjou Boulevard, Evin, P.O. 19839, Tehran, Iran.
| | - Mohammad Mehdi Dehghan
- Department of Surgery and Radiology, Center of Excellence for Cell Therapy and Tissue Engineering, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Pantea Nazeman
- Research Institute of Dental Sciences, Dental School, Shahid Behehshti University of Medical Sciences, Tehran, Iran
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16
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Kwak EJ, Cha IH, Nam W, Yook JI, Park YB, Kim HJ. Effects of locally administered rhBMP-2 and bisphosphonate on bone regeneration in the rat fibula. Oral Dis 2018; 24:1042-1056. [DOI: 10.1111/odi.12864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 02/23/2018] [Accepted: 03/16/2018] [Indexed: 12/25/2022]
Affiliation(s)
- E-J Kwak
- Department of Oral and Maxillofacial Surgery; College of Dentistry; Yonsei University; Seoul Korea
| | - I-H Cha
- Department of Oral and Maxillofacial Surgery; College of Dentistry; Yonsei University; Seoul Korea
| | - W Nam
- Department of Oral and Maxillofacial Surgery; College of Dentistry; Yonsei University; Seoul Korea
| | - JI Yook
- Department of Oral Pathology; College of Dentistry; Yonsei University; Seoul Korea
| | - Y-B Park
- Department of Prosthodontics; College of Dentistry; Yonsei University; Seoul Korea
| | - HJ Kim
- Department of Oral and Maxillofacial Surgery; College of Dentistry; Yonsei University; Seoul Korea
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17
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Cleemann R, Bechtold JE, Sorensen M, Soballe K, Baas J. Dose-Dependent Resorption of Allograft by rhBMP-2 Uncompensated by New Bone Formation-A Canine Study With Implants and Zoledronate. J Arthroplasty 2018; 33:1215-1221.e1. [PMID: 29248483 DOI: 10.1016/j.arth.2017.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/26/2017] [Accepted: 11/07/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Impacted bone allograft is used to restore lost bone in total joint arthroplasties. Bone morphogenetic proteins (BMPs) can induce new bone formation to improve allograft incorporation, but they simultaneously invoke a seemingly dose-dependent allograft resorption mediated by osteoclasts. Bisphosphonates effectively inhibit osteoclast activity. Predicting allograft resorption when augmented with bone morphogenetic protein 2 (BMP-2), we intended to investigate whether a balanced bone metabolism was achievable within a range of BMP-2 doses with systemic zoledronate treatment. METHODS Implants were coated with 1 of 3 BMP-2 doses (15 μg, 60 μg, and 240 μg) or left untreated. Implants were surrounded by a 2.5-mm gap filled with impacted morselized allograft. Each of the 12 dogs included received 1 of each implant (15 μg, 60 μg, 240 μg, and untreated), 2 in each proximal humerus. During the 4-week observation period, zoledronate intravenous (0.1 mg/kg) was administered to all animals 10 days after surgery as anticatabolic treatment. Implant osseointegration was evaluated by histomorphometry and mechanical push-out tests. RESULTS Untreated implants had the best mechanical fixation and superior retention of allograft as compared to any of the BMP-2 implants. Both mechanical implant fixation and retention of allograft decreased significantly with BMP-2 dose increments. Surprisingly, there was no difference among the treatment groups in the amount of new bone. CONCLUSION The use of BMP-2 to augment impaction-grafted implants cannot be recommended even when combined with systemic zoledronate.
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Affiliation(s)
- Rasmus Cleemann
- Orthopaedic Research Laboratory, Aarhus University Hospital, Aarhus, Denmark; Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Joan E Bechtold
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Mette Sorensen
- Department of Orthopaedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Kjeld Soballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jorgen Baas
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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18
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Hong C, Quach A, Lin L, Olson J, Kwon T, Bezouglaia O, Tran J, Hoang M, Bui K, Kim RH, Tetradis S. Local vs. systemic administration of bisphosphonates in rat cleft bone graft: A comparative study. PLoS One 2018; 13:e0190901. [PMID: 29304080 PMCID: PMC5755940 DOI: 10.1371/journal.pone.0190901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 12/21/2017] [Indexed: 11/29/2022] Open
Abstract
A majority of patients with orofacial cleft deformity requires cleft repair through a bone graft. However, elevated amount of bone resorption and subsequent bone graft failure remains a significant clinical challenge. Bisphosphonates (BPs), a class of anti-resorptive drugs, may offer great promise in enhancing the clinical success of bone grafting. In this study, we compared the effects of systemic and local delivery of BPs in an intraoral bone graft model in rats. We randomly divided 34 female 20-week-old Fischer F344 Inbred rats into four groups to repair an intraoral critical-sized defect (CSD): (1) Control: CSD without graft (n = 4); (2) Graft/Saline: bone graft with systemic administration of saline 1 week post-operatively (n = 10); (3) Graft/Systemic: bone graft with systemic administration of zoledronic acid 1 week post-operatively (n = 10); and (4) Graft/Local: bone graft pre-treated with zoledronic acid (n = 10). At 6-weeks post-operatively, microCT volumetric analysis showed a significant increase in bone fraction volume (BV/TV) in the Graft/Systemic (62.99 ±14.31%) and Graft/Local (69.35 ±13.18%) groups compared to the Graft/Saline (39.18±10.18%). Similarly, histological analysis demonstrated a significant increase in bone volume in the Graft/Systemic (78.76 ±18.00%) and Graft/Local (89.95 ±4.93%) groups compared to the Graft/Saline (19.74±18.89%). The local delivery approach resulted in the clinical success of bone grafts, with reduced graft resorption and enhanced osteogenesis and bony integration with defect margins while avoiding the effects of BPs on peripheral osteoclastic function. In addition, local delivery of BPs may be superior to systemic delivery with its ease of procedure as it involves simple soaking of bone graft materials in BP solution prior to graft placement into the defect. This new approach may provide convenient and promising clinical applications towards effectively managing cleft patients.
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Affiliation(s)
- Christine Hong
- Section of Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, California, United States of America
- * E-mail:
| | - Alison Quach
- Section of Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Lawrence Lin
- UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Jeffrey Olson
- UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Taewoo Kwon
- UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Olga Bezouglaia
- Section of Oral and Maxillofacial Radiology, Division of Diagnostic and Surgical Sciences, UCLA, Los Angeles, California, United States of America
| | - Jaime Tran
- UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Michael Hoang
- Section of Orthodontics, Division of Growth and Development, UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Kimberly Bui
- UCLA School of Dentistry, Los Angeles, California, United States of America
| | - Reuben H. Kim
- Section of Restorative Dentistry, Division of Constitutive and Regenerative Sciences, UCLA, Los Angeles, California, United States of America
| | - Sotirios Tetradis
- Section of Oral and Maxillofacial Radiology, Division of Diagnostic and Surgical Sciences, UCLA, Los Angeles, California, United States of America
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19
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Jakobsen T, Kold S, Shiguetomi-Medina J, Baas J, Soballe K, Rahbek O. Topical zoledronic acid decreases micromotion induced bone resorption in a sheep arthroplasty model. BMC Musculoskelet Disord 2017; 18:441. [PMID: 29132335 PMCID: PMC5683542 DOI: 10.1186/s12891-017-1802-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/03/2017] [Indexed: 12/28/2022] Open
Abstract
Background Initial micromotion of a total hip replacement is associated with aseptic loosening. The use of bisphosphonates could be one way to reduce peri-implant bone resorption induced by micromotion. Bisphosphonates compounds are inhibitors of bone resorption. The aim of this study was to investigate whether local treatment with bisphosphonate would reduce bone resorption and fibrous tissue around an experimental implant subjected to micromotion. Methods One micromotion implant were inserted into each medial femoral condyle in ten sheep. During each gait cycle the implant axially piston 0.5 mm. During surgery one of the femoral condyles were locally treated with 0.8 mg zoledronate. The other condyle served as control. Observation period was 12 weeks. Results Histological evaluation showed a fibrous capsule around both the control and bisphosphonate implants. Histomorphometrical analysis showed that 97% of the surface on both control and bisphosphonate implants were covered by fibrous tissue. However, the bisphosphonate was able to preserve bone in a 1 mm zone around the implants. Conclusion This study indicates that local treatment with bisphosphonate cannot prevent the formation of a fibrous capsule around an implant subjected to micromotion, but bisphosphonate is able to reduce resorption of peri-prosthetic bone.
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Affiliation(s)
- Thomas Jakobsen
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus, Denmark. .,Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark.
| | - Søren Kold
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus, Denmark.,Department of Orthopaedics, Aalborg University Hospital, Aalborg, Denmark
| | - Juan Shiguetomi-Medina
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus, Denmark
| | - Jorgen Baas
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus, Denmark
| | - Kjeld Soballe
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus, Denmark
| | - Ole Rahbek
- Orthopaedic Research Laboratory, Department of Orthopaedics, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000, Aarhus, Denmark
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20
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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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Baas J, Vestermark M, Jensen T, Bechtold J, Soballe K, Jakobsen T. Topical bisphosphonate augments fixation of bone-grafted hydroxyapatite coated implants, BMP-2 causes resorption-based decrease in bone. Bone 2017; 97:76-82. [PMID: 28082076 PMCID: PMC5367933 DOI: 10.1016/j.bone.2017.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/27/2016] [Accepted: 01/06/2017] [Indexed: 11/28/2022]
Abstract
Bone allograft is used in total joint arthroplasties in order to enhance implant fixation. BMPs are known to stimulate new bone formation within allograft, but also known to accelerate graft resorption. Bisphosphonates are strong inhibitor of bone resorption. The aim of this study was to investigate whether the bisphosphonate zoledronate was able to counteract the accelerated graft resorption without interfering with the BMP induced bone formation. In the present study the two drugs alone and in combination were studied in our canine model of impaction bone grafting. We included 10 dogs in this study. Cancellous allograft bone grafts were soaked in either saline or zoledronate solution (0.005mg/mL) and then vehicle or BMP2 (0.15mg rhBMP2) was added. This produced four treatment groups: A) control, B) BMP2, C) zoledronate and D) BMP2+zoledronate. The allograft treated with A, B, C or D was impacted into a circumferential defect of 2.5mm around HA-coated porous Ti implants. Each dog received all four treatment groups with two implants in the distal part of each femur. The group with allograft soaked in zoledronate (C) showed better biomechanical fixation than all other groups (p<0.05). It had less allograft resorption compared to all other groups (p<0.005) without any statistically significant change in new bone formation. The addition of BMP2 to the allograft did not increase new bone formation significantly, but did accelerate allograft resorption. This was also the case where the allograft was treated with BMP2 and zoledronate in combination (D). This caused a decrease in mechanical implant fixation in both these groups compared to the control group, however only statistically significant for the BMP2 group compared to control. The study shows that topical zoledronate can be a valuable tool for augmenting bone grafts when administered optimally. The use of BMP2 in bone grafting procedures seems associated with a high risk of bone resorption and mechanical weakening.
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Affiliation(s)
- Jorgen Baas
- Orthopaedic Research Laboratory, Aarhus University Hospital, 8000 Aarhus C, Denmark
| | - Marianne Vestermark
- Orthopaedic Research Laboratory, Aarhus University Hospital, 8000 Aarhus C, Denmark
| | - Thomas Jensen
- Orthopaedic Research Laboratory, Aarhus University Hospital, 8000 Aarhus C, Denmark
| | - Joan Bechtold
- Minneapolis Medical Research Foundation, University of Minnesota, Minneapolis, MN 55415, USA
| | - Kjeld Soballe
- Orthopaedic Research Laboratory, Aarhus University Hospital, 8000 Aarhus C, Denmark
| | - Thomas Jakobsen
- Orthopaedic Research Laboratory, Aarhus University Hospital, 8000 Aarhus C, Denmark.
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Ma JH, Guo WS, Li ZR, Wang BL. Local Administration of Bisphosphonate-soaked Hydroxyapatite for the Treatment of Osteonecrosis of the Femoral Head in Rabbit. Chin Med J (Engl) 2017; 129:2559-2566. [PMID: 27779162 PMCID: PMC5125334 DOI: 10.4103/0366-6999.192768] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Systemic administration of bisphosphonates has shown promising results in the treatment of osteonecrosis of the femoral head (ONFH). However, few studies have evaluated the efficacy of local zoledronate (ZOL) administration in the treatment of ONFH. The purpose of this study was to investigate whether local administration of bisphosphonate-soaked hydroxyapatite (HA) could improve bone healing in an experimental rabbit model of ONFH. Methods: This experimental study was conducted between October 2014 and June 2015. Forty-five rabbits underwent simulated ONFH surgery. Immediately following surgery, they were divided into three groups: model (untreated, n = 15), HA (treated with HA alone, n = 15), and HA + ZOL (treated with HA soaked in a low-dose ZOL solution, n = 15). Histological, immunohistochemical, and quantitative analyses were performed to evaluate bone formation and resorption 2, 4, and 8 weeks after surgery. Results: Gross bone matrix and hematopoietic tissue formation were observed in the HA + ZOL group 4 weeks after surgery. The immunohistochemical staining intensities for 5-bromodeoxyuridine, runt-related transcription factor 2, osteocalcin, osteopontin, and osteoprotegerin were significantly higher in the HA + ZOL group than that in the model (P < 0.001, P < 0.001, P < 0.001, P < 0.001, and P = 0.018, respectively) and HA groups (P = 0.003, P = 0.049, P < 0.001, P = 0.020, and P = 0.019, respectively), whereas receptor activator of the nuclear factor-κB ligand staining intensity was significantly lower in the HA + ZOL group than that in the model and HA groups (P = 0.029 and P = 0.015, respectively) 4 weeks after surgery. No significant differences in bone formation or bone resorption marker expression were found between the three groups 2 or 8 weeks after surgery (P > 0.05). Conclusions: Local administration of HA soaked in a low-dose ZOL solution increased new bone formation while inhibiting bone resorption in an animal model of ONFH, which might provide new evidence for joint-preserving surgery in the treatment of ONFH.
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Affiliation(s)
- Jin-Hui Ma
- Department of Bone and Joint Surgery, Peking University China Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - Wan-Shou Guo
- Department of Bone and Joint Surgery, Peking University China Japan Friendship School of Clinical Medicine, Beijing 100029; Department of Bone and Joint Surgery, Center for Osteonecrosis and Joint Preserving and Reconstruction, China Japan Friendship Hospital, Beijing 100029, China
| | - Zi-Rong Li
- Department of Bone and Joint Surgery, Peking University China Japan Friendship School of Clinical Medicine, Beijing 100029; Department of Bone and Joint Surgery, Center for Osteonecrosis and Joint Preserving and Reconstruction, China Japan Friendship Hospital, Beijing 100029, China
| | - Bai-Liang Wang
- Department of Bone and Joint Surgery, Peking University China Japan Friendship School of Clinical Medicine, Beijing 100029; Department of Bone and Joint Surgery, Center for Osteonecrosis and Joint Preserving and Reconstruction, China Japan Friendship Hospital, Beijing 100029, China
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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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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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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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Kettenberger U, Ston J, Thein E, Procter P, Pioletti DP. Does locally delivered Zoledronate influence peri-implant bone formation? – Spatio-temporal monitoring of bone remodeling in vivo. Biomaterials 2014; 35:9995-10006. [DOI: 10.1016/j.biomaterials.2014.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/01/2014] [Indexed: 11/27/2022]
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A collagen-hydroxyapatite scaffold allows for binding and co-delivery of recombinant bone morphogenetic proteins and bisphosphonates. Acta Biomater 2014; 10:2250-8. [PMID: 24456759 DOI: 10.1016/j.actbio.2014.01.016] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/16/2013] [Accepted: 01/14/2014] [Indexed: 01/28/2023]
Abstract
An emerging paradigm in orthopedics is that a bone-healing outcome is the product of the anabolic (bone-forming) and catabolic (bone-resorbing) outcomes. Recently, surgical and tissue engineering strategies have emerged that combine recombinant human bone morphogenetic proteins (rhBMPs) and bisphosphonates (BPs) in order to maximize anabolism and minimize catabolism. Collagen-based scaffolds that are the current surgical standard can bind rhBMPs, but not BPs. We hypothesized that a biomimetic collagen-hydroxyapatite (CHA) scaffold would bind both agents and produce superior in vivo outcomes. Consistent with this concept, in vitro elution studies utilizing rhBMP-2 ELISA assays and scintillation counting of (14)C-radiolabeled zoledronic acid (ZA) confirmed delayed release of both agents from the CHA scaffold. Next, scaffolds were tested for their capacity to form ectopic bone after surgical implantation into the rat hind limb. Using CHA, a significant 6-fold increase in bone volume was seen in rhBMP-2/ZA groups compared to rhBMP-2 alone, confirming the ability of ZA to enhance rhBMP-2 bone formation. CHA scaffolds were found to be capable of generating mineralized tissue in the absence of rhBMP-2. This study has implications for future clinical treatments of critical bone defects. It demonstrates the relative advantages of co-delivering anabolic and anti-catabolic agents using a multicomponent scaffold system.
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Mathijssen NMC, Buma P, Hannink G. Combining bisphosphonates with allograft bone for implant fixation. Cell Tissue Bank 2013; 15:329-36. [DOI: 10.1007/s10561-013-9416-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/12/2013] [Indexed: 11/29/2022]
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Sørensen M, Barckman J, Bechtold JE, Søballe K, Baas J. Preclinical evaluation of zoledronate to maintain bone allograft and improve implant fixation in revision joint replacement. J Bone Joint Surg Am 2013; 95:1862-8. [PMID: 24132360 PMCID: PMC3798180 DOI: 10.2106/jbjs.l.00641] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Revision arthroplasty surgery is often complicated by loss of bone stock that can be managed by the use of bone allograft. The allograft provides immediate stability for the revision implant but may be resorbed, impairing subsequent implant stability. Bisphosphonates can delay allograft resorption. We hypothesized that zoledronate-impregnated allograft impacted around revision implants would improve implant fixation as characterized by mechanical push-out testing and histomorphometry. METHODS Twenty-four axially pistoning micromotion devices were inserted bilaterally into the knees of twelve dogs according to our revision protocol. This produced a standardized revision cavity with a loose implant, fibrous tissue, and a sclerotic bone rim. Revision surgery was performed eight weeks later; after stable titanium revision components were implanted, saline solution-soaked allograft was impacted around the component on the control side and allograft soaked in 0.005 mg/mL zoledronate was impacted on the intervention side. The results were evaluated after four weeks. RESULTS The zoledronate treatment resulted in a 30% increase in ultimate shear strength (p = 0.023), a 54% increase in apparent shear stiffness (p = 0.002), and a 12% increase in total energy absorption (p = 0.444). The quantity of allograft in the gap was three times greater in the zoledronate group compared with the control group (p < 0.001). The volume fraction of new bone in the zoledronate group (25%; 95% confidence interval [CI], 22% to 28%) was similar to that in the control group (23%; 95% CI, 19% to 26%) (p = 0.311). CONCLUSIONS The data obtained in this canine model suggest that pretreating allograft with zoledronate may be beneficial for early stability of grafted revision arthroplasty implants, without any adverse effect on bone formation. Clinical studies are warranted. CLINICAL RELEVANCE The zoledronate treatment is simple to apply in the clinical setting. The treatment could increase early stability of revision joint replacements without impairing new bone formation. In the long term, this can potentially improve the longevity of revision joint replacements and reduce the number of subsequent revisions.
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Affiliation(s)
- Mette Sørensen
- Orthopaedic Research Laboratory, Aarhus University Hospital, Norrebrogade 44, Building 1A, Aarhus C, 8000, Denmark. E-mail address for M. Sørensen:
| | - Jeppe Barckman
- Orthopaedic Research Laboratory, Aarhus University Hospital, Norrebrogade 44, Building 1A, Aarhus C, 8000, Denmark. E-mail address for M. Sørensen:
| | - Joan E. Bechtold
- Orthopaedic Biomechanics Laboratory, University of Minnesota, Minneapolis Medical Research Foundation, Excelen Center for Bone and Joint Research and Education, 700 South 10th Avenue, Minneapolis, MN 55415
| | - Kjeld Søballe
- Aarhus University Hospital, Tage-Hansens Gade 2, Cuilding 9A, Aarhus C, 8000, Denmark
| | - Jørgen Baas
- Orthopaedic Research Laboratory, Aarhus University Hospital, Norrebrogade 44, Building 1A, Aarhus C, 8000, Denmark. E-mail address for M. Sørensen:
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Belfrage O, Isaksson H, Tägil M. Local treatment of a bone graft by soaking in zoledronic acid inhibits bone resorption and bone formation. A bone chamber study in rats. BMC Musculoskelet Disord 2012; 13:240. [PMID: 23217097 PMCID: PMC3528664 DOI: 10.1186/1471-2474-13-240] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 11/26/2012] [Indexed: 01/08/2023] Open
Abstract
Background Bone grafts are frequently used in orthopaedic surgery. Graft remodelling is advantageous but can occur too quickly, and premature bone resorption might lead to decreased mechanical integrity of the graft. Bisphosphonates delay osteoclastic bone resorption but may also impair formation of new bone. We hypothesize that these effects are dose dependent. In the present study we evaluate different ways of applying bisphosphonates locally to the graft in a bone chamber model, and compare that with systemic treatment. Methods Cancellous bone grafts were placed in titanium chambers and implanted in the tibia of 50 male rats, randomly divided into five groups. The first group served as negative control and the grafts were rinsed in saline before implantation. In the second and third groups, the grafts were soaked in a zoledronic acid solution (0.5 mg/ml) for 5 seconds and 10 minutes respectively before being rinsed in saline. In the fourth group, 8 μL of zoledronic acid solution (0.5 mg/ml) was pipetted onto the freeze-dried grafts without rinsing. The fifth group served as positive control and the rats were given zoledronic acid (0.1 mg/kg) systemically as a single injection two weeks after surgery. The grafts were harvested at 6 weeks and analysed with histomorphometry, evaluating the ingrowth distance of new bone into the graft as an equivalent to the anabolic osteoblast effect and the amount (bone volume/total volume; BV/TV) of remaining bone in the remodelled graft as equivalent to the catabolic osteoclast effect. Results In all chambers, almost the entire graft had been revascularized but only partly remodelled at harvest. The ingrowth distance of new bone into the graft was lower in grafts soaked in zoledronic acid for 10 minutes compared to control (p = 0.007). In all groups receiving zoledronic acid, the BV/TV was higher compared to control. Conclusions This study found a strong inhibitory effect on bone resorption by bisphosphonates but also a limited inhibition of the ingrowth of new bone. Local treatment at surgery resulted in stronger inhibition of both resorption and bone formation compared to systemic treatment.
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Affiliation(s)
- Ola Belfrage
- Department of Orthopedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.
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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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Schwartz Z, Hyzy SL, Moore MA, Hunter SA, Ronholdt CJ, Sunwoo M, Boyan BD. Osteoinductivity of demineralized bone matrix is independent of donor bisphosphonate use. J Bone Joint Surg Am 2011; 93:2278-86. [PMID: 22258774 PMCID: PMC3234347 DOI: 10.2106/jbjs.j.01469] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Demineralized bone matrix is commonly used as a bone graft substitute, either alone or to supplement an osteoconductive material, because of its osteoinductive properties. The aging of the population has led to an increase in the number of prospective donors of demineralized bone matrix who have taken bisphosphonates to prevent osteoclast-mediated bone resorption. The aim of this study was to determine whether oral bisphosphonate usage affects the osteoinductivity of demineralized bone matrix from donors. METHODS Sex-matched and age-matched pairs of samples were provided by four tissue banks (three or four pairs per bank). Demineralized bone matrix donors without bisphosphonate treatment had a mean age (and standard deviation) of 69.1 ± 2.5 years, and donors with bisphosphonate treatment had a mean age of 68.9 ± 2.0 years. Each pair included one donor known to have taken bisphosphonates and one who had not taken bisphosphonates. Demineralized bone matrix previously confirmed as osteoinductive was the positive control, and heat-inactivated demineralized bone matrix was the negative control. Demineralized bone matrix incubated with 1 mL of phosphate-buffered saline solution containing 0, 0.002, 2.0, or 2000 ng/mL of alendronate was also tested. Gelatin capsules containing 15 mg of demineralized bone matrix were implanted bilaterally in the gastrocnemius muscle of male nude mice (eight implants per group). The mice were killed thirty-five days after implantation, and hind limbs were recovered and processed for histological analysis. Osteoinductivity was measured with use of a qualitative score and by histomorphometry. RESULTS Nine of fifteen samples from donors who had had bisphosphonate treatment and ten of fifteen samples from patients who had not had bisphosphonate treatment were osteoinductive. Qualitative mean scores were comparable (1.7 ± 0.4 for those without bisphosphonates and 1.9 ± 0.7 for those with bisphosphonates). Osteoinductive demineralized bone matrix samples produced ossicles of comparable size, regardless of bisphosphonate usage. Histomorphometric measurements of the area of new bone formation and residual demineralized bone matrix were also comparable. The addition of alendronate to control demineralized bone matrix did not affect its osteoinductivity. CONCLUSIONS Demineralized bone matrix samples from donors treated with bisphosphonates and donors not treated with bisphosphonates have the same ability to induce bone formation. However, it is not known if the quality of the new bone is affected, with subsequent consequences affecting bone remodeling.
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Affiliation(s)
- Zvi Schwartz
- Department of Biomedical Engineering, Georgia Institute of Technology, 315 Ferst Drive N.W., Atlanta, GA 30332-0363. E-mail address for B.D. Boyan:
| | - Sharon L. Hyzy
- Department of Biomedical Engineering, Georgia Institute of Technology, 315 Ferst Drive N.W., Atlanta, GA 30332-0363. E-mail address for B.D. Boyan:
| | - Mark A. Moore
- LifeNet Health, Bio-Implants Division, 1864 Concert Drive, Virginia Beach, VA 23453. E-mail address:
| | - Shawn A. Hunter
- Community Tissue Services, Center for Tissue Innovation and Research, 2900 College Drive, Kettering, OH 45420. E-mail address:
| | - Chad J. Ronholdt
- LABS Inc., 6933-B South Revere Parkway, Centennial, CO 80112. E-mail address:
| | - MoonHae Sunwoo
- Musculoskeletal Transplant Foundation, 125 May Street, Edison, NJ 08837. E-mail address:
| | - Barbara D. Boyan
- Department of Biomedical Engineering, Georgia Institute of Technology, 315 Ferst Drive N.W., Atlanta, GA 30332-0363. E-mail address for B.D. Boyan:
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Abstract
BACKGROUND AND PURPOSE Allografts are often used during revision hip replacement surgery for stabilization of the implant. Resorption of the allograft may exceed new bone formation, and instability of the prosthesis can develop. We investigated whether strontium could regulate the imbalance of fast resorption of allograft and slower formation of new bone, because it is both an anabolic and an anticatabolic agent. METHOD Strontium was added to the implant interface environment by doping a hydroxyapatite bone graft extender. 10 dogs each received 2 experimental titanium implants. The implants were inserted within a 2.7-mm concentric gap in cancellous bone. The gap was filled with 50% (v/v) allograft mixed with 50% bone graft extender. The extender either had 5% strontium doping (SrHA) or was undoped (HA). After 4 weeks, osseointegration and mechanical fixation were evaluated by histomorphometry and by push-out test. RESULTS SrHA bone graft extender induced a 1.2-fold increase in volume of new bone, a 1.2-fold increase in allograft remaining in the gap, and a 1.4-fold increase in surface area of the bone graft extender material in contact with new bone compared to HA bone graft extender. All these increases were statistically significant. SrHA bone graft extender did not significantly improve ongrowth of bone onto the implants or improve any of the mechanical push-out parameters compared to HA bone graft extender. INTERPRETATION Doping of the HA bone graft extender with 5% strontium increased gap healing, preserved more of the allograft in the gap, and increased the ongrowth of bone onto the bone graft extender material, but did not improve mechanical fixation.
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Affiliation(s)
- Marianne T Vestermark
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Research Unit for Rheumatology and Bone Biology, Aarhus University Hospital, Aarhus, Denmark
| | - Kjeld Soballe
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Joan E Bechtold
- Orthopedic Biomechanics Lab, Excelen Center for Bone and Joint Research and Education and Minneapolis Medical Research Foundations, Minneapolis, MN, USA
| | - Thomas Jakobsen
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jorgen Baas
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
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Wilkinson JM, Little DG. Bisphosphonates in orthopedic applications. Bone 2011; 49:95-102. [PMID: 21256254 DOI: 10.1016/j.bone.2011.01.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 01/11/2011] [Accepted: 01/12/2011] [Indexed: 02/08/2023]
Abstract
Bisphosphonates (BPs) exert potent effects on the skeleton. As such, there are important questions relating to how treatment with BPs for metabolic disorders might affect outcomes of orthopedic problems. A further question is what role, if any, might BPs play as adjunctive therapeutics for orthopedic problems. This article outlines the research thus far in the application of BPs to the management of osteonecrosis, bone repair, and joint arthroplasty. Many animal studies show a benefit to decreasing bone resorption in models of osteonecrosis. These include studies in both small and large animals, backed up by limited human data. Further clinical trials are underway for this indication. In bone repair, again, multiple studies exist. There are concerns that BPs could interfere with the normal processes of healing. Some of the controversy about benefits or adverse effects of BPs in this context can be distilled down to effects of dosing and administration. With some exceptions, longer intervals between dosing seem to be more beneficial while not producing adverse healing effects in animal studies. In joint arthroplasty, animal studies suggest a role for topical or systemic BPs for enhancing bone on-growth to implant surfaces and strength of mechanical fixation, although these are yet to be confirmed in clinical studies. Clinical studies show that BPs inhibit periprosthetic bone loss due to strain-adaptive remodeling and after impaction bone grafting, although an efficacy in inhibiting inflammatory bone loss due to wear particle-induced osteolysis has not been confirmed. Lastly, as anabolic drugs have become available, there is increasing interest in their combined use with BPs. From experimental data, manipulation of both the anabolic and catabolic responses is a powerful approach in models of bone repair.
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Affiliation(s)
- J Mark Wilkinson
- Academic Unit of Bone Metabolism, Department of Human Metabolism, University of Sheffield, Metabolic Bone Centre, Sorby Wing, Northern General Hospital, Sheffield, UK.
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Sugata Y, Sotome S, Yuasa M, Hirano M, Shinomiya K, Okawa A. Effects of the systemic administration of alendronate on bone formation in a porous hydroxyapatite/collagen composite and resorption by osteoclasts in a bone defect model in rabbits. ACTA ACUST UNITED AC 2011; 93:510-6. [PMID: 21464492 DOI: 10.1302/0301-620x.93b4.25239] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Several bisphosphonates are now available for the treatment of osteoporosis. Porous hydroxyapatite/collagen (HA/Col) composite is an osteoconductive bone substitute which is resorbed by osteoclasts. The effects of the bisphosphonate alendronate on the formation of bone in porous HA/Col and its resorption by osteoclasts were evaluated using a rabbit model. Porous HA/Col cylinders measuring 6 mm in diameter and 8 mm in length, with a pore size of 100 μm to 500 μm and 95% porosity, were inserted into a defect produced in the lateral femoral condyles of 72 rabbits. The rabbits were divided into four groups based on the protocol of alendronate administration: the control group did not receive any alendronate, the pre group had alendronate treatment for three weeks prior to the implantation of the HA/Col, the post group had alendronate treatment following implantation until euthanasia, and the pre+post group had continuous alendronate treatment from three weeks prior to surgery until euthanasia. All rabbits were injected intravenously with either saline or alendronate (7.5 μg/kg) once a week. Each group had 18 rabbits, six in each group being killed at three, six and 12 weeks post-operatively. Alendronate administration suppressed the resorption of the implants. Additionally, the mineral densities of newly formed bone in the alendronate-treated groups were lower than those in the control group at 12 weeks post-operatively. Interestingly, the number of osteoclasts attached to the implant correlated with the extent of bone formation at three weeks. In conclusion, the systemic administration of alendronate in our rabbit model at a dose-for-weight equivalent to the clinical dose used in the treatment of osteoporosis in Japan affected the mineral density and remodelling of bone tissue in implanted porous HA/Col composites.
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Affiliation(s)
- Y Sugata
- Tokyo Medical and Dental University, Tokyo, Japan
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