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Liu J, Li C, Yang F, Li M, Wu B, Chen H, Li S, Zhang X, Yang J, Xia Y, Wu M, Li Y, Liu B, Zhao D. Effects of angiotensin II combined with asparaginase and dexamethasone on the femoral head in mice: A model of steroid-induced femoral head osteonecrosis. Front Cell Dev Biol 2022; 10:975879. [PMID: 36187471 PMCID: PMC9521711 DOI: 10.3389/fcell.2022.975879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background: To study the pathogenesis of steroid-induced femoral head osteonecrosis, an ideal animal model is very important. As experimental animals, mice are beneficial for studying the pathogenesis of disease. However, there are currently few mouse models of steroid-induced femoral head osteonecrosis, and there are many questions that require further exploration and research.Purposes: The purpose of this study was to establish a new model of osteonecrosis in mice using angiotensin II (Ang II) combined with asparaginase (ASP) and dexamethasone (DEX) and to study the effects of this drug combination on femoral head osteonecrosis in mice.Methods: Male BALB/c mice (n = 60) were randomly divided into three groups. Group A (normal control, NC) was treated with physiological saline and given a normal diet. Group B (DEX + ASP, DA) was given free access to food and water (containing 2 mg/L DEX) and subjected to intraperitoneal injection of ASP (1200 IU/kg twice/week for 8 weeks). Group C (DEX + ASP + Ang II, DAA) was treated the same as group B, it was also given free access to food and water (containing 2 mg/L DEX) and subjected to intraperitoneal injection of ASP (1200 IU/kg twice/week for 8 weeks), but in the 4th and 8th weeks, subcutaneous implantation of a capsule osmotic pump (0.28 mg/kg/day Ang II) was performed. The mice were sacrificed in the 4th and 8th weeks, and the model success rate, mouse mortality rate, body weight, blood lipids, coagulation factors, histopathology, and number of local vessels in the femoral head were evaluated.Results: DAA increased the model success rate [4th week, 30% (DA) vs. 40% (DAA) vs. 0% (NC); 8th week, 40% (DA) vs. 70% (DAA) vs. 0% (NC)]. There was no significant difference in mortality rate between the groups [4th week, 0% (DA) vs. 0% (DAA) vs. 0% (NC); 8th week, 5% (DA) vs. 10% (DAA) vs. 0% (NC)]. DAA affected mouse body weight and significantly affected blood lipids and blood coagulation factors. DAA reduces the number of blood vessels in the femoral head and destroys the local blood supply.Conclusion: Angiotensin II combined with asparaginase and dexamethasone can obviously promote the necrosis of femoral head and provide a new idea for the model and treatment of osteonecrosis.
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Affiliation(s)
- Jiahe Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Chenzhi Li
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Fan Yang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- Institute of Metal Research Chinese Academy of Sciences, Shenyang, Liaoning, China
| | - Minde Li
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Baolin Wu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Haojie Chen
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Shaopeng Li
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Xiuzhi Zhang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Jiahui Yang
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Yan Xia
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Mingjian Wu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Yancheng Li
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Baoyi Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- *Correspondence: Baoyi Liu, ; Dewei Zhao,
| | - Dewei Zhao
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
- *Correspondence: Baoyi Liu, ; Dewei Zhao,
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Ng FH, Lai TKB, Lam SY, Pan NY, Luk WH. Hybrid Magnetic Resonance Imaging with Single Photon Emission Computed Tomography/Computed Tomography Bone Scan for Diagnosis Of Avascular Necrosis of Femoral Head. J Clin Imaging Sci 2021; 11:2. [PMID: 33500837 PMCID: PMC7827511 DOI: 10.25259/jcis_205_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/29/2020] [Indexed: 12/04/2022] Open
Abstract
Magnetic resonance imaging (MRI) is a commonly used imaging modality to detect early avascular necrosis (AVN). When MRI is inconclusive, bone scan is helpful in detecting AVN during early phase of the disease. As newer nuclear medicine equipment, such as single photon emission computed tomography/computed tomography (SPECT/CT) and positron emission tomography, are emerging in medical science, the role of these imaging modalities in AVN of femoral head is re-evaluated.
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Affiliation(s)
- Fung Him Ng
- Department of Radiology, Princess Margaret Hospital, Hong Kong
| | | | - Sun Yu Lam
- Department of Radiology, Princess Margaret Hospital, Hong Kong
| | - Nin Yuan Pan
- Department of Radiology, Princess Margaret Hospital, Hong Kong
| | - Wing Hang Luk
- Department of Radiology, Princess Margaret Hospital, Hong Kong
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Gao YH, Dong N, Yang C, Li SQ, Liu JG, Qi X. Elevated synovial fluid IL-33 and IL-6 levels and cartilage degeneration in stage III osteonecrosis of the femoral head. Technol Health Care 2020; 28:203-212. [PMID: 31594271 DOI: 10.3233/thc-191811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yu-Hang Gao
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Ning Dong
- Department of Pediatric Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Chen Yang
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Shu-Qiang Li
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Jian-Guo Liu
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Xin Qi
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, China
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The Role of Immune Regulatory Cells in Nontraumatic Osteonecrosis of the Femoral Head: A Retrospective Clinical Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1302015. [PMID: 31828086 PMCID: PMC6886356 DOI: 10.1155/2019/1302015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/26/2019] [Accepted: 09/24/2019] [Indexed: 01/13/2023]
Abstract
The immunologic factors have been implicated in the pathogenesis of osteonecrosis. We aimed to investigate the potential role of immune regulatory cells in the development of osteonecrosis of femoral head (ONFH). Sixty-seven patients diagnosed with ONFH and fifty-eight age-, height-, and weight-matched healthy subjects were included in this retrospective study between September 2015 and September 2018. The flow cytometry was used to test the count, percentage, and ratio of T and B lymphocyte subsets in peripheral blood. The T and B lymphocyte levels were compared among different ARCO stages, CJFH types, and etiology groups. The total lymphocyte count, CD3+T cells, Ts cells (CD3+CD8+), B-1 cell count, and B-1 cells (CD5+CD19+) were significantly higher in the patients with ONFH than those in the control subjects. The percentage of T lymphocytes in the patients with ARCO IV stage was significantly smaller than that in the ONFH patients with ARCO II and III stages. The percentage of inhibitory T lymphocytes in patients with CJFH type L3 was significantly smaller than that in the patients with types L1 and L2. In terms of the different ONFH etiologies, the total lymphocyte count and Ts cells (CD3+CD8+) were significantly lower in the ONFH patients induced by excessive alcohol intake than those in the idiopathic ONFH patients. Our results seem to indicate that immune regulatory cells, such as T and B lymphocytes, play an important role in the pathogenesis of ONFH. The development and progression of ONFH may be associated with immune system imbalance.
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Mazur CM, Woo JJ, Yee CS, Fields AJ, Acevedo C, Bailey KN, Kaya S, Fowler TW, Lotz JC, Dang A, Kuo AC, Vail TP, Alliston T. Osteocyte dysfunction promotes osteoarthritis through MMP13-dependent suppression of subchondral bone homeostasis. Bone Res 2019; 7:34. [PMID: 31700695 PMCID: PMC6828661 DOI: 10.1038/s41413-019-0070-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 12/28/2022] Open
Abstract
Osteoarthritis (OA), long considered a primary disorder of articular cartilage, is commonly associated with subchondral bone sclerosis. However, the cellular mechanisms responsible for changes to subchondral bone in OA, and the extent to which these changes are drivers of or a secondary reaction to cartilage degeneration, remain unclear. In knee joints from human patients with end-stage OA, we found evidence of profound defects in osteocyte function. Suppression of osteocyte perilacunar/canalicular remodeling (PLR) was most severe in the medial compartment of OA subchondral bone, with lower protease expression, diminished canalicular networks, and disorganized and hypermineralized extracellular matrix. As a step toward evaluating the causality of PLR suppression in OA, we ablated the PLR enzyme MMP13 in osteocytes while leaving chondrocytic MMP13 intact, using Cre recombinase driven by the 9.6-kb DMP1 promoter. Not only did osteocytic MMP13 deficiency suppress PLR in cortical and subchondral bone, but it also compromised cartilage. Even in the absence of injury, osteocytic MMP13 deficiency was sufficient to reduce cartilage proteoglycan content, change chondrocyte production of collagen II, aggrecan, and MMP13, and increase the incidence of cartilage lesions, consistent with early OA. Thus, in humans and mice, defects in PLR coincide with cartilage defects. Osteocyte-derived MMP13 emerges as a critical regulator of cartilage homeostasis, likely via its effects on PLR. Together, these findings implicate osteocytes in bone-cartilage crosstalk in the joint and suggest a causal role for suppressed perilacunar/canalicular remodeling in osteoarthritis.
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Affiliation(s)
- Courtney M. Mazur
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA 94143 USA
| | - Jonathon J. Woo
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
| | - Cristal S. Yee
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
| | - Aaron J. Fields
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
| | - Claire Acevedo
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT 84112 USA
| | - Karsyn N. Bailey
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA 94143 USA
| | - Serra Kaya
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
| | - Tristan W. Fowler
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
| | - Jeffrey C. Lotz
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA 94143 USA
| | - Alexis Dang
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121 USA
| | - Alfred C. Kuo
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121 USA
| | - Thomas P. Vail
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
| | - Tamara Alliston
- Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143 USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA 94143 USA
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Wu J, Du Y, Song J, Dang X, Wang K, Wen Y, Zhang F, Liu R. Genome-wide DNA methylation profiling of hip articular cartilage identifies differentially methylated loci associated with osteonecrosis of the femoral head. Bone 2019; 127:296-304. [PMID: 31233934 DOI: 10.1016/j.bone.2019.06.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 06/09/2019] [Accepted: 06/20/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Recent studies demonstrated a critical role of hip articular cartilage destruction in the development of osteonecrosis of the femoral head (ONFH). The aim of this study was to characterize the genome-wide DNA methylation profile of hip cartilage obtained from patients with ONFH and healthy subjects. METHODS Hip articular cartilage specimens were collected from 15 ONFH patients (including 11 males and 4 females) and 15 control subjects (including 11 males and 4 females) with femoral neck fracture. The average ages of the ONFH patients and control subjects were 50.27 ± 5.27 years and 61.67 ± 3.38 years, respectively. Genome-wide DNA methylation profiles of 5 ONFH and 5 control cartilages were determined by Illumina HumanMethylation850 array. Differential methylation analysis of DNA methylation profiles were performed by the empirical Bayes moderated t-test of the limma package. Mass spectrograph (MS) analysis of 10 ONFH cartilages and 10 normal cartilages were performed to validate the results of genome-wide DNA methylation profiling. Immunohistochemistry (IHC) of 4 ONFH cartilages and 4 control cartilages were conducted to evaluate the expression levels of proteins encoded by identified differentially methylated genes. t-test was used to assess the significance of protein expression differences between ONFH patients and controls in IHC. RESULTS We identified a total of 2872 differentially methylated CpG sites, annotated to 480 hypermethylated genes and 1335 hypomethylated genes for ONFH. The results of MS validation were consistent with that of genome-wide DNA methylation profiling. IHC further confirmed the increased protein expression of CARS (mean and 95%CI of superficial zone 59.67% [48.46, 56.14], and deep zone 31% [25.85, 30.61]), PDE4D (superficial zone 50.33% [33.64, 40.68] and deep zone 28.67% [10.81, 36.47]), ADAMTS12 (superficial zone 53.67% [36.01, 40.93] and deep zone 34.67% [22.56, 37.18]), LRP5 (superficial zone 59.63% [27.32, 39.61] and deep zone 22.95% [5.28, 19.29]), RUNX2 (superficial zone 52.58% [11.64, 31.33] and deep zone 35.01% [10.03, 27.44]) in ONFH articular cartilage. CONCLUSION Our results suggest the implication of DNA methylation alterations in the development of ONFH, and provide novel clues for pathogenetic and therapeutic studies of ONFH.
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Affiliation(s)
- Junlong Wu
- Department of Orthopedics, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, PR China; Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, Henan Province, 471009, China
| | - Yanan Du
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, PR China
| | - Jidong Song
- Department of Orthopedics, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, PR China
| | - Xiaoqian Dang
- Department of Orthopedics, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, PR China
| | - Kunzheng Wang
- Department of Orthopedics, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, PR China
| | - Yan Wen
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, PR China
| | - Feng Zhang
- Key Laboratory of Trace Elements and Endemic Diseases, Collaborative Innovation Center of Endemic Disease and Health Promotion for Silk Road Region, School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, PR China.
| | - Ruiyu Liu
- Department of Orthopedics, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, PR China.
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Al-Omari AA, Aleshawi AJ, Marei OA, Younes HMB, Alawneh KZ, ALQuran E, Mohaidat ZM. Avascular necrosis of the femoral head after single steroid intra-articular injection. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:193-197. [PMID: 31538269 DOI: 10.1007/s00590-019-02555-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/16/2019] [Indexed: 12/29/2022]
Abstract
Femoral head avascular bone necrosis (AVN) is the loss of blood supply to the bone tissue of femoral head that results in cellular death. This condition causes a significant limitation in patient daily life activities and has a poor functional outcome. Long-term steroid intake was established as a cause of AVN. However, few cases reported femoral head AVN post-single steroid intra-articular injection. We review all cases of AVN that results from single intra-articular steroid injection and present a case of femoral head AVN developed in a 78-year-old male. The patient, who was not known to have any medical illness, presented complaining of mild left hip pain for 4 months with long distant ambulation and weight standing. He was diagnosed to have left hip joint osteoarthritis for which he received intra-articular steroid injection 2 months prior visiting our orthopedics center. MRI of the pelvis revealed AVN of the femoral head. He underwent total hip arthroplasty. The pathological examination confirmed the diagnosis of AVN. To best of our knowledge, this is the fifth case of AVN of femoral head AVN after single intra-articular steroid injection. We reviewed all cases of AVN of femoral head after single steroid injection. Intra-articular steroid injection can cause femoral head AVN, and the patient receiving these injections should be aware about this rare but significant complication that results in poor functional outcome and significant morbidity.
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Affiliation(s)
- Ali A Al-Omari
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, P. O. Box: 3030, Irbid, 22110, Jordan.
| | - Abdelwahab J Aleshawi
- King Abdullah University Hospital Jordan, University of Science and Technology, Irbid, 22110, Jordan
| | - Omar A Marei
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, P. O. Box: 3030, Irbid, 22110, Jordan
| | - Hamza M Bani Younes
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, P. O. Box: 3030, Irbid, 22110, Jordan
| | - Khaled Z Alawneh
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Esra'a ALQuran
- Department of Pathology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ziyad M Mohaidat
- Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, P. O. Box: 3030, Irbid, 22110, Jordan
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Porwal K, Pal S, Tewari D, Pal China S, Singh P, Chandra Tewari M, Prajapati G, Singh P, Cheruvu S, Khan YA, Sanyal S, Gayen JR, Ampapathi R, Mridha AR, Chattopadhyay N. Increased Bone Marrow-Specific Adipogenesis by Clofazimine Causes Impaired Fracture Healing, Osteopenia, and Osteonecrosis Without Extraskeletal Effects in Rats. Toxicol Sci 2019; 172:167-180. [PMID: 31393584 DOI: 10.1093/toxsci/kfz172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 12/18/2022] Open
Abstract
AbstractMycobacterium leprae infection causes bone lesions and osteoporosis, however, the effect of antileprosy drugs on the bone is unknown. We, therefore, set out to address it by investigating osteogenic differentiation from bone marrow (BM)-derived mesenchymal stem cells (MSCs). Out of 7 antileprosy drugs, only clofazimine (CFZ) reduced MSCs viability (IC50 ∼ 1 μM) and their osteogenic differentiation but increased adipogenic differentiation on a par with rosiglitazone, and this effect was blocked by a peroxisome proliferator-activated receptor gamma antagonist, GW9662. CFZ also decreased osteoblast viability and resulted in impaired bone regeneration in a rat femur osteotomy model at one-third human drug dose owing to increased callus adipogenesis as GW9662 prevented this effect. CFZ treatment decreased BM MSC population and homing of MSC to osteotomy site despite drug levels in BM being much less than its in vitro IC50 value. In adult rats, CFZ caused osteopenia in long bones marked by suppressed osteoblast function due to enhanced adipogenesis and increased osteoclast functions. A robust increase in marrow adipose tissue (MAT) by CFZ did not alter the hematologic parameters but likely reduced BM vascular bed leading to osteonecrosis (ON) characterized by empty osteocyte lacunae. However, CFZ had no effect on visceral fat content and was not associated with any metabolic and hematologic changes. Levels of unsaturated fatty acids in MAT were higher than saturated fatty acids and CFZ further increased the former. From these data, we conclude that CFZ has adverse skeletal effects and could be used for creating a rodent ON model devoid of extraskeletal effects.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sabyasachi Sanyal
- Division of Biochemistry, CSIR-Central Drug Research Institute, Lucknow 226 031, India
| | | | | | - Asit R Mridha
- Department of Pathology, All India Institute of Medical Sciences, New Delhi 110023, India
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Idiopathic Exposed Bone Lesions of the Jaw. Dent J (Basel) 2019; 7:dj7020055. [PMID: 31159353 PMCID: PMC6630877 DOI: 10.3390/dj7020055] [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: 03/19/2019] [Revised: 04/18/2019] [Accepted: 05/01/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Osteonecrosis of the jaw is defined as exposed bone in the oral cavity that does not heal longer than eight weeks after identification. The two most common predisposing factors for osteonecrosis of the jaw are medication-related and radiotherapy. Rarely, exposed bone in the maxillofacial region can occur due to other causes and represents a clinical and therapeutic challenge for the dentist because there is no universally accepted treatment protocol. CASE PRESENTATION We report a case of a patient with two idiopathic lesions of exposed bone which have healed after systemic antibiotic therapy, seven weeks after the first examination. CONCLUSION Exposed bone lesions of the jaw are a rare entity and are poorly documented in the literature. It is necessary to exclude possible local or systemic contributing factors. Surgical and conservative therapy (antibiotics) are the treatment of choice.
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Chen D, Li W, He W, Zhang H, Zhang Q, Lin H, Svanberg S, Svanberg K, Chen P. Laser-based gas absorption spectroscopy in decaying hip bone: water vapor as a predictor of osteonecrosis. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-6. [PMID: 31230426 PMCID: PMC6977013 DOI: 10.1117/1.jbo.24.6.065001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 05/23/2019] [Indexed: 05/24/2023]
Abstract
Affluent blood flow through a complicated net of vessels supplies skeletal bone tissue with oxygen and nutrients. Due to accidental events or physiological processes, the blood supply might be deficient or even disrupted, and the healthy bone decays in a process that, for the hip location, is denoted as osteonecrosis of the femoral head (ONFH) or avascular femoral head necrosis. Early diagnosis is important for the prognosis. X-ray-based imaging, such as CT or MRI, is not of much value for the early detection. As the decay theoretically is associated with the development of gas-filled pores, gas analysis should have diagnostic value. We have introduced gas in scattering media absorption spectroscopy, as a complementary modality. Eighteen extracted femoral joint heads, diseased as well as normal, were investigated. Diseased samples are associated with clear signals due to water vapor, whereas the normal ones largely lack such features. The results suggest that free water vapor could serve as an early indicator of pore development and thus as a promising predictor of ONFH pathological changes, once the technique has been fully refined.
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Affiliation(s)
- Delong Chen
- Guangzhou University of Chinese Medicine, First Clinical Medicine School, Guangzhou, China
- Guangzhou University of Chinese Medicine, Laboratory of Orthopedics and Traumatology of Chinese Medicine, Lingnan Medical Research Center, Guangzhou, China
| | - Wansha Li
- South China Normal University, South China Academy of Advanced Optoelectronics, Center for Optical and Electromagnetic Research, Guangzhou, China
| | - Wei He
- Guangzhou University of Chinese Medicine, Laboratory of Orthopedics and Traumatology of Chinese Medicine, Lingnan Medical Research Center, Guangzhou, China
- Guangzhou University of Chinese Medicine, Orthopedics Department, First Affiliated Hospital, Guangzhou, China
- Guangzhou University of Chinese Medicine, Hip Center, Guangzhou, China
| | - Hao Zhang
- South China Normal University, South China Academy of Advanced Optoelectronics, Center for Optical and Electromagnetic Research, Guangzhou, China
| | - Qingwen Zhang
- Guangzhou University of Chinese Medicine, Laboratory of Orthopedics and Traumatology of Chinese Medicine, Lingnan Medical Research Center, Guangzhou, China
- Guangzhou University of Chinese Medicine, Orthopedics Department, First Affiliated Hospital, Guangzhou, China
- Guangzhou University of Chinese Medicine, Hip Center, Guangzhou, China
| | - Huiying Lin
- South China Normal University, South China Academy of Advanced Optoelectronics, Center for Optical and Electromagnetic Research, Guangzhou, China
| | - Sune Svanberg
- South China Normal University, South China Academy of Advanced Optoelectronics, Center for Optical and Electromagnetic Research, Guangzhou, China
- Lund University, Lund Laser Center, Lund, Sweden
| | - Katarina Svanberg
- South China Normal University, South China Academy of Advanced Optoelectronics, Center for Optical and Electromagnetic Research, Guangzhou, China
- Lund University, Lund Laser Center, Lund, Sweden
| | - Peng Chen
- Guangzhou University of Chinese Medicine, Orthopedics Department, First Affiliated Hospital, Guangzhou, China
- Guangzhou University of Chinese Medicine, Hip Center, Guangzhou, China
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Bergman J, Nordström A, Nordström P. Epidemiology of osteonecrosis among older adults in Sweden. Osteoporos Int 2019; 30:965-973. [PMID: 30627759 PMCID: PMC6502772 DOI: 10.1007/s00198-018-04826-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/20/2018] [Indexed: 12/03/2022]
Abstract
UNLABELLED This study estimated the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults. Osteonecrosis was approximately 10 times more common than in previous studies. The strongest risk factors were dialysis, hip fracture, osteomyelitis, and organ transplantation, but only hip fractures could have contributed substantially to the disease burden. INTRODUCTION The aim of this study was to estimate the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults and in a large number of risk groups in that cohort. METHODS In this retrospective cohort study, we included everyone who was aged 50 years or older and who was living in Sweden on 31 December 2005. We used Swedish national databases to collect data about prescription medication use, diagnosed medical conditions, and performed medical and surgical procedures. The study outcome was diagnosis of primary or secondary osteonecrosis at any skeletal site. The strength of risk factors was assessed using age- and sex-standardized incidence ratios (SIRs). RESULTS The study cohort comprised 3,338,463 adults. The 10-year risk of osteonecrosis was 0.4% (n = 13,425), and the incidence rate was 4.7 cases/10000 person-years (95% confidence interval [CI], 4.6 to 4.7 cases). The strongest risk factors for osteonecrosis were hip fracture (SIR, 7.98; 95% CI, 7.69-8.27), solid organ transplantation (SIR, 7.14; 95% CI, 5.59-8.99), dialysis (SIR, 6.65; 95% CI, 5.62-7.81), and osteomyelitis (SIR, 6.43; 95% CI, 5.70-7.23). A history of hip fracture was present in 21.7% of cases of osteonecrosis, but osteomyelitis, dialysis, and solid organ transplantation were present in only 0.5 to 2% of cases. CONCLUSIONS Osteonecrosis was approximately 10 times more common than a small number of previous population-based studies have suggested. The strongest risk factors for osteonecrosis were dialysis, hip fracture, osteomyelitis, and solid organ transplantation, but only hip fractures could have contributed substantially to the disease burden.
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Affiliation(s)
- J Bergman
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden
| | - A Nordström
- Department of Public Health and Clinical Medicine, Unit of Occupational and Environmental Medicine, Umeå University, 90187, Umeå, Sweden
- School of Sport Sciences, UiT Arctic University of Norway, Postboks 1621, 9509, Alta, Norway
| | - P Nordström
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden.
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Ahmed N, Sriskandarajah P, Burd C, Riddell A, Boyd K, Kaiser M, Messiou C. Detection of avascular necrosis on routine diffusion-weighted whole body MRI in patients with multiple myeloma. Br J Radiol 2019; 92:20180822. [PMID: 30676781 PMCID: PMC6580907 DOI: 10.1259/bjr.20180822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Current therapies for multiple myeloma, which include corticosteroids, increase risk of avascular necrosis. The aim of this study was to assess incidental detection of femoral head avascular necrosis on routine whole body MRI including diffusion weighted MRI. METHODS All whole body MRI studies, performed on patients with known multiple myeloma between 1 January 2010 to 1 May 2017 were assessed for features of avascular necrosis. RESULTS 650 whole body MR scans were analysed. 15 patients (6.6%) had typical MR features of avascular necrosis: 2/15 (13.3%) had femoral head collapse, 4/15 (26.7%) had bilateral avascular necrosis and 9/15 (60%) were asymptomatic. CONCLUSION This is the first report of avascular necrosis detected on routine whole body MRI in patients with multiple myeloma. Targeted review of femoral heads in multiple myeloma patients undergoing whole body MR is recommended, including in patients without symptoms. ADVANCES IN KNOWLEDGE Whole body MR which includes diffusion-weighted MRI is extremely sensitive for evaluation of bone marrow. Although whole body MRI is primarily used for evaluation of multiple myeloma disease burden, it also presents an unique opportunity to evaluate the femoral heads for signs of avascular necrosis which can predate symptoms.
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Affiliation(s)
- Naeem Ahmed
- 1 Department of Radiology, The Royal Marsden Hospital , London , UK
| | | | - Christian Burd
- 1 Department of Radiology, The Royal Marsden Hospital , London , UK
| | - Angela Riddell
- 1 Department of Radiology, The Royal Marsden Hospital , London , UK
| | - Kevin Boyd
- 3 Department of Haematology, The Royal Marsden Hospital , Sutton , UK
| | - Martin Kaiser
- 2 Department of Molecular Pathology, Institute of Cancer Research , Sutton , UK
| | - Christina Messiou
- 4 Department of Radiology, The Royal Marsden Hospital and Faculty of Radiotherapy and Imaging Institute of Cancer Research , London , UK
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Human Immunodeficiency Virus Infection: Spectrum of Rheumatic Manifestations. INFECTIONS AND THE RHEUMATIC DISEASES 2019. [PMCID: PMC7120519 DOI: 10.1007/978-3-030-23311-2_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Emerging and reemerging viral infections have been a characteristic feature of the past several decades, with HIV infection being the most important example of an emergent viral infection. To date, the status of a considerable proportion of HIV/AIDS patients has changed from a near-fatal disorder secondary to opportunistic infections to a chronic disease in which a variety of co-morbid conditions have become prevalent and relevant. Arthralgia and myalgias are the most common symptoms. The rate of spondyloarthritis varies according to the geographic area, genetic and mode of transmission. Most RA and SLE patients might go into remission after the development of AIDS, but also there are patients that continue with active disease. Prevalence of DILS is highest among African Americans in less advanced stages. PAN is clinically less aggressive and peripheral neuropathy is the most common clinical manifestation. Anti-phospholipid syndrome (APS), systemic sclerosis and poly-dermatomyositis are uncommon. After the introduction of combination antiretroviral therapy (cART), a decline of spondyloarthritis disorders and of DILS and development of new syndromes such as IRIS, osteoporosis and avascular bone necrosis have occurred. The treatment of patients with rheumatic diseases and HIV infection remains a challenge.
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14
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Escudier JC, Ollivier M, Donnez M, Parratte S, Lafforgue P, Argenson JN. Superimposition of maximal stress and necrosis areas at the top of the femoral head in hip aseptic osteonecrosis. Orthop Traumatol Surg Res 2018; 104:353-358. [PMID: 29462725 DOI: 10.1016/j.otsr.2018.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/05/2018] [Accepted: 01/10/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Recent reports described possible mechanical factors in the development and aggravation of osteonecrosis of the femoral head (OFH), but these have yet to be confirmed on dedicated mechanical study. We therefore developed a 3D finite element model based on in-vivo data from patients with incipient OFH, with a view to determining whether the necrosis area was superimposed on the maximal stress area on the femoral head. HYPOTHESIS The location of the necrosis area is determined by stress on the femoral head. MATERIAL AND METHOD All patients from the rheumatology department with early stage OFH in our center were investigated. Analysis of CT scans showed stress distribution on the head by 3D finite elements models, enabling determination of necrosis volume within the maximal stress area and of the percentage intersection of necrosis within the stress area (%I n/s: necrosis volume in stress area divided by total stress area volume and multiplied by 100) and of stress within the necrosis area (%I s/n: stress volume in necrosis area divided by total necrosis area volume and multiplied by 100). RESULTS Nineteen of the 161 patients assessed retrospectively for the period between 2006 and 2015 had incipient unilateral OFH, 10 of whom (4 right, 6 left) had CT scans of sufficient quality for inclusion. Mean age was 52 years (range, 37-81 years). Mean maximal stress was 1.63MPa, mean maximal exported stress volume was 2,236.9 mm3 and mean necrosis volume 6,291.1 mm3. Mean %I n/s was 83% and mean %I s/n 35%, with no significant differences according to gender, age, side or stress volume. There was a strong inverse correlation between necrosis volume and %I s/n (R2=-0.92) and a strong direct correlation between exported stress volume and %I s/n (R2=0.55). %I s/n was greater in small necrosis (<7,000mm3). CONCLUSION OFH seems to develop within the maximal stress area on the femoral head. The present results need confirmation by larger-scale studies. We consider it essential to take account of these mechanical parameters to reduce failure rates in conservative treatment of OFH. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- J-C Escudier
- ISM UMR 7287, CNRS, Aix-Marseille University, 13288 Marseille cedex 09, France; Department of Orthopedic Surgery and Traumatology, Institute of Movement and Locomotion, Saint-Marguerite Hospital, 270, boulevard Sainte-Marguerite BP 29, 13274 Marseille, France
| | - M Ollivier
- ISM UMR 7287, CNRS, Aix-Marseille University, 13288 Marseille cedex 09, France; Department of Orthopedic Surgery and Traumatology, Institute of Movement and Locomotion, Saint-Marguerite Hospital, 270, boulevard Sainte-Marguerite BP 29, 13274 Marseille, France.
| | - M Donnez
- ISM UMR 7287, CNRS, Aix-Marseille University, 13288 Marseille cedex 09, France
| | - S Parratte
- ISM UMR 7287, CNRS, Aix-Marseille University, 13288 Marseille cedex 09, France; Department of Orthopedic Surgery and Traumatology, Institute of Movement and Locomotion, Saint-Marguerite Hospital, 270, boulevard Sainte-Marguerite BP 29, 13274 Marseille, France
| | - P Lafforgue
- ISM UMR 7287, CNRS, Aix-Marseille University, 13288 Marseille cedex 09, France; Department of Rheumatology, Institute of Movement and Locomotion, Saint-Marguerite Hospital, 270, boulevard Sainte-Marguerite BP 29, 13274 Marseille, France
| | - J-N Argenson
- ISM UMR 7287, CNRS, Aix-Marseille University, 13288 Marseille cedex 09, France; Department of Orthopedic Surgery and Traumatology, Institute of Movement and Locomotion, Saint-Marguerite Hospital, 270, boulevard Sainte-Marguerite BP 29, 13274 Marseille, France
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Dima A, Pedersen AB, Pedersen L, Baicus C, Thomsen RW. Association of common comorbidities with osteonecrosis: a nationwide population-based case-control study in Denmark. BMJ Open 2018; 8:e020680. [PMID: 29439082 PMCID: PMC5829903 DOI: 10.1136/bmjopen-2017-020680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine recent time trends in the incidence of osteonecrosis (ON) in Denmark and to investigate different common comorbidities association with ON in a population-based setting. METHODS Using Danish medical databases, we included all patients with a first-time hospital diagnosis of ON during 1995-2012. Each ON case was matched with 10 randomly selected population control subjects from general population. For all participants, we obtained a complete hospital history of comorbidities included in the CharlsonComorbidity Index 5 years preceding the inclusion date. RESULTS 4107 ON cases and 41 063 controls were included. The incidence of ON increased from 3.9 in 1995 to 5.5 in 2012 per 100 000 inhabitants. Solid cancer was the most common comorbidity, associated with an adjusted OR (aOR) for ON of 2.0 (95% CI 1.7 to 2.2). For advanced metastatic cancer, leukaemia and lymphoma, aORs of ON were 3.4 (95% CI 2.5 to 4.5), 4.3 (95% CI 2.7 to 7.0) and 5.8 (95% CI 4.3 to 7.8), respectively. Among other chronic conditions, aORs were 3.5 (95% CI 3.0 to 4.1) for connective tissue diseases and 2.3 (95% CI 2.0 to 2.7) for chronic pulmonary diseases. aORs were also increased at 2.8 (95% CI 1.9 to 4.1) and 4.5 (95% CI 2.5 to 8.2) for mild and moderate-to-severe liver disease, respectively, and 4.2 (95% CI 3.4 to 5.2) for renal disease. CONCLUSION This large population-based study provides evidence for an increasing ON incidence in the general population and documents an association between several common comorbid conditions and risk of ON.
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Affiliation(s)
- Alina Dima
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- RECIF (Réseau d' Epidémiologie Clinique International Francophone), Bucharest, Romania
| | - Alma Becic Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Cristian Baicus
- Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- RECIF (Réseau d' Epidémiologie Clinique International Francophone), Bucharest, Romania
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O'Brien EJO, Biggi M, Eley T, Fiske-Jackson AR, Smith KC, Chesworth M, Civello A, Smith RKW. Third tarsal bone osteonecrosis associated with chronic recurrent cellulitis in an adult horse. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.12884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- E. J. O. O'Brien
- Department of Clinical Sciences and Services; The Royal Veterinary College; University of London; North Mymms Hatfield Hertfordshire UK
| | - M. Biggi
- Department of Clinical Sciences and Services; The Royal Veterinary College; University of London; North Mymms Hatfield Hertfordshire UK
| | - T. Eley
- Department of Pathobiology and Population Sciences; The Royal Veterinary College; University of London; North Mymms Hatfield Hertfordshire UK
| | - A. R. Fiske-Jackson
- Department of Clinical Sciences and Services; The Royal Veterinary College; University of London; North Mymms Hatfield Hertfordshire UK
| | - K. C. Smith
- Department of Pathobiology and Population Sciences; The Royal Veterinary College; University of London; North Mymms Hatfield Hertfordshire UK
| | - M. Chesworth
- Department of Clinical Sciences and Services; The Royal Veterinary College; University of London; North Mymms Hatfield Hertfordshire UK
| | - A. N. Civello
- Department of Pathobiology and Population Sciences; The Royal Veterinary College; University of London; North Mymms Hatfield Hertfordshire UK
| | - R. K. W. Smith
- Department of Clinical Sciences and Services; The Royal Veterinary College; University of London; North Mymms Hatfield Hertfordshire UK
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17
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Fowler TW, Acevedo C, Mazur CM, Hall-Glenn F, Fields AJ, Bale HA, Ritchie RO, Lotz JC, Vail TP, Alliston T. Glucocorticoid suppression of osteocyte perilacunar remodeling is associated with subchondral bone degeneration in osteonecrosis. Sci Rep 2017; 7:44618. [PMID: 28327602 PMCID: PMC5361115 DOI: 10.1038/srep44618] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/10/2017] [Indexed: 11/09/2022] Open
Abstract
Through a process called perilacunar remodeling, bone-embedded osteocytes dynamically resorb and replace the surrounding perilacunar bone matrix to maintain mineral homeostasis. The vital canalicular networks required for osteocyte nourishment and communication, as well as the exquisitely organized bone extracellular matrix, also depend upon perilacunar remodeling. Nonetheless, many questions remain about the regulation of perilacunar remodeling and its role in skeletal disease. Here, we find that suppression of osteocyte-driven perilacunar remodeling, a fundamental cellular mechanism, plays a critical role in the glucocorticoid-induced osteonecrosis. In glucocorticoid-treated mice, we find that glucocorticoids coordinately suppress expression of several proteases required for perilacunar remodeling while causing degeneration of the osteocyte lacunocanalicular network, collagen disorganization, and matrix hypermineralization; all of which are apparent in human osteonecrotic lesions. Thus, osteocyte-mediated perilacunar remodeling maintains bone homeostasis, is dysregulated in skeletal disease, and may represent an attractive therapeutic target for the treatment of osteonecrosis.
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Affiliation(s)
- Tristan W Fowler
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Claire Acevedo
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.,Materials Science Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Courtney M Mazur
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.,UC Berkeley-UCSF Graduate Program in Bioengineering, University of California Berkeley, Berkeley, CA, USA
| | - Faith Hall-Glenn
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Aaron J Fields
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Hrishikesh A Bale
- Materials Science Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Robert O Ritchie
- Materials Science Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA.,Department of Materials Science and Engineering, University of California Berkeley, Berkeley, CA, USA
| | - Jeffrey C Lotz
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.,UC Berkeley-UCSF Graduate Program in Bioengineering, University of California Berkeley, Berkeley, CA, USA
| | - Thomas P Vail
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Tamara Alliston
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.,UC Berkeley-UCSF Graduate Program in Bioengineering, University of California Berkeley, Berkeley, CA, USA
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Yang Z, Liu H, Li D, Xie X, Qin T, Ma J, Kang P. The efficacy of statins in preventing glucocorticoid-related osteonecrosis in animal models: A meta-analysis. Bone Joint Res 2016; 5:393-402. [PMID: 27660333 PMCID: PMC5032300 DOI: 10.1302/2046-3758.59.2000500] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives The primary purpose of this meta-analysis was to determine whether statin usage could reduce the risk of glucocorticoid-related osteonecrosis in animal models. Methods A systematic literature search up to May 2015 was carried out using the PubMed, Ovid, EBM reviews, ISI Web of Science, EBSCO, CBM, CNKI databases with the term and boolean operators: statins and osteonecrosis in all fields. Risk ratio (RR), as the risk estimate of specific outcome, was calculated along with 95% confidence intervals (CI). The methodological quality of individual studies was assessed using a quantitative tool based on the updated Stroke Therapy Academic Industry Roundtable (STAIR) recommendations. Results A total of 11 eligible studies were included according to predetermined criteria. The pooled data demonstrated that animals with statin usage, either alone or combined with other treatments, were at a decreased risk of developing glucocorticoid-related osteonecrosis (RR = 2.06, 95% confidence interval (CI) 1.71 to 2.50). Moreover, subgroup analysis revealed that compared with statins alone, statins combined with other treatments significantly decreased the risk of osteonecrosis (RR = 1.23, 95% CI 1.02 to 1.47). However, we could find no significant risk difference for different gender, or for different time points. Conclusions The present study suggests that statins combined with other treatments are efficient in preventing the development of glucocorticoid-related osteonecrosis in animals. These results might shed light on clinical practice when glucocorticoids are prescribed, and could be further investigated in high-quality clinical trials. Cite this article: Z. Yang, H. Liu, D. Li, X. Xie, T. Qin, J. Ma, P. Kang. The efficacy of statins in preventing glucocorticoid-related osteonecrosis in animal models: A meta-analysis. Bone Joint Res 2016;5:393–402. DOI: 10.1302/2046-3758.59.2000500.
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Affiliation(s)
- Z Yang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - H Liu
- Department of Rehabilitation Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - D Li
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - X Xie
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - T Qin
- Chinese Evidence-Based Medicine Centre/Cochrane Center, West China Hospital, Chengdu, China
| | - J Ma
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
| | - P Kang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
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Ma J, Sun W, Gao F, Guo W, Wang Y, Li Z. Porous Tantalum Implant in Treating Osteonecrosis of the Femoral Head: Still a Viable Option? Sci Rep 2016; 6:28227. [PMID: 27324659 PMCID: PMC4915004 DOI: 10.1038/srep28227] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/01/2016] [Indexed: 02/08/2023] Open
Abstract
The purpose of this study is to evaluate the survivorship and risk factors for radiographic progression and conversion to total hip arthroplasty (THA) after porous tantalum implant surgery in the treatment of osteonecrosis of the femoral head (ONFH). The study comprised 90 ONFH patients (104 consecutive hips) who were treated with a porous tantalum implant combined with bone grafting between June 2008 and December 2013. The patients were 19–61 years of age (mean age, 38 years). The mean follow-up was 42 months. The outcome measures included Harris hip score (HHS), radiographic outcome measures, and survivorship analysis with conversion to THA as the endpoint. The mean postoperative HHS was significantly lower than the mean preoperative HHS (P < 0.001). The Cox proportional hazards model showed that age and Association Research Circulation Osseous (ARCO) stage were independent risk factors for conversion to THA, while age, China-Japan Friendship Hospital (CJFH) type, and ARCO stage were independent risk factors for radiological progression. Ultimately, only 52.9% hips survived. Porous tantalum implant surgery combined with bone grafting is not a viable option for treating ONFH, especially in patients >35 years of age with preoperative ARCO stage III and CJFH type L3.
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Affiliation(s)
- Jinhui Ma
- Peking University China-Japan Friendship School of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029 China
| | - Wei Sun
- Center for Osteonecrosis and Joint Preserving &Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029 China
| | - Fuqiang Gao
- Center for Osteonecrosis and Joint Preserving &Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029 China
| | - Wanshou Guo
- Center for Osteonecrosis and Joint Preserving &Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029 China
| | - Yunting Wang
- Center for Osteonecrosis and Joint Preserving &Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029 China
| | - Zirong Li
- Center for Osteonecrosis and Joint Preserving &Reconstruction, Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029 China
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He YX, Liu J, Guo B, Wang YX, Pan X, Li D, Tang T, Chen Y, Peng S, Bian Z, Liang Z, Zhang BT, Lu A, Zhang G. Src inhibitor reduces permeability without disturbing vascularization and prevents bone destruction in steroid-associated osteonecrotic lesions in rabbits. Sci Rep 2015; 5:8856. [PMID: 25748225 PMCID: PMC4352921 DOI: 10.1038/srep08856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/02/2015] [Indexed: 11/09/2022] Open
Abstract
To examine the therapeutic effect of Src inhibitor on the VEGF mediating vascular hyperpermeability and bone destruction within steroid-associated osteonecrotic lesions in rabbits. Rabbits with high risk for progress to destructive repair in steroid-associated osteonecrosis were selected according to our published protocol. The selected rabbits were systemically administrated with either Anti-VEGF antibody (Anti-VEGF Group) or Src inhibitor (Src-Inhibition Group) or VEGF (VEGF-Supplement Group) or a combination of VEGF and Src inhibitor (Supplement &Inhibition Group) or control vehicle (Control Group) for 4 weeks. At 0, 2 and 4 weeks after administration, in vivo dynamic MRI, micro-CT based-angiography, histomorphometry and immunoblotting were employed to evaluate the vascular and skeletal events in different groups. The incidence of the destructive repair in the Anti-VEGF Group, Src-Inhibition Group and Supplement &Inhibition Group was all significantly lower than that in the Control Group. The angiogenesis was promoted in VEGF-Supplement Group, Src-Inhibition Group and Supplement &Inhibition Group, while the hyperpermeability was inhibited in Anti-VEGF Group, Src-Inhibition Group and Supplement &Inhibition Group. The trabecular structure was improved in Src-Inhibition Group and Supplement &Inhibition Group. Src inhibitor could reduce permeability without disturbing vascularization and prevent destructive repair in steroid-associated osteonecrosis.
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Affiliation(s)
- Yi-Xin He
- 1] Institute for Advancing Translational Medicine in Bone &Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China [2] Hong Kong Baptist University Branch of State Key Laboratory of Chemo/Biosensing and Chemometrics of Hunan University, Hong Kong SAR, China [3] Shum Yiu Foon Shum Bik Chuen Memorial Centre for Cancer and Inflammation Research, Hong Kong Baptist University, Hong Kong SAR, China [4] Institute of Integrated Bioinformedicine &Translational Science, HKBU Shenzhen Research Institute and Continuing Education, Shenzhen, China [5] Academician Chen Xinzi Workroom for Advancing Translational Medicine in Bone &Joint Diseases, Kunshan RNAi Institute, Kunshan Industrial Technology Research Institute, Kunshan, Jiangsu, China [6] Hong Kong Baptist University - Northwestern Polytechnical University Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Shenzhen, China
| | - Jin Liu
- 1] Institute for Advancing Translational Medicine in Bone &Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China [2] Hong Kong Baptist University Branch of State Key Laboratory of Chemo/Biosensing and Chemometrics of Hunan University, Hong Kong SAR, China [3] Shum Yiu Foon Shum Bik Chuen Memorial Centre for Cancer and Inflammation Research, Hong Kong Baptist University, Hong Kong SAR, China [4] Institute of Integrated Bioinformedicine &Translational Science, HKBU Shenzhen Research Institute and Continuing Education, Shenzhen, China [5] Academician Chen Xinzi Workroom for Advancing Translational Medicine in Bone &Joint Diseases, Kunshan RNAi Institute, Kunshan Industrial Technology Research Institute, Kunshan, Jiangsu, China
| | - Baosheng Guo
- 1] Institute for Advancing Translational Medicine in Bone &Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China [2] Hong Kong Baptist University Branch of State Key Laboratory of Chemo/Biosensing and Chemometrics of Hunan University, Hong Kong SAR, China [3] Shum Yiu Foon Shum Bik Chuen Memorial Centre for Cancer and Inflammation Research, Hong Kong Baptist University, Hong Kong SAR, China [4] Institute of Integrated Bioinformedicine &Translational Science, HKBU Shenzhen Research Institute and Continuing Education, Shenzhen, China [5] Academician Chen Xinzi Workroom for Advancing Translational Medicine in Bone &Joint Diseases, Kunshan RNAi Institute, Kunshan Industrial Technology Research Institute, Kunshan, Jiangsu, China [6] Hong Kong Baptist University - Northwestern Polytechnical University Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Shenzhen, China
| | - Yi-Xiang Wang
- Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaohua Pan
- 1] Institute for Advancing Translational Medicine in Bone &Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China [2] Hong Kong Baptist University Branch of State Key Laboratory of Chemo/Biosensing and Chemometrics of Hunan University, Hong Kong SAR, China [3] Shum Yiu Foon Shum Bik Chuen Memorial Centre for Cancer and Inflammation Research, Hong Kong Baptist University, Hong Kong SAR, China [4] Institute of Integrated Bioinformedicine &Translational Science, HKBU Shenzhen Research Institute and Continuing Education, Shenzhen, China [5] Department of Orthopedics, Second Hospital of Medical College of Ji Nan University, Shenzhen People's Hospital, 518020 Shenzhen, China
| | - Defang Li
- 1] Institute for Advancing Translational Medicine in Bone &Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China [2] Hong Kong Baptist University Branch of State Key Laboratory of Chemo/Biosensing and Chemometrics of Hunan University, Hong Kong SAR, China [3] Shum Yiu Foon Shum Bik Chuen Memorial Centre for Cancer and Inflammation Research, Hong Kong Baptist University, Hong Kong SAR, China [4] Institute of Integrated Bioinformedicine &Translational Science, HKBU Shenzhen Research Institute and Continuing Education, Shenzhen, China [5] Academician Chen Xinzi Workroom for Advancing Translational Medicine in Bone &Joint Diseases, Kunshan RNAi Institute, Kunshan Industrial Technology Research Institute, Kunshan, Jiangsu, China [6] Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tao Tang
- 1] Institute for Advancing Translational Medicine in Bone &Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China [2] Hong Kong Baptist University Branch of State Key Laboratory of Chemo/Biosensing and Chemometrics of Hunan University, Hong Kong SAR, China [3] Shum Yiu Foon Shum Bik Chuen Memorial Centre for Cancer and Inflammation Research, Hong Kong Baptist University, Hong Kong SAR, China [4] Institute of Integrated Bioinformedicine &Translational Science, HKBU Shenzhen Research Institute and Continuing Education, Shenzhen, China [5] Department of Obstetrics &Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yang Chen
- Department of Orthopaedics and Traumatology, BaoAn Hospital affiliated to Southern Medical University &Shenzhen 8th People Hospital, Shenzhen, PR China
| | - Songlin Peng
- Department of Orthopedics, Second Hospital of Medical College of Ji Nan University, Shenzhen People's Hospital, 518020 Shenzhen, China
| | - Zhaoxiang Bian
- 1] Institute for Advancing Translational Medicine in Bone &Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China [2] Hong Kong Baptist University Branch of State Key Laboratory of Chemo/Biosensing and Chemometrics of Hunan University, Hong Kong SAR, China [3] Shum Yiu Foon Shum Bik Chuen Memorial Centre for Cancer and Inflammation Research, Hong Kong Baptist University, Hong Kong SAR, China [4] Institute of Integrated Bioinformedicine &Translational Science, HKBU Shenzhen Research Institute and Continuing Education, Shenzhen, China [5] Academician Chen Xinzi Workroom for Advancing Translational Medicine in Bone &Joint Diseases, Kunshan RNAi Institute, Kunshan Industrial Technology Research Institute, Kunshan, Jiangsu, China
| | - Zicai Liang
- Academician Chen Xinzi Workroom for Advancing Translational Medicine in Bone &Joint Diseases, Kunshan RNAi Institute, Kunshan Industrial Technology Research Institute, Kunshan, Jiangsu, China
| | - Bao-Ting Zhang
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Aiping Lu
- 1] Institute for Advancing Translational Medicine in Bone &Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China [2] Hong Kong Baptist University Branch of State Key Laboratory of Chemo/Biosensing and Chemometrics of Hunan University, Hong Kong SAR, China [3] Shum Yiu Foon Shum Bik Chuen Memorial Centre for Cancer and Inflammation Research, Hong Kong Baptist University, Hong Kong SAR, China [4] Institute of Integrated Bioinformedicine &Translational Science, HKBU Shenzhen Research Institute and Continuing Education, Shenzhen, China [5] Academician Chen Xinzi Workroom for Advancing Translational Medicine in Bone &Joint Diseases, Kunshan RNAi Institute, Kunshan Industrial Technology Research Institute, Kunshan, Jiangsu, China [6] Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ge Zhang
- 1] Institute for Advancing Translational Medicine in Bone &Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China [2] Hong Kong Baptist University Branch of State Key Laboratory of Chemo/Biosensing and Chemometrics of Hunan University, Hong Kong SAR, China [3] Shum Yiu Foon Shum Bik Chuen Memorial Centre for Cancer and Inflammation Research, Hong Kong Baptist University, Hong Kong SAR, China [4] Institute of Integrated Bioinformedicine &Translational Science, HKBU Shenzhen Research Institute and Continuing Education, Shenzhen, China [5] Academician Chen Xinzi Workroom for Advancing Translational Medicine in Bone &Joint Diseases, Kunshan RNAi Institute, Kunshan Industrial Technology Research Institute, Kunshan, Jiangsu, China [6] Hong Kong Baptist University - Northwestern Polytechnical University Joint Research Centre for Translational Medicine on Musculoskeletal Health in Space, Shenzhen, China
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Development of non-traumatic osteonecrosis of the femoral head requires toll-like receptor 7 and 9 stimulations and is boosted by repression on nuclear factor kappa B in rats. J Transl Med 2015; 95:92-9. [PMID: 25384124 PMCID: PMC7100527 DOI: 10.1038/labinvest.2014.134] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/21/2014] [Accepted: 09/09/2014] [Indexed: 12/03/2022] Open
Abstract
Non-traumatic osteonecrosis of the femoral head (ONFH) often occurs after corticosteroid therapy in patients with inflammatory diseases. Recent studies suggest that toll-like receptor (TLR) signaling may contribute to the pathogenesis of inflammatory diseases, and that the reason for corticosteroid therapy for inflammatory diseases is related to the anti-inflammatory activities of corticosteroids through the reduction of NF-κB. We hypothesized that the administration of TLR ligands in combination with corticosteroid causes ONFH and that transcription factors may contribute to the pathogenesis of ONFH. The aim of the study was to evaluate (1) the incidence of ONFH in rats after the administration of TLR7 or TLR9 ligands together with methylprednisolone (MPSL) and (2) whether transcription factors contribute to the development of ONFH. Male Wistar rats (n=148) were divided into five groups as follows: Group 1: Saline+MPSL, Group 2: Imiquimod+Saline, Group 3: Imiquimod+MPSL, Group 4: CpG-C+MPSL, Group 5: Imiquimod+BAY11-7082+MPSL. As a result, ONFH was observed in 0 of 12 rats in Group 1, in 1 of 10 in Group 2, in 6 of 12 in Group 3, in 4 of 12 in Group 4, in 0 of 9 in Group 5. MPSL treatment did not significantly affect IRF7 activity, whereas NF-κB activity was significantly repressed in Group 2 and Group 3. Furthermore, the repression in interferon regulatory factor 7 (IRF7) activity by BAY11-7082 interfered with the development of ONFH simultaneously with the MPSL treatment-induced repression in NF-κB activity. In conclusion, in the present study, corticosteroid treatment after the administration of TLR7 or TLR9 ligands caused ONFH. Repression in NF-κB activity by corticosteroid treatment boosted the development of ONFH.
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Podiatric Problems and Management in Patients with Substance Abuse. Subst Abus 2015. [DOI: 10.1007/978-1-4939-1951-2_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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23
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Nakamura Y, Kamimura M, Mukaiyama K, Ikegami S, Uchiyama S, Kato H. A case with atypical clinical course diagnosed as osteoarthritis, osteonecrosis, subchondral insufficiency fracture, or rapidly destructive coxopathy. Open Rheumatol J 2014; 8:20-3. [PMID: 25250098 PMCID: PMC4166791 DOI: 10.2174/1874312901408010020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 07/07/2014] [Accepted: 07/16/2014] [Indexed: 11/25/2022] Open
Abstract
Osteonecrosis (ON), subchondral insufficiency fracture (SIF), and rapidly destructive coxopathy (RDC) are considered to be clinically different disorders despite exhibiting several overlapping features. We encountered an elderly female patient with an atypical clinical course who was radiographically diagnosed as having osteoarthritis (OA), ON, SIF, and/or RDC over a long-term follow-up. In this case, radiographic diagnosis was apparently affected by the timing of imaging evaluation and was challenging because of radiographic overlap and atypical disease progression. The disorders of OA, SIF, ON, and RDC might share a similar pathophysiology.
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Affiliation(s)
- Yukio Nakamura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan
| | - Mikio Kamimura
- Center of Osteoporosis and Spinal Disorders: Kamimura Orthopaedic Clinic, Matsumoto 399-0021, Japan
| | - Keijiro Mukaiyama
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan
| | - Shigeharu Uchiyama
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan
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24
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Schultz GD. Hematologic Bone Diseases. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00011-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Fukushima W, Yamamoto T, Takahashi S, Sakaguchi M, Kubo T, Iwamoto Y, Hirota Y. The effect of alcohol intake and the use of oral corticosteroids on the risk of idiopathic osteonecrosis of the femoral head. Bone Joint J 2013; 95-B:320-5. [DOI: 10.1302/0301-620x.95b3.30856] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The systemic use of steroids and habitual alcohol intake are two major causative factors in the development of idiopathic osteonecrosis of the femoral head (ONFH). To examine any interaction between oral corticosteroid use and alcohol intake on the risk of ONFH, we conducted a hospital-based case-control study of 71 cases with ONFH (mean age 45 years (20 to 79)) and 227 matched controls (mean age 47 years (18 to 79)). Alcohol intake was positively associated with ONFH among all subjects: the adjusted odds ratio (OR) of subjects with ≥ 3032 drink-years was 3.93 (95% confidence interval (CI) 1.18 to 13.1) compared with never-drinkers. When stratified by steroid use, the OR of such drinkers was 11.1 (95% CI 1.30 to 95.5) among those who had never used steroids, but 1.10 (95% CI 0.21 to 4.79) among those who had. When we assessed any interaction based on a two-by-two table of alcohol and steroid use, the OR of those non-drinkers who did use steroids was markedly elevated (OR 31.5) compared with users of neither. However, no further increase in OR was noted for the effect of using both (OR 31.6). We detected neither a multiplicative nor an additive interaction (p for multiplicative interaction 0.19; synergy index 0.95), suggesting that the added effect of alcohol may be trivial compared with the overwhelming effect of steroids in the development of ONFH. Cite this article: Bone Joint J 2013;95-B:320–5.
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Affiliation(s)
- W. Fukushima
- Osaka City University Faculty of Medicine, Department
of Public Health, 1-4-3, Asahi-machi, Abeno-ku, Osaka
545-8585, Japan
| | - T. Yamamoto
- Kyushu University , Department
of Orthopaedic Surgery, 3-1-1 Maidashi, Higashi-ku, Fukuoka
812-8582, Japan
| | - S. Takahashi
- Osaka City University Faculty of Medicine, Department
of Public Health, 1-4-3, Asahi-machi, Abeno-ku, Osaka
545-8585, Japan
| | - M. Sakaguchi
- Osaka City University Faculty of Medicine, Department
of Public Health, 1-4-3, Asahi-machi, Abeno-ku, Osaka
545-8585, Japan
| | - T. Kubo
- Kyoto Prefectural University of Medicine, Department
of Orthopaedics, Graduate School of Medical
Science, 465 Kajii-chou, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Y. Iwamoto
- Kyushu University , Department
of Orthopaedic Surgery, 3-1-1 Maidashi, Higashi-ku, Fukuoka
812-8582, Japan
| | - Y. Hirota
- Osaka City University Faculty of Medicine, Department
of Public Health, 1-4-3, Asahi-machi, Abeno-ku, Osaka
545-8585, Japan
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26
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Zhang CQ, Sun Y, Chen SB, Jin DX, Sheng JG, Cheng XG, Xu J, Zeng BF. Free vascularised fibular graft for post-traumatic osteonecrosis of the femoral head in teenage patients. ACTA ACUST UNITED AC 2011; 93:1314-9. [PMID: 21969428 DOI: 10.1302/0301-620x.93b10.26555] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Free vascularised fibular grafting has been reported to be successful for adult patients with osteonecrosis of the femoral head (ONFH). However, its benefit in teenage patients with post-traumatic ONFH has not been determined. We evaluated the effectiveness of free vascularised fibular grafting in the treatment of this condition in children and adolescents. We retrospectively analysed 28 hips in 28 patients in whom an osteonecrotic femoral head had been treated with free vascularised fibular grafting between 2002 and 2008. Their mean age was 16.3 years (13 to 19). The stage of the disease at time of surgery, and results of treatment including pre- and post-operative Harris hip scores, were studied. We defined clinical failure as conversion to total hip replacement. All patients were followed up for a mean of four years (2 to 7). The mean Harris hip score improved from 60.4 (37 to 84) pre-operatively to 94.2 (87 to 100) at final follow-up. At the latest follow-up we found improved or unchanged radiographs in all four initially stage II hips and in 23 of 24 stage III or IV hips. Only one hip (stage V) deteriorated. No patient underwent total hip replacement. Free vascularised fibular grafting is indicated for the treatment of post-traumatic ONFH in teenage patients.
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Affiliation(s)
- C Q Zhang
- Shanghai Sixth People's Hospital, Department of Orthopaedic Surgery, 600 Yishan Road, Shanghai 200233, China.
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27
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Osteonecrosis of the Humeral Head in a Patient with Non-small Cell Lung Cancer Receiving Bevacizumab. J Thorac Oncol 2011; 6:1960-1. [DOI: 10.1097/jto.0b013e31822e726f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ziraldo L, O'Connor MB, Blake SP, Phelan MJ. Osteonecrosis following alcohol, cocaine, and steroid use. Subst Abus 2011; 32:170-3. [PMID: 21660880 DOI: 10.1080/08897077.2011.562751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Alcohol, steroids and cocaine have all been shown to be independent risk factors for osteonecrosis when taken in excess. Here we present a case of a young girl who developed debilitating osteonecrosis secondary to low doses of alcohol, steroids and cocaine. We feel it is important to highlight to those caring for such patients of the potential devastating complication of these three agents.
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Affiliation(s)
- Laura Ziraldo
- Department of Medicine, South Infirmary-Victoria University Hospital, Cork, Ireland
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Xie XH, Wang XL, Zhang G, Liu Z, Yao D, Hung LK, Hung VWY, Qin L. Impaired bone healing in rabbits with steroid-induced osteonecrosis. ACTA ACUST UNITED AC 2011; 93:558-65. [PMID: 21464501 DOI: 10.1302/0301-620x.93b4.25442] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Corticosteroids are prescribed for the treatment of many medical conditions and their adverse effects on bone, including steroid-associated osteoporosis and osteonecrosis, are well documented. Core decompression is performed to treat osteonecrosis, but the results are variable. As steroids may affect bone turnover, this study was designed to investigate bone healing within a bone tunnel after core decompression in an experimental model of steroid-associated osteonecrosis. A total of five 28-week-old New Zealand rabbits were used to establish a model of steroid-induced osteonecrosis and another five rabbits served as controls. Two weeks after the induction of osteonecrosis, core decompression was performed by creating a bone tunnel 3 mm in diameter in both distal femora of each rabbit in both the experimental osteonecrosis and control groups. An in vivo micro-CT scanner was used to monitor healing within the bone tunnel at four, eight and 12 weeks postoperatively. At week 12, the animals were killed for histological and biomechanical analysis. In the osteonecrosis group all measurements of bone healing and maturation were lower compared with the control group. Impaired osteogenesis and remodelling within the bone tunnel was demonstrated in the steroid-induced osteonecrosis, accompanied by inferior mechanical properties of the bone. We have confirmed impaired bone healing in a model of bone defects in rabbits with pulsed administration of corticosteroids. This finding may be important in the development of strategies for treatment to improve the prognosis of fracture healing or the repair of bone defects in patients receiving steroid treatment.
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Affiliation(s)
- X.-H. Xie
- Department of Orthopaedics and Traumatology, Musculoskeletal Research Laboratory, 5/F, Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong SAR, People’s Republic of China
| | - X.-L. Wang
- Department of Orthopaedics and Traumatology, Musculoskeletal Research Laboratory, 5/F, Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong SAR, People’s Republic of China
| | - G. Zhang
- Department of Orthopaedics and Traumatology, Musculoskeletal Research Laboratory, 5/F, Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong SAR, People’s Republic of China
| | - Z. Liu
- Department of Orthopaedics and Traumatology, Musculoskeletal Research Laboratory, 5/F, Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong SAR, People’s Republic of China
| | - D. Yao
- Department of Orthopaedics and Traumatology, Musculoskeletal Research Laboratory, 5/F, Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong SAR, People’s Republic of China
| | - L.-K. Hung
- Department of Orthopaedics and Traumatology, Musculoskeletal Research Laboratory, 5/F, Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong SAR, People’s Republic of China
| | - V. W.-Y. Hung
- Department of Orthopaedics and Traumatology, Musculoskeletal Research Laboratory, 5/F, Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong SAR, People’s Republic of China
| | - L. Qin
- Department of Orthopaedics and Traumatology, Musculoskeletal Research Laboratory, 5/F, Clinical Science Building, Prince of Wales Hospital, The Chinese University of Hong Kong SAR, People’s Republic of China
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30
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McAlindon T, Ward RJ. Osteonecrosis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Abstract
Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease with a highly variable clinical course. Pediatric-onset SLE (pSLE) represents 10-20% of all SLE cases, and is associated with higher disease severity, including more-rapid damage accrual, than adult-onset SLE. As in adults, pSLE disease expression varies according to ethnicity, with a milder disease course in white patients. The majority of pSLE patients will have developed damage within 5-10 years of disease onset, most frequently involving the musculoskeletal, ocular, renal and neuropsychiatric systems. Owing to improvements in disease management and recognition over the past 20-30 years, patients now live longer, but as a result have increased disease damage. Premature atherosclerosis and osteoporosis have become increasingly prevalent morbidities in pSLE patients. Early atherosclerosis leads to a considerable rise in cardiovascular and cerebrovascular events, and failure to develop adequate peak bone mass during adolescence-a crucial period of bone accrual-is likely to lead to early osteoporosis and fractures. Patients with pSLE have an incurable, potentially devastating disease that occurs during a vulnerable period of psychosocial development, leading to specific and unique psychosocial stressors. Additional large, long-term follow-up studies in pSLE are needed to better understand the disease prognosis and to facilitate development of tailored treatments.
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Zhao G, Yamamoto T, Ikemura S, Motomura G, Mawatari T, Nakashima Y, Iwamoto Y. Radiological outcome analysis of transtrochanteric curved varus osteotomy for osteonecrosis of the femoral head at a mean follow-up of 12.4 years. ACTA ACUST UNITED AC 2010; 92:781-6. [PMID: 20513873 DOI: 10.1302/0301-620x.92b6.23621] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We investigated the factors related to the radiological outcome of a transtrochanteric curved varus osteotomy in patients with osteonecrosis of the hip. We reviewed 73 hips in 62 patients with a mean follow-up of 12.4 years (5 to 31.1). There were 28 men and 34 women, with a mean age of 33.3 years (15 to 68) at the time of surgery. The 73 hips were divided into two groups according to their radiological findings: group 1 showed progression of collapse and/or joint-space narrowing; group 2 had neither progressive collapse nor joint-space narrowing. Both of these factors and the radiological outcomes were analysed by a stepwise discriminant analysis. A total of 12 hips were categorised as group 1 and 61 as group 2. Both the post-operative intact ratio and the localisation of the necrotic lesion correlated with the radiological outcome. The cut-off point of the postoperative intact ratio to prevent the progression of collapse was 33.6%, and the cut-off point to prevent both the progression of collapse and joint-space narrowing was 41.9%. The results of this study indicate that a post-operative intact ratio of 33.0% is necessary if a satisfactory outcome is to be achieved after this varus osteotomy.
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Affiliation(s)
- G Zhao
- Department of Orthopaedic Surgery, Kyushu University, Higashi-ku, Fukuoka, Japan
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Role of hypercoagulability in steroid-induced femoral head necrosis in rabbits. J Orthop Sci 2010; 15:365-70. [PMID: 20559805 DOI: 10.1007/s00776-010-1452-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The pathogenesis of femoral head necrosis is still uncertain. Both steroid treatment and hypercoagulopathy are considered risk factors. To investigate possible changes in coagulability and histology during steroid-induced osteonecrosis, we used a combination of the Shwartzman reaction and corticoid injections in rabbits to develop an animal model of femoral head necrosis. We studied blood coagulability and histopathological characteristics of the femoral head and liver. METHODS A total of 30 rabbits were divided into three groups. In group A, rabbits were given two injections of lipopolysaccharide (40 microg/kg) at an interval of 24 h and were then immediately given one injection of prednisolone acetate (20 mg/kg). In group B, 10 rabbits were given one injection of prednisolone acetate (20 mg/kg). In group C, 10 rabbits were given no treatment and served as controls. At 1, 3, 7, 14, and 21 days after prednisolone injection, coagulability, blood lipid levels, and blood platelet levels were measured; and the femoral head and liver were removed for histopathological examination. RESULTS At 24 h after the prednisolone injection in group A, coagulability and blood lipid levels were increased (P < 0.01), and blood platelet levels were decreased (P < 0.01). These abnormal levels were maintained throughout the entire observation period. Histologically, degeneration and necrosis of hepatocytes and osteocytes were found at day 21 after prednisolone injection in group A. In group B, coagulability and blood lipid levels were significantly increased by day 3 after treatment. CONCLUSIONS Abnormal hypercoagulability might potentiate the thrombotic status and induce thrombus formation in the presence of steroid-induced necrosis of the femoral head.
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Sánchez J, Gonzalo-Orden JM, Ginja MMD, Oliveira PA, Reyes LE, Serantes AE, Orden MA. Imaging diagnosis--Medullary tibial infarction in a horse. Vet Radiol Ultrasound 2010; 51:159-61. [PMID: 20402402 DOI: 10.1111/j.1740-8261.2009.01643.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
An Andalusian Stallion with left hind limb lameness had a radiolucent lesion in the medullary cavity of distal tibial metaphysis. After euthanasia for other disease, the tibia was examined with magnetic resonance (MR). The MR imaging sequences were characterized by a double line sign, although showing quite different lesion area intensities. Histologically, the lesion was compatible with medullary infarction being characterized by normal spongy bone, areas of abundant fibrous tissue and numerous necrotic adipocytes in various stages of destruction.
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Affiliation(s)
- Jesus Sánchez
- Department of Animal Pathology, Animal Medicine, University of León, 24071 León, Spain
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35
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Sheng HH, Zhang GG, Cheung WHW, Chan CWC, Wang YXY, Lee KMK, Wang HFH, Leung KSK, Qin LL. Elevated adipogenesis of marrow mesenchymal stem cells during early steroid-associated osteonecrosis development. J Orthop Surg Res 2007; 2:15. [PMID: 17937789 PMCID: PMC2146995 DOI: 10.1186/1749-799x-2-15] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 10/15/2007] [Indexed: 12/18/2022] Open
Abstract
Background Increased bone marrow lipid deposition in steroid-associated osteonecrosis (ON) implies that abnormalities in fat metabolism play an important role in ON development. The increase in lipid deposition might be explained by elevated adipogenesis of marrow mesenchymal stem cells (MSCs). However, it remains unclear whether there is a close association between elevated adipogenesis and steroid-associated ON development. Objective The present study was designed to test the hypothesis that there might be a close association between elevated adipogenesis and steroid-associated ON development. Methods ON rabbit model was induced based on our established protocol. Dynamic-MRI was employed for local intra-osseous perfusion evaluation in bilateral femora. Two weeks after induction, bone marrow was harvested for evaluating the ability of adipogenic differentiation of marrow MSCs at both cellular and mRNA level involving adipogenesis-related gene peroxisome proliferator-activated receptor gamma2 (PPARγ2). The bilateral femora were dissected for examining marrow lipid deposition by quantifying fat cell number, fat cell size, lipid deposition area and ON lesions. For investigating association among adipogenesis, lipid deposition and perfusion function with regard to ON occurrence, the rabbits were divided into ON+ (with at least one ON lesion) group and ON- (without ON lesion) group. For investigating association among adipogenesis, lipid deposition and perfusion function with regard to ON extension, the ON+ rabbits were further divided into sub-single-lesion group (SON group: with one ON lesion) and sub-multiple-lesion group (MON group: with more than one ON lesion). Results Local intra-osseous perfusion index was found lower in either ON+ or MON group when compared to either ON- or SON group, whereas the marrow fat cells number and area were much larger in either ON+ or MON group as compared with ON- and SON group. The adipogenic differentiation ability of MSCs and PPARγ2 expression in either ON+ or MON group were elevated significantly as compared with either ON- or SON group. Conclusion These findings support our hypothesis that there is a close association between elevated adipogenesis and steroid-associated osteonecrosis development.
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Affiliation(s)
- Hui H Sheng
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
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Baraboutis IG, Papastamopoulos V, Skoutelis A. Streptococcus pneumoniae septic arthritis complicating hip osteonecrosis in adults: case report and review of the literature. South Med J 2007; 100:712-6. [PMID: 17639752 DOI: 10.1097/smj.0b013e318070c98c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 42-year-old patient presented acutely with bacteremic pneumococcal pneumonia along with metastatic pneumococcal infection of the hip joint. Diagnostic evaluation revealed evidence of a pre-existing bilateral hip osteonecrosis. The osteonecrotic changes were attributed to chronic alcohol abuse and/or an old motor vehicle accident. Appropriate therapy was promptly instituted and the septic arthritis responded well, necessitating hip aspiration only once. A few months later, the patient had no permanent sequelae of the infection.
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Qin L, Zhang G, Sheng H, Griffth JF, Yeung KW, Leung KS. Contrast-Enhanced MRI and Micro-CT Adopted for Evaluation of a Lipid-Lowering and Anticoagulant Herbal Epimedium-Derived Phytoestrogenic Extract for Prevention of Steroid-Associated Osteonecrosis. ADVANCED BIOIMAGING TECHNOLOGIES IN ASSESSMENT OF THE QUALITY OF BONE AND SCAFFOLD MATERIALS 2007. [PMCID: PMC7120779 DOI: 10.1007/978-3-540-45456-4_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We developed an alternative steroid-associated osteonecrosis (ON) rabbit model using a combination of a single injection of low-dose lipopolysaccharide (LPS) and three subsequent injections of pulsed high-dose methylprednisolone (MPS).The usefulness of this experimental ON model was evaluated using both conventional and advanced bio-imaging techniques, including contrast-enhanced dynamic MRI and a high-resolution micro-CT. Details on establishment of methodology are described, which were adopted into an efficacy study on a herbal Epimedium-derived phytoestrogenic extract (HEPE) developed for prevention of steroid-associated ON using an established rabbit model. The underlying mechanisms of HEPE for prevention of steroid-associated ON were found to be associated with inhibition of both intravascular thrombosis and extravascular bone marrow lipid deposition, the two known mechanistic pathways in pathogenesis of ON. Our experimental results provide for potential clinical trials or applications of HEPE in the prevention of ON among hig-hrisk patients undergoing steroid treatment.
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Van den Wyngaert T, Huizing MT, Vermorken JB. Bisphosphonates and osteonecrosis of the jaw: cause and effect or a post hoc fallacy? Ann Oncol 2006; 17:1197-204. [PMID: 16873439 DOI: 10.1093/annonc/mdl294] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND An increasing amount of reports are being published suggesting a relationship between the use of bisphosphonates (BPs) and the development of osteonecrosis of the jaw (ONJ). We reviewed the currently available evidence and explore the potential mechanisms of action based on the known effects of the concerned BP. DESIGN The MEDLine, Current Contents and Science Citation Index Expanded databases were queried and the results augmented by analyzing cited references and recent congress proceedings. RESULTS 22 papers were included detailing 225 patients, all based on retrospective chart review without control groups. The prevalence of ONJ was estimated at 1.5%. The involved BPs were pamidronate, zoledronic acid, alendronate and risedronate, all potent nitrogen-containing agents. The most common symptom was pain (81.7%), although 12.2% of cases were asymptomatic. In 69.3% of patients ONJ was preceded by a dental extraction. At the time of diagnosis, 74.5% of patients were receiving chemotherapy and in 38.2% of cases corticosteroids were administered. Although various conservative and surgical treatment modalities were reported, residual sites of ONJ persisted in 72.5% of cases. CONCLUSION Although not enough evidence is available to prove a causal link, it seems that under specific circumstances local defenses can become overwhelmed resulting in ONJ.
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Nguyen T, Zacharin MR. Pamidronate treatment of steroid associated osteonecrosis in young patients treated for acute lymphoblastic leukaemia--two-year outcomes. J Pediatr Endocrinol Metab 2006; 19:161-7. [PMID: 16562590 DOI: 10.1515/jpem.2006.19.2.161] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To assess outcomes of young patients with osteonecrosis (ON) treated with pamidronate in terms of relief of pain, prevention of progress and bony collapse of involved area. PATIENTS AND METHODS A non-randomised interventional study in six patients with a history of acute lymphoblastic leukaemia (ALL) for which treatment protocols included long-term, high dose use of glucocorticoids. Subsequent development of ON was treated with a bisphosphonate (pamidronate) for 2 years. Mobility and pain control were assessed regularly with MRI and X-ray of affected areas at 0, 12 and 24 months. RESULTS Reduction in pain was reported in four of six patients in the first year with increased mobility. Two patients who had radiological evidence of joint destruction prior to treatment and when continued on corticosteroids reported no improvement in pain or mobility. In the second year, patients who started treatment in the first few months after diagnosis were stable while patients who had treatment initiated later deteriorated but had less pain than prior to treatment with pamidronate. MRIs of affected areas were completely unchanged over 2 years. X-rays revealed no new bony collapse in four of six patients after 12 months of treatment. However, three of six patients continued to undergo extensive collapse of femoral heads (one at 12 months, two at 24 months) and all these required urgent hip replacement. CONCLUSION Pamidronate treatment has a palliative effect in control of pain and may delay the natural history of bony collapse in the acute phase of ON, especially in early treated patients, but does not prevent late bone collapse and joint destruction in corticosteroid treated patients with ALL. Larger studies are needed to provide evidence as to whether bisphosphonate is indicated for treatment of ON for patients using corticosteroids.
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Affiliation(s)
- ThiThuyAn Nguyen
- Department of Paediatrics, University of Melbourne, Royal Children 's Hospital, Parkville, Victoria, Australia
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