Differences in static cortical bone remodeling parameters in human mandible and iliac crest

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

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

Does maxillary sinus proximity affect molar root resorption during distalization using Invisalign? a CBCT study

BACKGROUND

This study aimed to assess the correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption during molar distalization using clear aligner therapy (CAT).

MATERIALS AND METHODS

Thirty-eight cone beam computed tomography scans (CBCTs) obtained pre- (T0) and post-treatment (T1) from 19 adult patients (36.68 ± 13.50 years), who underwent maxillary molar distalization using Invisalign® aligners (Align Technology, Inc., San José, CA, USA) with a minimum of 2 mm distalization, were evaluated in this study At least 22 h of aligner wear per day was a main inclusion criterion. Sinus proximity and changes in root lengths were measured for 61 molars (183 roots). Spearman coefficient analysis was used for assessing correlation between sinus proximity and root resorption. The level of significance was set at p ≤ 0.05. The reproducibility of measurements was assessed by intraclass correlation coefficient (ICC).

RESULTS

Spearman coefficient revealed no significant correlation between sinus proximity and molar root resorption for mesiobuccal, distobuccal or palatal roots (p = 0.558, p = 0.334, p = 0.931, respectively).

CONCLUSION

There was no correlation between maxillary sinus proximity to root apices of maxillary molars and root resorption.

Three-Dimensional Evaluation of Maxillary Sinus Changes in Growing Subjects: A Retrospective Cross-Sectional Study

This study aims to evaluate changes of maxillary sinuses in growing subjects. Cone Beam Computed Tomography (CBCT) scans of 146 patients were divided according to gender and age (6–8, 9–11, 12–14 years old). Left, right and total maxillary sinus volume (MSV-R, MSV-L, MSV-Tot) and surface (MSS-R, MSS-L, MSS-Tot), left and right linear maximum width (LMW-L, LMW-R), depth (LMD-R, LMD-L) and height (LMH-R, LMH-R) were calculated using Mimics Research 22. Kruskal–Wallis Test and showed a statistically significant increase in both genders for all variables. Pairwise comparisons in females are always statistically significant in: LMH-R, LMH-R, MSS-Tot, MSV-Tot. All other variables showed a statistical significant increase between 9–11 and 12–14, and between 6–8 and 12–14 age groups, apart from LMSW-R, LMSW-L, LMSD-R, LMSD-L between 6–8 and 12–14 age groups. Pairwise comparisons in males are always and only statistically significant between 9–11 and 12–14, and between 6–8 and 12–14 groups. Symmetrical measurements (right and left) evaluated using Wilcoxon test retrieved no statistical significant difference. Comparisons between measurements on male and female subjects using Mann–Whitney test showed a statistical significant difference in 6–8 years group in MSV-R, MSV-L and MSV-Tot, and in 12–14 age group in MSV-R, MSV-L, MSV-Tot, MSS-r, MSS-l, MSS-Tot, MSW-R, MSW-L, MSD-R, MSD-L. Intraclass Correlation Coefficient (ICC) assessing inter-operator and intra-operator concordance retrieved excellent results for all variables. It appears that maxillary sinus growth resembles the differential peak of growth in male and female subjects. Sinuses starts to develop early in female subjects. However, in the first and last age group female sinuses are statistically significantly smaller compared to male ones. In male subjects, sinus growth occurs mainly between the second and third age group whilst in female subjects it starts between the first and second age group and continues between the second and the last. Sinus has a vertical development during the peak of growth, which is the main reason for its increase in volume.

Treatment of Class II malocclusion with tooth movement through the maxillary sinus

This case report describes the successful extraction treatment of a Class II malocclusion with excessive maxillary sinus pneumatization. A 20-year-old man sought treatment with the major complaint of protrusive mouth and anterior teeth. He was diagnosed with a skeletal Class II relationship and protrusion of the maxilla. The clinical examination showed a severe Class II molar relationship with excessive overjet and deep overbite. Panoramic radiograph showed obvious maxillary sinus pneumatization bilaterally. Three premolars and one deciduous molar were extracted, and spaces were used to correct molar relationship and retract maxillary incisors. Light forces and low speed movement were applied to overcome the challenge of moving teeth through the maxillary sinus wall. Balanced facial esthetic and stable occlusion were obtained posttreatment with a notable bone formation of the maxillary sinus wall. This result highlights the possibility of tooth movement through cortical floor with bone remodeling and no obvious complications.

Comparative evaluation of bone microstructure in alveolar cleft repair by cone beam CT: influence of different autologous donor sites and additional application of β-tricalcium phosphate

OBJECTIVES

This study used cone beam computed tomography (CBCT) images to comparatively evaluate the three-dimensional microstructural features of reconstructed bone bridge based on the bone harvesting site and the presence/absence of artificial bone material, as well as the features of regenerated bone tissue after bone harvesting from mandibular symphysis in secondary alveolar bone grafting (SABG) for patients with cleft lip, with or without cleft palate.

MATERIALS AND METHODS

Thirty-one patients were divided into three groups in which SABG was performed by autologous bone harvesting from iliac crest (IC), mandibular symphysis (MS), or MS combined with β-TCP granules (MS+TCP). The microstructural trabecular bone parameters (TBPs) and bone structure indexes (SIs) were analyzed using datasets of CBCT images taken before and after SABG.

RESULTS

TBPs showed differences between IC and MS groups (P < 0.05), resulting in greater values of bone volume density (P < 0.05) and inferior value of TBPf (P = 0.070) in IC group compared with MS group. Using MS+TCP or filling β-TCP granules into donor site significantly improved reconstructed or regenerated BV/TV and Tb.Th (P < 0.05) compared with group without β-TCP.

CONCLUSIONS

Microstructural characteristics of reconstructed bone bridge were dependent on the donor site of bone harvesting; using an absorbable bone conductive material improved bone quality and increased bone volume density.

CLINICAL RELEVANCE

Application of β-TCP granules as a partial alternative with autologous bone from mandibular symphysis could obtain comparable outcomes in the microstructure of bone bridge to SABG with autologous iliac crest.

Understanding age-induced cortical porosity in women: Is a negative BMU balance in quiescent osteons a major contributor?

Cortical bone is remodeled by intracortical basic multicellular units (BMUs), whose end result can be observed as quiescent osteons in histological sections. These osteons offer a unique opportunity to investigate the BMU balance between the magnitude of bone resorption and subsequent bone formation at the BMU level. Our main objective was to investigate whether the latter parameters change between defined categories of osteons and with age, and to which extend these changes contribute to age-induced cortical porosity. Cortices of iliac bone specimens from 35 women (aged 16-78 years) with a higher porosity with age were investigated. A total of 3084 quiescent osteons reflecting 75% of the intracortical pores were histological examined. The osteons diameter, pore diameter, wall thickness, prevalence and contribution to the porosity were highly variable, but unchanged with age. Next, the osteons were categorized according to whether they reflected the remodeling of existing canals (type 2Q osteons) or the generation of new canals (type 1Q osteons). Type 2Q osteons versus type 1Q osteons: (i) had more frequently a pore diameter > 75 μm (7.4 vs. 1.3%; p < 0.001); (ii) had a larger mean pore diameter (40 ± 10 vs. 25 ± 4 μm; p < 0.001), osteon diameter (120 ± 21 vs. 94 ± 21 μm; p < 0.001) and wall thickness (40 ± 10 vs. 35 ± 9; p < 0.05); (iii) had a larger contribution to the cortical porosity (29 ± 18 vs. 8 ± 8%; p < 0.001); (iv) were more prevalent (44 ± 10 vs. 31 ± 11%; p < 0.001); and (v) were more prevalent with age. Collectively, this study demonstrates that quiescent osteons with age more frequently result from remodeling of existing canals, which in some cases had a more negative BMU balance. Still, the osteons showed no overall age-related change in their pore diameter i.e. BMU balance. In contrast to conventional wisdom, these data show that non-quiescent pores, not pores of quiescent osteons, were the main contributor to a higher cortical porosity.

Estrogens and Androgens in Skeletal Physiology and Pathophysiology

Estrogens and androgens influence the growth and maintenance of the mammalian skeleton and are responsible for its sexual dimorphism. Estrogen deficiency at menopause or loss of both estrogens and androgens in elderly men contribute to the development of osteoporosis, one of the most common and impactful metabolic diseases of old age. In the last 20 years, basic and clinical research advances, genetic insights from humans and rodents, and newer imaging technologies have changed considerably the landscape of our understanding of bone biology as well as the relationship between sex steroids and the physiology and pathophysiology of bone metabolism. Together with the appreciation of the side effects of estrogen-related therapies on breast cancer and cardiovascular diseases, these advances have also drastically altered the treatment of osteoporosis. In this article, we provide a comprehensive review of the molecular and cellular mechanisms of action of estrogens and androgens on bone, their influences on skeletal homeostasis during growth and adulthood, the pathogenetic mechanisms of the adverse effects of their deficiency on the female and male skeleton, as well as the role of natural and synthetic estrogenic or androgenic compounds in the pharmacotherapy of osteoporosis. We highlight latest advances on the crosstalk between hormonal and mechanical signals, the relevance of the antioxidant properties of estrogens and androgens, the difference of their cellular targets in different bone envelopes, the role of estrogen deficiency in male osteoporosis, and the contribution of estrogen or androgen deficiency to the monomorphic effects of aging on skeletal involution.

Factors related to the rate of orthodontically induced tooth movement

INTRODUCTION

The purpose of this study was to investigate the variations of orthodontically induced tooth movement in the maxillary and mandibular arches between patients and the factors such as age, sex, and presence of an interference that might influence the amount of tooth displacement.

METHODS

By using a standardized experimental orthodontic tooth movement in 30 subjects, 57 premolars were moved buccally during 8 weeks with the application of a 1-N force. Forty-four contralateral premolars not subjected to orthodontic tooth movement served as the controls. Plaster models from before and after the experimental tooth movement were digitized and superimposed to evaluate the amounts of tooth movement. Differences in tooth movement between the experimental and control groups were tested by an unpaired t test. For the experimental teeth, subject-related factors (age and sex) and tooth-related factors (location in the maxillary or mandibular dental arch, and the presence or absence of an intra-arch or interarch obstacle such as neighboring touching teeth or teeth interfering with the occlusion) were examined with analysis of variance. Multiple linear regression analysis was performed to determine correlations between tooth displacement, age, sex, tooth location, and presence of an interference.

RESULTS

Each subject contributed at least 2 experimental premolars and 1 control premolar. The displacement of the orthodontically moved teeth was 2.42 mm (range, 0.3-5.8 mm). Younger subjects (<16 years; n = 19; number of teeth, 36) had significantly greater amounts of tooth displacement compared with older subjects (≥16 years; n = 11; number of teeth, 21): 2.6 ± 1.3 mm vs 1.8 ± 0.8 mm; P <0.01. When an interarch or intra-arch obstacle was present, the amount of tooth movement was significantly less (2.6 ± 1.3 mm vs 1.8 ± 0.8 mm) (P <0.05). Neither sex nor the location of the experimental teeth in the mandible or the maxilla had any effect.

CONCLUSIONS

Younger patients showed greater tooth movement velocity than did older ones. An interarch or intra-arch obstacle decreased the amount of tooth displacement.

Mechanotransduction activates α₅β₁ integrin and PI3K/Akt signaling pathways in mandibular osteoblasts

It is unclear how bone cells at different sites detect mechanical loading and how site-specific mechanotransduction affects bone homeostasis. To differentiate the anabolic mechanical responses of mandibular cells from those of calvarial and long bone cells, we isolated osteoblasts from C57B6J mouse bones, cultured them for 1week, and subjected them to therapeutic low intensity pulsed ultrasound (LIPUS). While the expression of the marker proteins of osteoblasts and osteocytes such as alkaline phosphatase and FGF23, as well as Wnt1 and β-catenin, was equally upregulated, the expression of mandibular osteoblast messages related to bone remodeling and apoptosis differed from that of messages of other osteoblasts, in that the messages encoding the pro-remodeling protein RANKL and the anti-apoptotic protein Bcl-2 were markedly upregulated from the very low baseline levels. Blockage of the PI3K and α(5)β(1) integrin pathways showed that the mandibular osteoblast required mechanotransduction downstream of α(5)β(1) integrin to upregulate expression of the proteins β-catenin, p-Akt, Bcl-2, and RANKL. Mandibular osteoblasts thus must be mechanically loaded to preserve their capability to promote remodeling and to insure osteoblast survival, both of which maintain intact mandibular bone tissue. In contrast, calvarial Bcl-2 is fully expressed, together with ILK and phosphorylated mTOR, in the absence of LIPUS. The antibody blocking α(5)β(1) integrin suppressed both the baseline expression of all calvarial proteins examined and the LIPUS-induced expression of all mandibular proteins examined. These findings indicate that the cellular environment, in addition to the tridermic origin, determines site-specific bone homeostasis through the remodeling and survival of osteoblastic cells. Differentiated cells of the osteoblastic lineage at different sites transmit signals through transmembrane integrins such as α(5)β(1) integrin in mandibular osteoblasts, whose signaling may play a major role in controlling bone homeostasis.

Assessment of mandibular buccal and lingual cortical bones in postmenopausal women

OBJECTIVE

Correlations between the widths of mandibular cortical bones and the bone mineral density (BMD) of the spine were analyzed to evaluate the influence of the general bone condition.

STUDY DESIGN

Thirty postmenopausal women were enrolled in this investigation. The widths of cortical bones in sites of the mental foramen and the BMD of the mandibular cancellous bone were measured using multislice computerized tomography (CT) images. The BMD of the lumbar spine was measured using dual-energy x-ray absorptiometry, and the ratio to the young adult mean (YAM) was obtained.

RESULTS

A weak correlation between the widths of cortical bones and the ratio to the YAM was observed. Also, correlations between the widths of cortical bones and the BMD of the mandible were noted.

CONCLUSION

The widths of buccal and lingual cortical bones in the mesial and distal sites of the mental foramen measured on axial CT images do not serve as a reliable examination for the BMD of the lumbar spine.

Porosity of human mandibular condylar bone

Quantification of porosity and degree of mineralization of bone facilitates a better understanding of the possible effects of adaptive bone remodelling and the possible consequences for its mechanical properties. The present study set out first to give a three-dimensional description of the cortical canalicular network in the human mandibular condyle, in order to obtain more information about the principal directions of stresses and strains during loading. Our second aim was to determine whether the amount of remodelling was larger in the trabecular bone than in cortical bone of the condyle and to establish whether the variation in the amount of remodelling was related to the surface area of the cortical canals and trabeculae. We hypothesized that there were differences in porosity and orientation of cortical canals between various cortical regions. In addition, as greater cortical and trabecular porosities are likely to coincide with a greater surface area of cortical canals and trabeculae available for osteoblastic and osteoclastic activity, we hypothesized that this surface area would be inversely proportional to the degree of mineralization of cortical and trabecular bone, respectively. Micro-computed tomography was used to quantify porosity and mineralization in cortical and trabecular bone of ten human mandibular condyles. The cortical canals in the subchondral cortex of the condyle were orientated in the mediolateral direction, and in the anterior and posterior cortex in the superoinferior direction. Cortical porosity (average 3.5%) did not differ significantly between the cortical regions. It correlated significantly with the diameter and number of cortical canals, but not with cortical degree of mineralization. In trabecular bone (average porosity 79.3%) there was a significant negative correlation between surface area of the trabeculae and degree of mineralization; such a correlation was not found between the surface area of the cortical canals and the degree of mineralization of cortical bone. No relationship between trabecular and cortical porosity, nor between trabecular degree of mineralization and cortical degree of mineralization was found, suggesting that adaptive remodelling is independent and different between trabecular and cortical bone. We conclude (1) that the principal directions of stresses and strains are presumably directed mediolaterally in the subchondral cortex and superoinferiorly in the anterior and posterior cortex, (2) that the amount of remodelling is larger in the trabecular than in the cortical bone of the mandibular condyle; in trabecular bone variation in the amount of remodelling is related to the available surface area of the trabeculae.

Remodeling dynamics in the alveolar process in skeletally mature dogs

Bone turnover rates can be altered by metabolic and mechanical demands. Due to the difference in the pattern of loading, we hypothesized that there are differences in bone remodeling rates between the maxillary and mandibular alveolar processes. Furthermore, in a canine model, the alveolar process of teeth that lack contact (e.g., second premolars) would have a different turnover rate than bone supporting teeth with functional contact (e.g., first molars). Six skeletally mature male dogs were given a pair of calcein labels. After sacrifice, specimens representing the anterior and posterior locations of both jaws were prepared for examination by histomorphometric methods to evaluate the bone volume/total volume (BV/TV; %), bone volume (mm2), mineral apposition rate (MAR; microm/day), and bone formation rate (BFR; %/year) in the alveolar process. There were no significant differences (P>0.05) in the BV/TV within the jaws. The bone volume within the alveolar process of the mandible was 2.8-fold greater than in the maxilla. The MAR was not significantly different between the jaws and anteroposterior locations. However, the BFR was significantly (P<0.0001) greater in the mandible than in the maxilla. The anterior location had higher (P=0.002) remodeling than the posterior location in the maxilla but not in the mandible. While there was a greater bone mass and increased remodeling in the mandible, no remodeling gradient in the coronal-apical direction was apparent in the alveolar process. Bone adaptation probably involves a complex interplay of bone turnover, mass, and architecture.

Significance of osteoporosis in craniomaxillofacial surgery: a review of the literature

Osteoporosis is a common problem in orthopedic surgery. The purpose of this review of the literature was to examine whether osteoporosis is also an important factor in patient treatment in the field of craniomaxillofacial surgery. Emphasis was given to the consequences of osteoporosis for the maxilla and mandible, the influence of osteoporosis on fracture treatment, the use of dental implants, the importance of soft tissues and the effect of osteoporosis therapies. It was found that osteoporosis does affect the bones of the skull. The effect of osteoporosis on treatment, however, is controversial and necessitates better ways of quantifying bone loss. Large inter-individual and site-specific differences in bone density, as well as other effects such as removal of teeth, periodontitis, implant insertion, augmentation procedures and altered loading with dystrophic consequences need to be considered in future studies. Special attention should be given to osteoporosis during fracture treatment.

Microdamage in porcine alveolar bone due to functional and orthodontic loading

Bone remodelling has been associated with microdamage. The aim of this study was to investigate the presence of microdamage in the alveolar bone and its potential role in the initiation of bone remodelling following the application of an orthodontic load. The three-dimensional morphology of the alveolar bone was investigated by means of high resolution micro-CT scanning. In 25, 3-month-old, male Danish land-race pigs, the alveolar bone around the lower right and left first molars was analysed. The right first molar was moved buccally with a force of 130 cN by means of a custom-made cantilever made of a TMA 0.017 x 0.025 inch wire. The left molar was left untreated. After 1, 2, 4, 7 and 15 days of treatment the regions containing the right and left molars were excised and en bloc stained in basic fuchsin and the presence of microdamage detected. Diffuse damage was present in the alveolar bone of both the treated and the untreated teeth on both sides. On the lingual sides, diffuse damage showed the same orientation as the periodontal fibres. Bone microcracks were also detected on both the treated and untreated teeth. On the buccal surfaces they where often observed in close proximity to scalloped resorption surfaces. After 1 day of treatment, the presence of microcracks on the buccal-treated side was particularly marked. To conclude, bone microdamage is present in porcine alveolar bone in form of both microcracks and diffuse damage, suggesting that microdamage-driven remodelling also occurs in the alveolar bone. The presence of bone microcracks in the direction of the orthodontic force at day 1 suggests that they could represent the first damage induced by the orthodontic load that has to be repaired.

Bone remodeling at the iliac crest can predict the changes in remodeling dynamics, microdamage accumulation, and mechanical properties in the lumbar vertebrae of dogs

We previously demonstrated that suppression of bone remodeling allows microdamage to accumulate, thereby leading to reduced bone toughness in dog bone. In this study we evaluated the relationships between bone remodeling at the iliac crest and skeletal activation frequency, microdamage accumulation, or biomechanical properties of lumbar vertebrae using the same dogs to determine whether bone remodeling at the iliac crest can predict damage accumulation and mechanical parameters of the lumbar spine following treatment with antiresorptive agents. Thirty-six female beagles, 1 to 2 years old, were divided into three groups. The control group was treated daily for 12 months with saline vehicle. The remaining two groups were treated daily with oral risedronate at a dose of 0.5 mg/kg/day, or alendronate at 1.0 mg/kg/day orally. The doses of these bisphosphonates were 5 to 6 times the clinical doses approved for treatment of osteoporosis in humans. After sacrifice, the right ilium and L2 vertebra were assigned to histomorphometry. The left ilium and L3 vertebra were used for microdamage analysis. The L4 vertebra was mechanically tested to failure in compression, and bone toughness calculated from the stress-strain curve. There was a strong positive relationship for activation frequency (Ac.f) between ilium and lumbar vertebrae (r2 = 0.82; P < 0.0001). Iliac crest Ac.f underestimates Ac.f in L2, but L2 Ac.f reaches a minimum threshold and does not decline further when iliac crest Ac.f is below 0.10/yr. Microdamage (Cr.S.Dn) accumulation at the ilium was significantly associated with increased microdamage accumulation in the L3 lumbar vertebra (r2 = 0.43, P < 0.0001). The data also show that bisphosphonate treatment increased Cr.S.Dn at a faster rate in L3 than in the iliac crest. Although bisphosphonate treatment decreased bone toughness in L4, this decrease demonstrated no relationship to decreased Ac.f in the ilium. These results clearly indicate that bone remodeling data obtained from iliac crest biopsy could be used to estimate the activation frequency and microdamage burden in the vertebral column.

Quantitative assessment of post-extraction healing and alveolar ridge remodelling of the mandible in female rats

OBJECTIVE

To quantitatively evaluate the healing and bone changes in the mandible of adult female rats following unilateral extraction of the mandibular molars and the incisor.

METHODS

Six-month old female rats had their mandibular molars and the incisor on one side of the mandible extracted. Nine rats were sacrificed at 0, 14, 28, 56 and 112 days post-extraction. Bone mineral density (BMD) as observed by dual energy X-ray absorptiometry (DEXA) and histomorphometric measurements of total bone volume (TBV/TV%) as well as changes in size; height and width on backscattered electron microscopy images of cross-sections of the mandible were evaluated.

RESULTS

There was a total increase of 28% in BMD of the body of the mandible and 35.1% increase in TBV/TV% at 112 days post-extraction. A maximal increase of 25% in BMD was observed at 14 days post-extraction. TBV/TV% increased by 9.5% at 14 days post-extraction and further increased by 15.9% (P < 0.001) from 14 to 28 days and by 9.2% (P < 0.001) from 28 to 56 days. A further slight but non-significant increase of 6% (P = 0.108) occurred from 56 to 112 days post-extraction. Regression equations demonstrated that the maximal increase in TBV/TV% and BMD occurred between 0 and 28 days, which subsequently slowed down between 28 and 56 days and further declined between 56 and 112 days post-extraction. Healing was associated with a reduction in cross-sectional area (32.89%), height (21%) and width of the mandible (12.84%).

CONCLUSIONS

BMD of the edentulous mandible following extraction of mandibular molars and the incisor on one side of the mandible increases up to 56 days, but that total bone volume increases up to 112 days post-extraction. This indicates that bone volume measurement is more sensitive than BMD measurements in detecting small increase in bone formation at later stages of healing, possibly because of changes in geometry of the edentulous mandible following teeth extraction. The edentulous mandible undergoes a significant reduction in size as a result of reduction in both height and width up to 112 days post-extraction.

Osteoprotegerin inhibits prostate cancer-induced osteoclastogenesis and prevents prostate tumor growth in the bone

Prostate cancer (CaP) forms osteoblastic skeletal metastases with an underlying osteoclastic component. However, the importance of osteoclastogenesis in the development of CaP skeletal lesions is unknown. In the present study, we demonstrate that CaP cells directly induce osteoclastogenesis from osteoclast precursors in the absence of underlying stroma in vitro. CaP cells produced a soluble form of receptor activator of NF-kappaB ligand (RANKL), which accounted for the CaP-mediated osteoclastogenesis. To evaluate for the importance of osteoclastogenesis on CaP tumor development in vivo, CaP cells were injected both intratibially and subcutaneously in the same mice, followed by administration of the decoy receptor for RANKL, osteoprotegerin (OPG). OPG completely prevented the establishment of mixed osteolytic/osteoblastic tibial tumors, as were observed in vehicle-treated animals, but it had no effect on subcutaneous tumor growth. Consistent with the role of osteoclasts in tumor development, osteoclast numbers were elevated at the bone/tumor interface in the vehicle-treated mice compared with the normal values in the OPG-treated mice. Furthermore, OPG had no effect on CaP cell viability, proliferation, or basal apoptotic rate in vitro. These results emphasize the important role that osteoclast activity plays in the establishment of CaP skeletal metastases, including those with an osteoblastic component.