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Wei Y, Wang Z, Lei L, Han J, Zhong S, Yang X, Gou Z, Chen L. Appreciable biosafety, biocompatibility and osteogenic capability of 3D printed nonstoichiometric wollastonite scaffolds favorable for clinical translation. J Orthop Translat 2024; 45:88-99. [PMID: 38516038 PMCID: PMC10955556 DOI: 10.1016/j.jot.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/29/2024] [Accepted: 02/12/2024] [Indexed: 03/23/2024] Open
Abstract
Background Alveolar bone destruction due to periodontal disease often requires a bone graft substitute to reconstruct the anatomical structures and biological functions of the bone tissue. Despite significant advances in the development of foreign ion-doped nonstoichiometric wollastonite bioceramics (CaSiO3, nCSi) for alveolar bone regeneration over the past decade, the in vivo biosafety and osteogenesis of nCSi scaffolds remain uncertain. In this study, we developed a customized porous nCSi scaffold to investigate the in vivo biocompatibility and osteogenic properties of nCSi bioceramics. Methods Six percent Mg-doped nCSi bioceramic scaffolds were fabricated by digital light processing (DLP), and the scaffold morphology, pore architecture, compressive strength, in vitro biodegradation, and apatite-forming ability of the bioceramic scaffolds were investigated systematically. Subsequently, an alveolar bone defect rabbit model was used to evaluate the biocompatibility and osteogenic efficacy of the nCSi bioceramics. Animal weight, hematological test, blood biochemical test, wet weight of the main organs, and pathological examination of the main organs were conducted. Micro-CT and histological staining were performed to analyze the osteogenic potential of the personalized bioceramic scaffolds. Results The nCSi scaffolds exhibited appreciable initial compressive strength (>30 MPa) and mild mechanical decay over time during in vitro biodissolution. In addition, the scaffolds induced apatite remineralization in SBF. Bioceramic scaffolds have been proven to have good biocompatibility in vivo after implantation into the alveolar bone defect of rabbits. No significant effects on the hematological indices, blood biochemical parameters, organ wet weight, or organ histopathology were detected from 3 to 180 days postoperatively. The porous scaffolds exhibited strong bone regeneration capability in the alveolar bone defect model of rabbits. Micro-CT and histological examination showed effective maintenance of bone morphology in the bioceramic scaffold group; however, depressed bone tissue was observed in the control group. Conclusions Our results suggest that personalized nCSi bioceramic scaffolds can be fabricated using the DLP technique. These newly developed strong bioceramic scaffolds exhibit good biocompatibility and osteogenic capability in vivo and have excellent potential as next-generation oral implants. The translational potential of this article Tissue-engineered strategies for alveolar bone repair require a bone graft substitute with appreciable biocompatibility and osteogenic capability. This article provides a systematic investigation of the in vivo biosafety and osteogenic property of nCSi to further development of a silicate-based bioceramics materials for clinical applications.
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Affiliation(s)
- Yingming Wei
- Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, 310008, China
| | - Zhongxiu Wang
- Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, 310008, China
| | - Lihong Lei
- Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, 310008, China
| | - Jiayin Han
- Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, 310008, China
| | - Shuaiqi Zhong
- Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, 310008, China
| | - Xianyan Yang
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou, 310058, China
| | - Zhongru Gou
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou, 310058, China
| | - Lili Chen
- Department of Oral Medicine, The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, 310008, China
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Li Z, Xue J, Dong J, Sun J, Wang L, Zhang Y. A Comparative Study of Bone Tissue Morphology and Bone Turnover Markers in Different Stages of Kümmell's Disease. J Clin Densitom 2022; 25:622-629. [PMID: 35513958 DOI: 10.1016/j.jocd.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/27/2022] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
Abstract
Although the incidence of Kümmell's disease (KD) has increased significantly in recent years, its pathological mechanism is still unclear. The aim of this study is to investigate the histomorphological characteristics and the kinetics of bone turnover markers following KD. This study involves 82 patients with KD, and fasting blood samples were collected to detect the serum concentration of bone turnover markers. A transpedicular bone biopsy was performed to collect bone biopsy specimens during vertebroplasty surgery. According to Li's staging system for KD, all cases were divided into 3 stages. Comparisons of the 3 stages and their kinetics were conducted. 19 (23.2%) patients were classified as Stage I, 39 (47.5%) as Stage II, 24 (29.2%) as Stage III. Bone histomorphological analysis showed that the ratios of WBV and FV reached a peak value (14.23 ± 0.62 and 54.63% ± 3.52%; p = 0.001 and 0.001) at Stage I. The ratios of NBV remained low (4.81% ± 2.61%) in Stage I, but reached a peak value (18.50% ± 2.77%; p = 0.001) in Stage III. Bone metabolism index level showed that the serum concentration of OST and β-CTX continued to rise after fracture, reaching a peak value of (38.15 ± 3.84 and 1.31 ± 0.16 ng/Ml; p = 0.073 and 0.026), while PINP reached its valley value (48.57 ± 7.25 ng/Ml; p = 0.069) in Stage III. A significant and negative correlation was found between the ratio of β-CTX and EBV/TV (p= 0.0194, r = -0.2037), and FV/TV (p= 0.0001, r = -0.5368). At the same time, β-CTX had a positive significant correlation with the NBV/TV (p= 0.0001, r = 0.6218). Bone histomorphometric analysis and bone turnover markers showed that KD has a possibility of healing in the early stage.
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Affiliation(s)
- Zhichao Li
- Department of spine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, P.R. China
| | - Jingcai Xue
- Department of spine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, P.R. China
| | - Jianwen Dong
- Department of spine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, P.R. China
| | - Jianmin Sun
- Department of spine, Shandong Provincial Hospital, Jinan, P.R. China
| | - Lei Wang
- Department of spine, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, P.R. China.
| | - Yun Zhang
- Department of geriatrics, Shandong University of Traditional Chinese Medicine, Jinan, P.R. China.
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Abstract
Objectives: Methods: Results: Conclusions:
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Rozental TD, Merchan N, Johannesdottir F, Lechtig A, Earp BE, Harper CM, Bouxsein ML. Longitudinal Changes in Serum Markers of Bone Metabolism and Bone Material Strength in Premenopausal Women with Distal Radial Fracture. J Bone Joint Surg Am 2022; 104:15-23. [PMID: 34648480 DOI: 10.2106/jbjs.21.00540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Markers of bone metabolism (MBM) play an important role in fracture evaluation, and changes have been associated with increased fracture risk. The purpose of the present study was to describe changes in MBM in premenopausal women with distal radial fractures. METHODS Premenopausal women with distal radial fractures (n = 34) and without fractures (controls) (n = 39) were recruited. Serum MBM in patients with distal radial fractures were obtained at the time of the initial presentation, 6 weeks, and 3, 6, and 12 months. MBM included 25(OH) vitamin D, PTH, osteocalcin, P1NP, BSAP, CTX, sclerostin, DKK1, periostin, and TRAP5b. Areal bone mineral density (aBMD) was assessed with dual x-ray absorptiometry, and the bone material strength index (BMSi) was assessed with microindentation. RESULTS Most MBM reached peak levels at 6 weeks after the injury, including osteocalcin (+17.7%), sclerostin (+23.5%), and DKK1 (12.6%). Sclerostin was lower (-27.4%) and DKK1 was higher (+22.2%) at 1 year after the fracture. CTX declined below baseline levels at 6 and 12 months, whereas TRAP5b, BSAP, and periostin did not significantly change. At 12 months, sclerostin was lower (p = 0.003) and DKK1 was higher (p = 0.03) in the distal radial fracture group than in the control group. Greater fracture severity was associated with greater increases in P1NP and BSAP. aBMD and BMSi were not associated with fracture. CONCLUSIONS Distal radial fractures caused increases in several MBM, which typically peaked at 6 weeks after injury and gradually decreased over 6 months. Sclerostin and DKK1 remained below and above baseline at 1 year, respectively. Increasing fracture severity resulted in larger changes in MBM. aBMD and BMSi did not discriminate between patients with distal radial fractures and controls. Continued efforts to identify markers of skeletal fragility in young women are warranted to mitigate future fracture risk. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tamara D Rozental
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Nelson Merchan
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Fjola Johannesdottir
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Aron Lechtig
- Harvard Combined Orthopaedic Surgery Residency Program, Boston, Massachusetts
| | - Brandon E Earp
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carl M Harper
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Aliuskevicius M, Østgaard SE, Vestergaard P, Rasmussen S. The Influence of Ibuprofen on the Healing of Nonsurgically Treated Colles' Fractures. Orthopedics 2021; 44:105-110. [PMID: 33373464 DOI: 10.3928/01477447-20201216-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Nonsteroidal anti-inflammatory drugs can delay bone healing. This knowledge is mainly derived from retrospective and animal studies. The authors therefore conducted a human study to investigate whether ibuprofen affects radiological, functional, densitometrical, and biochemical outcomes following a Colles' fracture, as well as the analgesic effect of ibuprofen. This was a single-center, triple-blinded, randomized, placebo-controlled clinical trial with a total of 96 patients. All of the patients received basic treatment with 1000 mg of acetaminophen 4 times daily. The placebo group received a placebo for 7 days. The 3-day ibuprofen group received 600 mg of ibuprofen 3 times daily for the first 3 days and a placebo for the following 4 days. The 7-day ibuprofen group received ibuprofen 3 times daily for 7 days. The primary outcome was the fragment migration for a period of 5 weeks. The secondary outcomes were changes in the wrist's range of motion; Disabilities of the Arm, Shoulder and Hand score; bone mineral density of the injured wrist; changes in serum CrossLaps (Roche Diagnostics) and osteocalcin; and analgesic effects. Analyses were performed according to an intention-to-treat approach. No significant differences in radiological migration or functional, densitometrical, and biochemical effects were established among the treatment groups (.06≤P≤.9). During the first 3 days, the pain score was lower (P=.02) in the ibuprofen groups than in the placebo group. The findings of this study offer an indication for ibuprofen as a bone-safe analgesic treatment after Colles' fracture and may be translated into other fields of cancellous bone fracture treatment. [Orthopedics. 2021;44(2):105-110.].
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Abstract
Bone turnover markers fill a clinical need that improves comprehensive care of metabolic bone health and osteoporosis. Creating a standard process for drawing them that reduces modifiable variability improves their precision and clinical usefulness. Creating a standard process for interpreting them by applying statistical significance improves their clinical applicability. Understanding what causes them to increase and decrease can help elucidate secondary causes of osteoporosis. Monitoring them can assess patient adherence to therapy for a silent disease that will progressively become louder with an aging global population.
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Affiliation(s)
- Sumeet Jain
- Division of Endocrinology and Metabolism, Department of Medicine, Rush University Medical Center, 1725 West Harrison Street, Suite 250, Chicago, IL 60612, USA.
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Qi H, Qi J, Gao J, Sun J, Wang G. The Impact of Bone Mineral Density on Bone Metabolism and the Fracture Healing Process in Elderly Chinese Patients With Osteoporotic Vertebral Compression Fractures. J Clin Densitom 2021; 24:135-145. [PMID: 33323310 DOI: 10.1016/j.jocd.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study was to investigate the effect of bone mineral density (BMD) on bone histomorphological parameters and bone turnover markers (BTMs) following osteoporotic vertebral compression fracture (OVCF) and to determine the correlation between BMD and the percentage of middle height compression during the healing process. METHODS A total of 206 patients with OVCFs were included in this study. Bone biopsy specimens were acquired during surgery. Blood samples were obtained to determine the serum concentrations of BTMs. The patients were divided into 2 groups according to BMD. RESULTS The concentrations of N-terminal propeptide of type I collagen (PINP) in the T-score ≤ -2.5 group (50.92 ± 12.78 ng/ml) were significantly lower than those in the T-score > -2.5 group (68.75 ± 28.66 ng/ml, p = 0.025) 3-6 mo after fracture. Moreover, the volume of necrotic bone in the T-score ≤ -2.5 group (15.15 ± 5.44%) was higher than that (1.67 ± 0.79%, p < 0.001) in the T-score > -2.5 group during the same period. BMD was statistically correlated with cancellous bone content (RS = 0.761, p <0.001), PMHC (RS = 0.85, p < 0.001), fibrous tissue volume (RS = -0.376, p < 0.001), and necrotic bone content (RS = -0.487, p < 0.001). CONCLUSIONS The healing process of OVCFs in the setting of low bone mass frequently occurs in the presence of decreased bone formation abilities, severe vertebral body height loss and a large amount of necrotic bone.
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Affiliation(s)
- Haoran Qi
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; School of Medicine, Shandong University, Jinan, China
| | - Jun Qi
- Laboratory Department, Jinan Infectious Diseases Hospital, Jinan, China
| | | | - Jianmin Sun
- Department of Spine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China; School of Medicine, Shandong University, Jinan, China.
| | - Guodong Wang
- Department of Spine, Provincial Hospital Affiliated to Shandong First medical University, Jinan, China.
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Qi H, Xue J, Gao J, Zhang Y, Sun J, Wang G. Changes of Bone Turnover Markers and Bone Tissue Content After Severe Osteoporotic Vertebral Compression Fracture. Med Sci Monit 2020; 26:e923713. [PMID: 32535613 PMCID: PMC7313424 DOI: 10.12659/msm.923713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The incidence of osteoporotic vertebral fractures (OVCFs) has increased significantly in recent years. In order to assess osteoporotic fracture healing process, it is necessary to study the characteristics after this type of vertebral fracture. However, there are few researches on fracture healing process in severe OVCFs. We aim to investigate the histological healing process and the kinetics of bone turnover markers following severe OVCFs. Material/Methods There were 149 patients with severe OVCFs included in this study. Fasting blood samples were obtained to detect bone turnover markers levels. A transpedicular bone biopsy was performed to collect bone biopsy specimens during vertebroplasty surgery. Stratification of healing process was performed: stage I (1–3 days), stage II (4–10 days), stage III (11–20 days), stage IV (21–30 days), stage V (1–3 months), stage VI (3–6 months). Results Quantitative analysis of bone histomorphometry showed that a large amount of necrotic bone tissue was observed in stage VI (12.92±3.66%). Bone turnover markers showed the concentration of β-isomerized C-terminal telopeptide (β-CTX) which reflects activity in osteoclast continued to increase in stage VI (0.9±0.33 ng/mL). These results differed from previous reports of other type vertebral fractures. Conclusions Bone histomorphometric analysis and bone turnover markers showed that severe osteoporotic vertebral compression fractures often associated with delayed union and nonunion during the healing process.
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Affiliation(s)
- Haoran Qi
- School of Medicine, Shandong University, Jinan, Shandong, China (mainland).,Department of Spine, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Jingcai Xue
- School of Medicine, Shandong University, Jinan, Shandong, China (mainland).,Department of Spine, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Junying Gao
- Fisheries College, Ocean University of China, Qingdao, Shandong, China (mainland)
| | - Yun Zhang
- Department of Geriatrics, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China (mainland)
| | - Jianmin Sun
- Department of Spine, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Guodong Wang
- Department of Spine, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China (mainland)
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Therapeutic Effects of Revascularisation on the Healing of Free Bone Grafts in Dogs. J Vet Res 2020; 64:175-180. [PMID: 32258815 PMCID: PMC7105986 DOI: 10.2478/jvetres-2020-0023] [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: 07/15/2019] [Accepted: 03/02/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction The therapeutic effect of subcutaneous embedding and revascularisation on the repair of canine bone defects caused by open fracture was examined. Material and Methods A total of 12 adult beagle dogs were randomly split into a control group (group C) and a test group (group T). A section of the radius was removed from each dog under general anaesthesia and the deficit supported by an orthopaedic implant. Group T had the section surgically implanted next to the blood vessel-rich saphenous vein and Group C had it cryopreserved at -80°C. After eight weeks, the bone was surgically implanted back into the matching radial deficit. Bone healing was evaluated by gross morphological and X-ray examinations, post-mortem histology, and successive blood measurements of key bone biochemical markers. Results At 12 weeks, the bone healing boundary was disappearing more quickly in group T dogs than in their group C counterparts. X-ray and histological examinations showed that the cortical repair of group T subjects was complete and the bony plate arrangement was more regular than that in group C. The levels of bone biochemical markers also proved that the healing state of group T was better. Conclusion The results showed that the degree of healing, osteoclast activity, and bone formation status of group T were better than those of group C, proving that the vascularised bone graft had a significantly shorter healing time than the cryopreserved bone graft.
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Yu DM, Zhang T, Liu JH, Wang WT, Wang WB. The molecular mechanism of platelet lysate promotes transformation of non-union cells into osteoblasts. Transl Cancer Res 2020; 9:1985-1992. [PMID: 35117545 PMCID: PMC8798210 DOI: 10.21037/tcr.2019.12.95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022]
Abstract
Background Platelet lysate (PL) had a remarkable therapeutic effect on bone repair related diseases, such as delayed fracture healing, femoral head necrosis and meniscal tear. In this study, we investigated the effect of PL on patients with nonunion, cartilage repair and osteonecrosis, and to evaluate the effect of PL on nonunion cells proliferation and the effect of PL on OPG/RANKL signaling pathway in nonunion cell of male rats. To reveal the molecular mechanism of PL for bone healing. Methods We used different concentrations of PL to treat nonunion cells, then detected cell proliferation and protein expression levels of osteoprotegerin (OPG), RANKL, osteopontin (OPN), osteocalcin (OCN) and alkaline phosphatase (ALP). Results The proliferation rate of nonunion cells treated by 5% PL, was significantly higher than that of the control group (P<0.05). Surprisingly, there were no significant difference among the proliferation rates of nonunion cells treated by 8% PL, 10% FBS and the control group (P>0.05). the results of western blot analysis and immunofluorescence analysis showed that PL improved the expression of OPG, OPN, OCN and ALP proteins in nonunion cells, but PL had no effect on the expression of nuclear factor-κB ligand (RANKL) protein. Conclusions We found that PL had a remarkable therapeutic effect on bone repair related diseases; 5% PL significantly improved the proliferation rate of the nonunion cells; 10% PL had a significantly positive effect on improving the expression levels of osteogenic related genes.
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Affiliation(s)
- Da-Miao Yu
- Department of Orthopaedics, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Tao Zhang
- Department of Orthopaedics, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Jian-Hui Liu
- Department of Orthopaedics, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Wan-Tao Wang
- Department of Orthopaedics, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Wen-Bo Wang
- Department of Orthopaedics, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
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Aliuskevicius M, Østgaard SE, Hauge EM, Vestergaard P, Rasmussen S. Influence of Ibuprofen on Bone Healing After Colles' Fracture: A Randomized Controlled Clinical Trial. J Orthop Res 2020; 38:545-554. [PMID: 31646668 DOI: 10.1002/jor.24498] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/04/2019] [Indexed: 02/04/2023]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) may delay bone healing. [Therefore, it is important to establish whether NSAID preparations delay bone healing and what correlations, if any, exist between different bone studies-DEXA-scanning, bone markers, roentgenology controls, and histological examination of newly formed bone]. The purpose of this prospective controlled study was to investigate whether ibuprofen affects bone mineral density, turnover biomarkers, and histomorphometric characteristics of the callus after a Colles' fracture. This study was a single-center, triple-blinded, randomized clinical trial. Ninety-five patients (80 females) with displaced Colles' fracture, median age 65 (range 40-85) years were included in the study and operated on by external fixation from June 2012 through to June 2015. Eighty-nine patients received interventional medicine and 83 completed the 1-year follow-up. The 7-day ibuprofen group received 600 mg of ibuprofen three times a day (N = 29), the 3-day ibuprofen group received ibuprofen for 3 days (N = 30) and a placebo for the following 4 days, and finally, the placebo group received a placebo for 7 days (N = 30). The primary outcome was the difference in bone mineral density between the ultra-distal region of the injured and non-injured radius at 3 months after surgery. The histomorphometric outcomes included the assessment of callus tissue volume and surface fractions at 6 weeks postoperatively. The biomarkers Osteocalcin and CrossLaps were measured at baseline, 1 week, 2 weeks, 6 weeks, 3 months, and 1 year. We included the results of the dropped-out patients in the intention to treat analysis. There was no difference between treatment groups in bone mineral density, histomorphometric estimations, and changes in bone biomarkers. These findings may offer an indication of ibuprofen as a bone-safe analgesic treatment in an acute fracture-phase. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:545-554, 2020.
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Affiliation(s)
- Marius Aliuskevicius
- Department of Orthopedic Surgery, Clinic Orto-Head, Aalborg University Hospital, 18-22 Hobrovej, DK-9000, Aalborg, Denmark
| | - Svend Erik Østgaard
- Department of Orthopedic Surgery, Clinic Orto-Head, Aalborg University Hospital, 18-22 Hobrovej, DK-9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, 15 Sdr. Skovvej, DK-9000, Aalborg, Denmark
| | - Ellen Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, 99 Palle Juul-Jensens Boulevard, DK-8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Incuba/Skejby, Building 2, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
| | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg University, 15 Sdr. Skovvej, DK-9000, Aalborg, Denmark.,Department of Endocrinology, Clinic of Internal Medicine, Aalborg University Hospital, 18-22 Hobrovej, DK-9000, Aalborg, Denmark.,Steno Diabetes Center North Jutland, Aalborg University Hospital, Dk-9000, Aalborg, Denmark
| | - Sten Rasmussen
- Department of Orthopedic Surgery, Clinic Orto-Head, Aalborg University Hospital, 18-22 Hobrovej, DK-9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, 15 Sdr. Skovvej, DK-9000, Aalborg, Denmark
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Kwon TG, Han MD. Current status of surgery first approach (part II): precautions and complications. Maxillofac Plast Reconstr Surg 2019; 41:23. [PMID: 31218215 PMCID: PMC6546776 DOI: 10.1186/s40902-019-0206-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/22/2019] [Indexed: 11/10/2022] Open
Abstract
The choice of surgical technique in orthognathic surgery is based primarily on the surgical treatment objectives (STO), which is a fundamental component of the orthognathic treatment process. In the conventional orthodontics-first approach, presurgical planning can be performed twice, during the preorthodontic (initial STO) and presurgical phases (final STO). Recently, a surgery-first orthognathic approach (SFA) without presurgical orthodontic treatment has been introduced and combined initial and final STO at the same time. In contrast to the conventional surgical-orthodontic treatment protocol that includes preoperative orthodontics for dental decompensations to maximize stable postoperative occlusion, the SFA potentially shortens the treatment period and minimizes esthetic concerns during the decompensation period because skeletal problems are corrected from the beginning. The indications for the SFA have been proposed in the literature, but no consensus exists. Moreover, because dental occlusion of the pre-orthodontic arches cannot be used as a guide for establishing the surgical treatment plan, there are fundamental limitations in accurate prediction of postsurgical results in the SFA. Recently, the concepts of postsurgical orthodontic treatment are continuously changing and evolving to overcome this inherent limitation of the SFA. The elimination of presurgical orthodontics can change the paradigm of orthognathic surgery but still requires cautious case selection and thorough discussion and collaboration between orthodontists and surgeons regarding the goals and postoperative management of the orthognathic procedure.
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Affiliation(s)
- Tae-Geon Kwon
- 1Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-daero, Jung-gu, Daegu, 41940 Republic of Korea
| | - Michael D Han
- 2Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Illinois at Chicago , Chicago, IL 60612-7211 USA
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Pan C, Liu X, Li T, Wang G, Sun J. Kinetic of bone turnover markers after osteoporotic vertebral compression fractures in postmenopausal female. J Orthop Surg Res 2018; 13:314. [PMID: 30526635 PMCID: PMC6286497 DOI: 10.1186/s13018-018-1025-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/28/2018] [Indexed: 01/15/2023] Open
Abstract
Background Osteoporotic fracture occurs mostly at the spine, in which the commonest one is vertebral compression fracture. Bone turnover markers (BTMs) can be applied to assess bone formation and resorption activity. Nevertheless, there are few reports on BTMs changes after osteoporotic vertebral compression fracture. The aim of this study is to investigate the kinetics of bone turnover markers after osteoporotic vertebral compression fractures in postmenopausal female. Methods Three hundred nine postmenopausal female patients with osteoporotic vertebral compression fractures were included in the study. Fasting blood samples were obtained to analyze the serum concentration of bone turnover markers including osteocalcin (OC), β-isomerized type I collagen amino-terminal peptide (β-CTX), alkaline phosphatase (ALP), type I procollagen amino-terminal peptides (PINP), calcium, and phosphorus. According to periods long after vertebral fracture, all the cases were divided into seven phases: phase 1 (within 3 days), phase 2 (3 days to 1 week), phase 3 (1 to 2 weeks), phase 4 (2 to 4 weeks), phase 5 (4 to 12 weeks), phase 6 (12 to 24 weeks), and phase 7 (24 weeks to 1 year). Comparisons among the phases and kinetics during the phases were conducted. Results All the kinds of BTM’s serum concentration began to increase within 3 days after vertebral fracture in phase 1. Osteocalcin and β-CTX had two peaks, the first one in phase 2 (21.4 ± 6.0 ng/ml and 0.72 ± 0.17 ng/ml, respectively) and the second in phase 6 (25.8 ± 7.5 ng/ml and 0.89 ± 0.23 ng/ml, respectively). The peak of ALP arrived in phase 4 at the value of 123.9 ± 25.7 U/L. PINP reached its peak value (69.50 ± 16.82 ng/ml) in phase 6. Serum phosphorus arrived at its first peak (1.21 ± 0.13 mmol/L) in phase 2 and the second peak (1.23 ± 0.13 mmol/L) in phase 4. Serum calcium reached the first peak (2.30 ± 0.07 mmol/L) in phase 3 and the second peak (2.34 ± 0.08 mmol/L) in phase 5. Conclusion The time-dependent variations of BTMs based on the fracture healing process of inflammation, regeneration, and remodeling occur after vertebral fracture. Kinetics of BTMs after vertebral fracture as well as the reference value at each period were established in the present study. It is helpful to assess vertebral fracture healing process according to the kinetics of BTMs.
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Affiliation(s)
- Changyu Pan
- Department of Spine, Shandong Provincial hospital affiliated to Shandong University, No.9677 Jingshi road, Jinan, 250013, People's Republic of China
| | - Xiaoyang Liu
- Department of Spine, Shandong Provincial hospital affiliated to Shandong University, No.9677 Jingshi road, Jinan, 250013, People's Republic of China
| | - Tao Li
- Department of Spine, Shandong Provincial hospital affiliated to Shandong University, No.9677 Jingshi road, Jinan, 250013, People's Republic of China
| | - Guodong Wang
- Department of Spine, Shandong Provincial hospital affiliated to Shandong University, No.9677 Jingshi road, Jinan, 250013, People's Republic of China.
| | - Jianmin Sun
- Department of Spine, Shandong Provincial hospital affiliated to Shandong University, No.9677 Jingshi road, Jinan, 250013, People's Republic of China.
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14
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Abstract
PURPOSE OF REVIEW Osteoporosis is a common public health problem that is often undertreated and underdiagnosed. The clinical management of osteoporosis is often reactionary to devastating fracture events. Bone turnover markers may improve the ease and rapidity at which osteoporosis is monitored and treated. Bone turnover markers are biochemical byproducts of bone formation or bone resorption. The clinical use of bone turnover markers is limited by significant preanalytical variability. Effective interpretation of bone turnover markers requires a detailed understanding of the variables that can affect their responses to osteoporosis treatment and monitoring. RECENT FINDINGS Progress is continuously being made on the standardization of bone turnover markers. The literature on the response of bone turnover markers to unique clinical situations is expanding. Data for evidence-based reference intervals for bone turnover markers has increased. Variables that affect the appropriate timing of lab draws like diurnal variation, postprandial status, exercise and alcohol use have been described. Studies examining the expected response of bone turnover markers to treatments of osteoporosis and other medications that affect bone health continue to increase. SUMMARY Bone turnover markers have clinical utility in the comprehensive evaluation of osteoporosis. When interpreted with caution and with a good understanding of their natural variability, bone turnover markers provide information that supplements osteoporosis management and provides useful clinical information about conditions that alter bone turnover.
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Affiliation(s)
- Sumeet Jain
- Loyola University Medical Center, Maywood, Illinois, USA
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15
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Solomon LB, Kitchen D, Anderson PH, Yang D, Starczak Y, Kogawa M, Perilli E, Smitham PJ, Rickman MS, Thewlis D, Atkins GJ. Time dependent loss of trabecular bone in human tibial plateau fractures. J Orthop Res 2018; 36:2865-2875. [PMID: 29786151 DOI: 10.1002/jor.24057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 05/15/2018] [Indexed: 02/04/2023]
Abstract
We investigated if time between injury and surgery affects cancellous bone properties in patients suffering tibial plateau fractures (TPF), in terms of structural integrity and gene expression controlling bone loss. A cohort of 29 TPF, operated 1-17 days post-injury, had biopsies from the fracture and an equivalent contralateral limb site, at surgery. Samples were assessed using micro-computed tomography and real-time RT-PCR analysis for the expression of genes known to be involved in bone remodeling and fracture healing. Significant decreases in the injured vs control side were observed for bone volume fraction (BV/TV, -13.5 ± 6.0%, p = 0.011), trabecular number (Tb.N, -10.5 ± 5.9%, p = 0.041) and trabecular thickness (Tb.Th, -4.6 ± 2.5%, p = 0.033). Changes in these parameters were more evident in patients operated 5-17 days post-injury, compared to those operated in the first 4 days post-injury. A significant negative association was found between Tb.Th (r = -0.54, p < 0.01) and BV/TV (r = -0.39, p < 0.05) in relation to time post-injury in the injured limb. Both BV/TV and Tb.Th were negatively associated with expression of key molecular markers of bone resorption, CTSK, ACP5, and the ratio of RANKL:OPG mRNA. These structure/gene expression relationships did not exist in the contralateral tibial plateau of these patients. This study demonstrated that there is a significant early time-dependent bone loss in the proximal tibia after TPF. This bone loss was significantly associated with altered expression of genes typically involved in the process of osteoclastic bone resorption but possibly also bone resorption by osteocytes. The mechanism of early bone loss in such fractures should be a subject of further investigation. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2865-2875, 2018.
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Affiliation(s)
- Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia.,Orthopaedic and Trauma Service, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - David Kitchen
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia.,Orthopaedic and Trauma Service, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Paul H Anderson
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, 5000, Australia
| | - Dongqing Yang
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Yolandi Starczak
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Masakazu Kogawa
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Egon Perilli
- The Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, 5001, Australia
| | - Peter J Smitham
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia.,Orthopaedic and Trauma Service, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Mark S Rickman
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia.,Orthopaedic and Trauma Service, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Gerald J Atkins
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia
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16
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Peterburs B, Mittelstaedt A, Haas P, Petri M, Westphal R, Dullin C, Sehmisch S, Neunaber C. Biomechanical and histological analyses of the fracture healing process after direct or prolonged reduction. Eur J Med Res 2018; 23:39. [PMID: 30180907 PMCID: PMC6122772 DOI: 10.1186/s40001-018-0337-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/23/2018] [Indexed: 12/30/2022] Open
Abstract
Background Reduction of femoral shaft fractures remains a challenging problem in orthopaedic surgery. Robot-assisted reduction might ease reduction and fracture treatment. However, the influence of different reduction pathways on patients’ physiology is not fully known yet. Therefore, the aim of this study was to examine the biomechanics and histology of fracture healing after direct and prolonged robot-assisted reduction in an in vivo rat model. Methods 144 male CD® rats were randomly assigned to 12 groups. Each animal received an external fixator and an osteotomy on the left femoral shaft. On the fourth postoperative day, the 1× reduction groups received a single reduction maneuver, whereas the 10× reduction groups received the same reduction pathway with ten repetitions. The control groups did not undergo any reduction maneuvers. Animals were killed after 1, 2, 3 and 4 weeks, respectively, and the composition of the fracture gap was analyzed by µCT and non-decalcified histology. Biomechanical properties were investigated by a three-point bending test, and the bone turnover markers PINP, bCTx, OPG, sRANKL, TRACP-5b, BALP, and OT/BGP were measured. Results One week after the reduction maneuver, µCT analysis showed a higher cortical bone volume in the 1× reduction group compared to the 10× reduction group. Biomechanically, the control group showed higher maximum force values measured by three-point bending test compared to both reduction groups. Furthermore, less collagen I formation was examined in the 10× reduction group compared to the control group after 1 week of fracture healing. PINP concentration was decreased in 10× reduction group after 1 week compared to control group. The same trend was seen after 3 weeks. Conclusion A single reduction maneuver has a beneficial effect in the early phase of the fracture healing process compared to repeated reduction maneuvers. In the later phase of fracture healing, no differences were found between the groups.
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Affiliation(s)
- Benedikt Peterburs
- Hannover Medical School (MHH) -Trauma Department, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Anke Mittelstaedt
- Hannover Medical School (MHH) -Trauma Department, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Philipp Haas
- Hannover Medical School (MHH) -Trauma Department, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Maximilian Petri
- Hannover Medical School (MHH) -Trauma Department, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ralf Westphal
- Institute for Robotics and Process Control, Technical University Braunschweig, Mühlenpfordtstraße 23, 38106, Brunswick, Germany
| | - Christian Dullin
- Department for Diagnostic and Interventional Radiology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.,Italian Synchrotron Light Source 'Elettra', SYRMEP Beamline, Trieste, Italy
| | - Stephan Sehmisch
- Department of Trauma Surgery, Orthopaedic and Reconstructive Surgery, University Medical Center Goettingen, Robert-Koch Str. 40, Goettingen, 37075, Germany
| | - Claudia Neunaber
- Hannover Medical School (MHH) -Trauma Department, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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17
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Zimmerman SM, Heard-Lipsmeyer ME, Dimori M, Thostenson JD, Mannen EM, O'Brien CA, Morello R. Loss of RANKL in osteocytes dramatically increases cancellous bone mass in the osteogenesis imperfecta mouse (oim). Bone Rep 2018; 9:61-73. [PMID: 30105276 PMCID: PMC6077550 DOI: 10.1016/j.bonr.2018.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/30/2018] [Accepted: 06/29/2018] [Indexed: 12/24/2022] Open
Abstract
Osteogenesis imperfecta (OI) is characterized by osteopenia and bone fragility, and OI patients during growth often exhibit high bone turnover with the net result of low bone mass. Recent evidence shows that osteocytes significantly affect bone remodeling under physiological and pathological conditions through production of osteoclastogenic cytokines. The receptor activator of nuclear factor kappa-B ligand (RANKL) produced by osteocytes for example, is a critical mediator of bone loss caused by ovariectomy, low-calcium diet, unloading and glucocorticoid treatment. Because OI bone has increased density of osteocytes and these cells are embedded in matrix with abnormal type I collagen, we hypothesized that osteocyte-derived RANKL contributes to the OI bone phenotype. In this study, the conditional loss of RANKL in osteocytes in oim/oim mice (oim-RANKL-cKO) resulted in dramatically increased cancellous bone mass in both the femur and lumbar spine compared to oim/oim mice. Bone cortical thickness increased significantly only in spine but ultimate bone strength in the long bone and spine was minimally improved in oim-RANKL-cKO mice compared to oim/oim mice. Furthermore, unlike previous findings, we report that oim/oim mice do not exhibit high bone turnover suggesting that their low bone mass is likely due to defective bone formation and not increased bone resorption. The loss of osteocyte-derived RANKL further diminished parameters of formation in oim-RANKL-cKO. Our results indicate that osteocytes contribute significantly to the low bone mass observed in OI and the effect of loss of RANKL from these cells is similar to its systemic inhibition. Osteocyte-specific deletion of RANKL in oim mice greatly increases cancellous bone. Skeletal effects of osteocyte RANKL deletion on OI mimic its systemic inhibition. Oim mice do not have high bone turnover. Low bone mass in oim mice is primarily caused by decreased bone formation. This study supports a potentially important role for osteocytes in OI.
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Affiliation(s)
- Sarah M. Zimmerman
- Department of Physiology & Biophysics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Melissa E. Heard-Lipsmeyer
- Department of Physiology & Biophysics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Milena Dimori
- Department of Physiology & Biophysics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Jeff D. Thostenson
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Erin M. Mannen
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Charles A. O'Brien
- Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
- Central Arkansas Veterans Healthcare System, Little Rock, AR, United States of America
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Roy Morello
- Department of Physiology & Biophysics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
- Division of Genetics, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
- Corresponding author at: Department of Physiology & Biophysics, University of Arkansas for Medical Sciences, 4301 W. Markham St., #505, Little Rock, AR 72205-7199, United States of America.
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18
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Hussein AI, Mancini C, Lybrand KE, Cooke ME, Matheny HE, Hogue BL, Tornetta P, Gerstenfeld LC. Serum proteomic assessment of the progression of fracture healing. J Orthop Res 2018; 36:1153-1163. [PMID: 28971515 PMCID: PMC5880751 DOI: 10.1002/jor.23754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/27/2017] [Indexed: 02/04/2023]
Abstract
A targeted proteomic analysis of murine serum over a 35-day course of fracture healing was carried out to determine if serum proteomic changes could be used to monitor the biological progression of fracture healing. Transverse, closed femoral fractures where generated and stabilized with intramedullary fixation. A single stranded DNA aptamer-based multiplexed proteomic approach was used to assay 1,310 proteins. The transcriptomic profiles for genes matching the 1,310 proteins were obtained by microarray analysis of callus mRNA. Of the 1,310 proteins analyzed, 850 proteins showed significant differences among the time points (p-value <0.05). Ontology assessment associated these proteins with osteoblasts, monocyte/macrophage lineages, mesenchymal stem cell lines, hepatic tissues, and lymphocytes. Temporal clustering of these data identified proteins associated with inflammation, cartilage formation and bone remodeling stages of healing. VEGF, Wnt, and TGF-βsignaling pathways were restricted to the period of cartilage formation. Comparison of the proteomic and transcriptomic profiles showed that 87.5% of proteins in serum had concordant expression to their mRNA expression in the callus, while 12.5% of the protein and mRNA expression patterns were discordant. The discordant proteins that were elevated in the serum but down regulated in callus mRNA expression were related to clotting functions, allograft rejection, and complement function. While proteins down regulated in the serum and elevated in callus mRNA were associated with osteoblast function, NF-ĸb, and activin signaling. These data show the serum proteome may be used to monitor the different biological stages of fracture healing and have translational potential in assessing human fracture healing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1153-1163, 2018.
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Affiliation(s)
- Amira I. Hussein
- Department of Orthopaedic Surgery; Boston University; 715 Albany Street, E 243 Boston 02118 Massachusetts
| | - Christian Mancini
- Department of Orthopaedic Surgery; Boston University; 715 Albany Street, E 243 Boston 02118 Massachusetts
| | - Kyle E. Lybrand
- Department of Orthopaedic Surgery; Boston University; 715 Albany Street, E 243 Boston 02118 Massachusetts
| | - Margaret E. Cooke
- Department of Orthopaedic Surgery; Boston University; 715 Albany Street, E 243 Boston 02118 Massachusetts
| | - Heather E. Matheny
- Department of Orthopaedic Surgery; Boston University; 715 Albany Street, E 243 Boston 02118 Massachusetts
| | - Brenna L. Hogue
- Department of Orthopaedic Surgery; Boston University; 715 Albany Street, E 243 Boston 02118 Massachusetts
| | - Paul Tornetta
- Department of Orthopaedic Surgery; Boston University; 715 Albany Street, E 243 Boston 02118 Massachusetts
| | - Louis C. Gerstenfeld
- Department of Orthopaedic Surgery; Boston University; 715 Albany Street, E 243 Boston 02118 Massachusetts
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19
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Prognostic potential of markers of bone turnover in delayed-healing tibial diaphyseal fractures. Eur J Trauma Emerg Surg 2017; 45:31-38. [DOI: 10.1007/s00068-017-0879-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/10/2017] [Indexed: 12/21/2022]
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20
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Andrade VB, Sá MA, Mendes RM, Martins-Júnior PA, Silva GA, Sousa BR, Caliari MV, Ávila ES, Ladeira LO, Resende RR, Ferreira AJ. Enhancement of Bone Healing by Local Administration of Carbon Nanotubes Functionalized with Sodium Hyaluronate in Rat Tibiae. Cells Tissues Organs 2017; 204:137-149. [DOI: 10.1159/000453030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 11/19/2022] Open
Abstract
It has been reported that carbon nanotubes (CNTs) serve as nucleation sites for the deposition of bone matrix and cell proliferation. Here, we evaluated the effects of multi-walled CNTs (MWCNTs) on bone repair of rat tibiae. Furthermore, because sodium hyaluronate (HY) accelerates bone restoration, we associated CNTs with HY (HY-MWCNTs) in an attempt to boost bone repair. The bone defect was created by a 1.6-mm-diameter drill. After 7 and 14 days, tibiae were processed for histological and morphometric analyses. Immunohistochemistry was used to evaluate the expression of vascular endothelial growth factor (VEGF) in bone defects. Expression of osteocalcin (OCN), bone morphogenetic protein-2 (BMP-2), and collagen I (Col I) was assessed by real-time PCR. Histomorphometric analysis showed a similar increase in the percentage of bone trabeculae in tibia bone defects treated with HY and HY-MWCNTs, and both groups presented more organized and thicker bone trabeculae than nontreated defects. Tibiae treated with MWCNTs or HY- MWCNTs showed a higher expression of VEGF. Treatment with MWCNTs or HY-MWCNTs increased the expression of molecules involved in the bone repair process, such as OCN and BMP-2. Also, HY- and MWCNT-treated tibiae had an increased expression of Col I. Thus, it is tempting to conclude that CNTs associated or not with other materials such as HY emerged as a promising biomaterial for bone tissue engineering.
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21
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Sousa CP, Lopez-Peña M, Guzón FM, Abreu HVD, Luís MR, Viegas CA, Camassa J, Azevedo JTD, Cabrita AS, Reis RL, Gomes ME, Dias IR. Evaluation of bone turnover markers and serum minerals variations for predicting fracture healing versus non-union processes in adult sheep as a model for orthopedic research. Injury 2017; 48:1768-1775. [PMID: 28601248 DOI: 10.1016/j.injury.2017.05.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 05/09/2017] [Accepted: 05/15/2017] [Indexed: 02/02/2023]
Abstract
Bone turnover markers (BTMs) have been considered as an auxiliary method of following the fracture healing process and for early prediction of impaired bone healing. A better understanding of the potential of BTMs in this application could allow for earlier interventions and improved patient care. The aim of this study with a large animal experimental model was to assess the variation of bone formation markers - namely the total alkaline phosphatase (ALP) and its bone-specific isoform (BALP), serum concentration of intact osteocalcin (OC), N-terminal propeptide type III procollagen (PIIINP) and of bone resorption markers - namely tartrate resistant acid phosphatase (TRAP) and deoxypyridinoline crosslink (DPD) during the first stages of a normal fracture healing process and of a segmental critical size defect (CSD), which progresses to a non-union process. Thirty healthy female sheep (Portuguese Churra-da-Terra-Quente breed), approximately 4-years-old, were enrolled in this study. Jugular venous blood samples were collected pre-operatively and at 1, 2, 3, 4, 6, 8, 10 and 12 post-operative weeks. The animals of the CSD group showed significant lower serum levels of BALP, OC and significant higher serum PIIINP levels at early stages of the fracture healing process, compared with animals that progressed in a normal fracture healing process. Serum BALP, OC and PIIINP levels could be useful as non-invasive auxiliary tools with other complementary methods for predicting the outcome of traumatic bone fractures.
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Affiliation(s)
- Cristina P Sousa
- Center Hospitalar of Porto, Largo Prof. Abel Salazar 4099-001 Porto, Portugal.
| | - Mónica Lopez-Peña
- Department of Veterinary Clinics Sciences, Faculty of Veterinary Medicine, University of Santiago de Compostela, University Campus, Av. Carballo Calero, 27002 Lugo, Spain
| | - Fernando M Guzón
- Department of Veterinary Clinics Sciences, Faculty of Veterinary Medicine, University of Santiago de Compostela, University Campus, Av. Carballo Calero, 27002 Lugo, Spain
| | - Humberto V De Abreu
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School (ECAV), University of Trás-os-Montes and Alto Douro (UTAD), Quinta de Prados, 5000-801 Vila Real, Portugal
| | - Maurino R Luís
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School (ECAV), University of Trás-os-Montes and Alto Douro (UTAD), Quinta de Prados, 5000-801 Vila Real, Portugal
| | - Carlos A Viegas
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School (ECAV), University of Trás-os-Montes and Alto Douro (UTAD), Quinta de Prados, 5000-801 Vila Real, Portugal; CITAB - Centre for the Research and Technology of Agro-Environmental and Biological Sciences, UTAD, Vila Real, Portugal
| | - José Camassa
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School (ECAV), University of Trás-os-Montes and Alto Douro (UTAD), Quinta de Prados, 5000-801 Vila Real, Portugal
| | - Jorge T De Azevedo
- Department of Animal Sciences, ECAV, UTAD, Vila Real, Portugal; CECAV - Centre for Animal Sciences and Veterinary Studies, UTAD, Vila Real, Portugal
| | - António S Cabrita
- Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, Rua larga, 3004-504 Coimbra, Portugal
| | - Rui L Reis
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Manuela E Gomes
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Isabel R Dias
- Department of Veterinary Sciences, Agricultural and Veterinary Sciences School (ECAV), University of Trás-os-Montes and Alto Douro (UTAD), Quinta de Prados, 5000-801 Vila Real, Portugal; CITAB - Centre for the Research and Technology of Agro-Environmental and Biological Sciences, UTAD, Vila Real, Portugal
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22
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Changes of Bone Turnover Markers in Long Bone Nonunions Treated with a Regenerative Approach. Stem Cells Int 2017; 2017:3674045. [PMID: 28744314 PMCID: PMC5506673 DOI: 10.1155/2017/3674045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/06/2017] [Accepted: 05/14/2017] [Indexed: 02/07/2023] Open
Abstract
In this clinical trial, we investigated if biochemical bone turnover markers (BTM) changed according to the progression of bone healing induced by autologous expanded MSC combined with a biphasic calcium phosphate in patients with delayed union or nonunion of long bone fractures. Bone formation markers, bone resorption markers, and osteoclast regulatory proteins were measured by enzymatic immunoassay before surgery and after 6, 12, and 24 weeks. A satisfactory bone healing was obtained in 23 out of 24 patients. Nine subjects reached a good consolidation already at 12 weeks, and they were considered as the “early consolidation” group. We found that bone-specific alkaline phosphatase (BAP), C-terminal propeptide of type I procollagen (PICP), and beta crosslaps collagen (CTX) changed after the regenerative treatment, BAP and CTX correlated to the imaging results collected at 12 and 24 weeks, and BAP variation along the healing course differed in patients who had an “early consolidation.” A remarkable decrease in BAP and PICP was observed at all time points in a single patient who experienced a treatment failure, but the predictive value of BTM changes cannot be determined. Our findings suggest that BTM are promising tools for monitoring cell therapy efficacy in bone nonunions, but studies with larger patient numbers are required to confirm these preliminary results.
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23
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Cunningham BP, Brazina S, Morshed S, Miclau T. Fracture healing: A review of clinical, imaging and laboratory diagnostic options. Injury 2017; 48 Suppl 1:S69-S75. [PMID: 28483359 DOI: 10.1016/j.injury.2017.04.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A fundamental issue in clinical orthopaedics is the determination of when a fracture is united. However, there are no established "gold standards," nor standardized methods for assessing union, which has resulted in significant disagreement among orthopaedic surgeons in both clinical practice and research. A great deal of investigative work has been directed to addressing this problem, with a number of exciting new techniques described. This review provides a brief summary of the burden of nonunion fractures and addresses some of the challenges related to the assessment of fracture healing. The tools currently available to determine union are discussed, including various imaging modalities, biomechanical testing methods, and laboratory and clinical assessments. The evaluation of fracture healing in the setting of both patient care and clinical research is integral to the orthopaedic practice. Weighted integration of several available metrics must be considered to create a composite outcome measure of patient prognosis.
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Affiliation(s)
| | | | - Saam Morshed
- Orthopaedic Trauma Institute San Francisco, CA, USA
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Xiaofeng L, Daxia X, Yunzhen C. Teriparatide as a nonoperative treatment for tibial and femoral fracture nonunion: A case report. Medicine (Baltimore) 2017; 96:e6571. [PMID: 28422848 PMCID: PMC5406064 DOI: 10.1097/md.0000000000006571] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Fracture nonunion is a great challenge for orthopedic surgeons. Many surgical interventions are associated with significant pain and heavy economic burden. Therefore, our aim was to evaluate the outcomes of a new nonoperative treatment for fracture nonunion. PATIENT CONCERNS A 44-year-old man suffered closed fractures of the right tibia and left femur. Eleven months after surgery, there was no radiographic healing between fracture fragments. DIAGNOSES Fracture nonunion of the right tibia and left femur. INTERVENTIONS The patient received systemic treatment with teriparatide (recombinant human Parathyroid Hormone 1-34) 20 μg/d for 8 months, with further observation at 4 months after discontinuation. During treatment, bone metabolic markers were measured to evaluate metabolic activity of osteoblasts and osteoclasts. The Ethics Committee of Qilu Hospital of Shandong University approved this study. OUTCOMES Satisfactory healing of fracture nonunion was obtained without further intervention. LESSONS Anabolic treatment with teriparatide showed a positive effect on healing of fracture nonunion. Evaluation of bone metabolic markers during treatment is necessary to observe the curative effect. In view of the positive effect of teriparatide on healing of fracture nonunion in numerous animal models and clinical studies, it may be a promising alternative treatment for fracture nonunion in patients who are not suitable for surgical intervention.
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Evaluation of Tryptophan/Kynurenine Pathway Relevance With Immune System Biomarkers of Low Energy Trauma Hip Fractures in Osteoporotic Patients. Arch Rheumatol 2017; 32:203-208. [PMID: 30375548 DOI: 10.5606/archrheumatol.2017.6216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/08/2016] [Indexed: 01/18/2023] Open
Abstract
Objectives This study aims to evaluate tryptophan degradation and clarify whether altered levels of kynurenine and tryptophan (Kyn/Trp) ratio could be correlated to osteoporotic hip fractures via immune system. Patients and methods The study included 60 patients with osteoporotic hip fracture (20 males, 40 females, mean age 76.6±6.9 years; range 59 to 95 years). Patients were divided into two as patients with collum femoris fractures (group 1; n=23) and intertrochanteric fractures (group 2; n=37). Fifteen healthy subjects without any fracture were selected as control group (group 3; 3 males, 12 females; mean age 69.7±8.4; range 60 to 86 years). All fractures were simple falls due to low energy trauma. Bone mineral density measurements were performed with Lunar dual energy X-ray absorptiometry. Kyn/Trp levels were measured by high performance liquid chromatography. Interleukin (IL)-6 and IL-1 beta levels were measured with solid-phase sandwich enzyme-linked immunosorbent assay. Results All bone mineral density values were in agreement for osteoporosis and there was no significant difference between the two groups. Higher Kyn/Trp ratios were observed in groups 1 and 2 compared to group 3. This difference was more significant in group 1 (p=0.0001) than that in group 2 (p=0.048). Also, group 1 had significantly higher Kyn/Trp ratio than group 2 (p=0.011). There were significantly higher IL-6 and lower IL-1 beta levels both in groups 1 and 2 compared to group 3 (p=0.0001). There was no significant difference between group 1 and group 2 in terms of IL-6 and IL-1 beta levels. There was positive correlation with Kyn/Trp ratio (r=0.581, p=0.004) in group 2. Also, significant correlation was detected between IL-6 and IL-1 beta levels in the same group (r=0.665, p=0.036). Conclusion Both increased degradation of tryptophan and ratio of Kyn/Trp indicate the relationship of immune activation with bone healing.
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Gu XC, Zhang XB, Hu B, Zi Y, Li M. Neuropeptide Y accelerates post-fracture bone healing by promoting osteogenesis of mesenchymal stem cells. Neuropeptides 2016; 60:61-66. [PMID: 27720230 DOI: 10.1016/j.npep.2016.09.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 09/09/2016] [Accepted: 09/11/2016] [Indexed: 01/27/2023]
Abstract
Fracture repair is a complex yet well orchestrated regenerative process involving numerous signaling and cell types including osteoblasts. Here we showed that NPY, a neurotransmitter with regulatory functions in bone homeostasis, may contribute to the post-fracture bone healing in patients with traumatic brain injury-fracture combined injuries. Our results suggested NPY levels were increased in patients with the combined injuries, accomplished by arising of bone healing markers, such as ALP, OC, PICP and ICTP, than in those with simple fractures, and NPY have direct actions on MSCs to promote their osteogenic differentiation. Our results provided clinical evidences for NPY participating in the bone healing process in a nonhypothalamic manner, most probably by directly promoting osteogenesis of mesenchymal stem cells.
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Affiliation(s)
- Xiao-Chuan Gu
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiao-Bin Zhang
- Department of Emergency Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bing Hu
- Department of Medical Oncology, Shanghai Minhang District Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Ying Zi
- Department of Emergency, 463rd Hospital of PLA, Shenyang 110042, China.
| | - Ming Li
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, China.
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Abstract
This review describes the normal healing process for bone, ligaments, and tendons, including primary and secondary healing as well as bone-to-bone fusion. It depicts the important mediators and cell types involved in the inflammatory, reparative, and remodeling stages of each healing process. It also describes the main challenges for clinicians when trying to repair bone, ligaments, and tendons with a specific emphasis on Charcot neuropathy, fifth metatarsal fractures, arthrodesis, and tendon sheath and adhesions. Current treatment options and research areas are also reviewed.
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Affiliation(s)
- Jessica A Cottrell
- Department of Biological Sciences, Seton Hall University, 400 South Orange Avenue, South Orange, NJ 07101, USA.
| | - Jessica Cardenas Turner
- Department of Biomedical Engineering, New Jersey Institute of Technology, 323 Martin Luther King Boulevard, Newark, NJ 07102, USA
| | - Treena Livingston Arinzeh
- Department of Biomedical Engineering, New Jersey Institute of Technology, 323 Martin Luther King Boulevard, Newark, NJ 07102, USA
| | - J Patrick O'Connor
- Department of Orthopaedics, Rutgers-New Jersey Medical School, Medical Sciences Building, Room E-659, 185 South Orange Avenue, Newark, NJ 07103, USA
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de Seny D, Cobraiville G, Leprince P, Fillet M, Collin C, Mathieu M, Hauzeur JP, Gangji V, Malaise MG. Biomarkers of inflammation and innate immunity in atrophic nonunion fracture. J Transl Med 2016; 14:258. [PMID: 27599571 PMCID: PMC5011805 DOI: 10.1186/s12967-016-1019-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/22/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nonunion is a failure of healing following a bone fracture. Its physiopathology remains partially unclear and the discovery of new mediators could promote the understanding of bone healing. METHODS Thirty-three atrophic nonunion (NU) patients that failed to demonstrate any radiographic improvement for 6 consecutive months were recruited for providing serum samples. Thirty-five healthy volunteers (HV) served as the control group. Proteomics studies were performed using SELDI-TOF-MS and 2D-DIGE approaches, associated or not with Proteominer® preprocessing, to highlight biomarkers specific to atrophic nonunion pathology. Peak intensities were analyzed by two statistical approaches, a nonparametric Mann-Whitney U tests (univariate approach) and a machine-learning algorithm called extra-trees (multivariate approach). Validation of highlighted biomarkers was performed by alternative approaches such as microfluidic LC-MS/MS, nephelometry, western blotting or ELISA assays. RESULTS From the 35 HV and 33 NU crude serum samples and Proteominer® eluates, 136 spectra were collected by SELDI-TOF-MS using CM10 and IMAC-Cu(2+) ProteinChip arrays, and 665 peaks were integrated for extra-trees multivariate analysis. Accordingly, seven biomarkers and several variants were identified as potential NU biomarkers. Their levels of expression were found to be down- or up-regulated in serum of HV vs NU. These biomarkers are inter-α-trypsin inhibitor H4, hepcidin, S100A8, S100A9, glycated hemoglobin β subunit, PACAP related peptide, complement C3 α-chain. 2D-DIGE experiment allowed to detect 14 biomarkers as being down- or up-regulated in serum of HV vs NU including a cleaved fragment of apolipoprotein A-IV, apolipoprotein E, complement C3 and C6. Several biomarkers such as hepcidin, complement C6, S100A9, apolipoprotein E, complement C3 and C4 were confirmed by an alternative approach as being up-regulated in serum of NU patients compared to HV controls. CONCLUSION Two proteomics approaches were used to identify new biomarkers up- or down-regulated in the nonunion pathology, which are involved in bone turn-over, inflammation, innate immunity, glycation and lipid metabolisms. High expression of hepcidin or S100A8/S100A9 by myeloid cells and the presence of advanced glycation end products and complement factors could be the result of a longstanding inflammatory process. Blocking macrophage activation and/or TLR4 receptor could accelerate healing of fractured bone in at-risk patients.
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Affiliation(s)
- Dominique de Seny
- Laboratory of Rheumatology, Department of Rheumatology, GIGA Research, University of Liège, Tour GIGA, +2, CHU, 4000, Liège, Belgium.
| | - Gaël Cobraiville
- Laboratory of Rheumatology, Department of Rheumatology, GIGA Research, University of Liège, Tour GIGA, +2, CHU, 4000, Liège, Belgium.,Laboratory for the Analysis of Medicines, Department of Pharmacy, CIRM, University of Liège, 4000, Liège, Belgium
| | - Pierre Leprince
- GIGA-Neurosciences, University of Liège, 4000, Liège, Belgium
| | - Marianne Fillet
- Laboratory for the Analysis of Medicines, Department of Pharmacy, CIRM, University of Liège, 4000, Liège, Belgium
| | - Charlotte Collin
- Laboratory of Rheumatology, Department of Rheumatology, GIGA Research, University of Liège, Tour GIGA, +2, CHU, 4000, Liège, Belgium
| | - Myrielle Mathieu
- Laboratory of Bone and Metabolic Biochemistry, Department of Rheumatology, Université Libre de Bruxelles (ULB), 1000, Brussels, Belgium
| | - Jean-Philippe Hauzeur
- Laboratory of Rheumatology, Department of Rheumatology, GIGA Research, University of Liège, Tour GIGA, +2, CHU, 4000, Liège, Belgium
| | - Valérie Gangji
- Laboratory of Bone and Metabolic Biochemistry, Department of Rheumatology, Université Libre de Bruxelles (ULB), 1000, Brussels, Belgium.,Department of Rheumatology and Physical Medicine, Hôpital Erasme, Université Libre de Bruxelles (ULB), 1000, Brussels, Belgium
| | - Michel G Malaise
- Laboratory of Rheumatology, Department of Rheumatology, GIGA Research, University of Liège, Tour GIGA, +2, CHU, 4000, Liège, Belgium
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Sousa CP, Dias IR, Lopez-Peña M, Camassa JA, Lourenço PJ, Judas FM, Gomes ME, Reis RL. Bone turnover markers for early detection of fracture healing disturbances: A review of the scientific literature. AN ACAD BRAS CIENC 2015; 87:1049-61. [PMID: 25993365 DOI: 10.1590/0001-3765201520150008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/30/2015] [Indexed: 01/18/2023] Open
Abstract
Imaging techniques are the standard method for assessment of fracture healing processes. However, these methods are perhaps not entirely reliable for early detection of complications, the most frequent of these being delayed union and non-union. A prompt diagnosis of such disorders could prevent prolonged patient distress and disability. Efforts should be directed towards the development of new technologies for improving accuracy in diagnosing complications following bone fractures. The variation in the levels of bone turnover markers (BTMs) have been assessed with regard to there ability to predict impaired fracture healing at an early stage, nevertheless the conclusions of some studies are not consensual. In this article the authors have revised the potential of BTMs as early predictors of prognosis in adult patients presenting traumatic bone fractures but who did not suffer from osteopenia or postmenopausal osteoporosis. The available information from the different studies performed in this field was systematized in order to highlight the most promising BTMs for the assessment of fracture healing outcome.
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Affiliation(s)
- Cristina P Sousa
- Departamento de Ciências Veterinárias, Escola das Ciências Agrárias e Veterinárias, Universidade de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Isabel R Dias
- Departamento de Ciências Veterinárias, Escola das Ciências Agrárias e Veterinárias, Universidade de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Mónica Lopez-Peña
- Department of Veterinary Clinics Sciences, Faculty of Veterinary Medicine, Universidad de Santiago de Compostela, Lugo, Spain
| | - José A Camassa
- Departamento de Ciências Veterinárias, Escola das Ciências Agrárias e Veterinárias, Universidade de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | | | | | - Manuela E Gomes
- Departamento de Engenharia de Polímeros, Universidade do Minho, Barco GMR, Portugal
| | - Rui L Reis
- Departamento de Engenharia de Polímeros, Universidade do Minho, Barco GMR, Portugal
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Evaluation of a topical herbal agent for the promotion of bone healing. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:905270. [PMID: 25810746 PMCID: PMC4355818 DOI: 10.1155/2015/905270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/10/2015] [Accepted: 02/13/2015] [Indexed: 11/17/2022]
Abstract
A topically used Chinese herbal paste, namely, CDNR, was designed to facilitate fracture healing which is usually not addressed in general hospital care. From our in vitro studies, CDNR significantly inhibited the release of nitric oxide from RAW264.7 cells by 51 to 77%. This indicated its anti-inflammatory effect. CDNR also promoted the growth of bone cells by stimulating the proliferation of UMR106 cells up to 18%. It also increased the biomechanical strength of the healing bone in a drill-hole defect rat model by 16.5% significantly. This result revealed its in vivo efficacy on facilitation of bone healing. Furthermore, the detection of the chemical markers of CDNR in the skin and muscle of the treatment area demonstrated its transdermal properties. However, CDNR did not affect the bone turnover markers in serum of the rats. With its anti-inflammatory and bone formation properties, CDNR is found effective in promoting bone healing.
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Abstract
Determining whether a bone fracture is healed is one of the most important and fundamental clinical determinations made in orthopaedics. However, there are currently no standardized methods of assessing fracture union, which in turn has created significant disagreement among orthopaedic surgeons in both clinical and research settings. An extensive amount of research has been dedicated to finding novel and reliable ways of determining healing with some promising results. Recent advancements in imaging techniques and introduction of new radiographic scores have helped decrease the amount of disagreement on this topic among physicians. The knowledge gained from biomechanical studies of bone healing has helped us refine our tools and create more efficient and practical research instruments. Additionally, a deeper understanding of the molecular pathways involved in the bone healing process has led to emergence of serologic markers as possible candidates in assessment of fracture union. In addition to our current physician centered methods, patient-centered approaches assessing quality of life and function are gaining popularity in assessment of fracture union. Despite these advances, assessment of union remains an imperfect practice in the clinical setting. Therefore, clinicians need to draw on multiple modalities that directly and indirectly measure or correlate with bone healing when counseling patients.
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Affiliation(s)
- Saam Morshed
- Department of Orthopaedic Surgery, University of San Francisco School of Medicine, San Francisco, CA 94143-0410, USA
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Meyer U, de Jong JJ, Bours SGP, Keszei AP, Arts JJ, Brink PRG, Menheere P, van Geel TACM, van Rietbergen B, van den Bergh JPW, Geusens PP, Willems PC. Early changes in bone density, microarchitecture, bone resorption, and inflammation predict the clinical outcome 12 weeks after conservatively treated distal radius fractures: an exploratory study. J Bone Miner Res 2014; 29:2065-73. [PMID: 24644096 DOI: 10.1002/jbmr.2225] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/26/2014] [Accepted: 03/12/2014] [Indexed: 01/08/2023]
Abstract
Fracture healing is an active process with early changes in bone and inflammation. We performed an exploratory study evaluating the association between early changes in densitometric, structural, biomechanical, and biochemical bone parameters during the first weeks of fracture healing and wrist-specific pain and disability at 12 weeks in postmenopausal women with a conservatively treated distal radius fracture. Eighteen patients (aged 64 ± 8 years) were evaluated at 1 to 2 and 3 to 4 weeks postfracture, using high-resolution peripheral quantitative computed tomography (HR-pQCT), micro-finite element analysis, serum procollagen type-I N-terminal propeptide (P1NP), carboxy-terminal telopeptide of type I collagen (ICTP), and high-sensitive C-reactive protein (hsCRP). After 12 weeks, patients rated their pain and disability using Patient Rated Wrist Evaluation (PRWE) questionnaire. Additionally, Quick Disability of the Arm Shoulder and Hand (QuickDASH) questionnaire and active wrist range of motion was evaluated. Linear regression models were used to study the relationship between changes in bone parameters and in hsCRP from visit 1 to 2 and PRWE score after 12 weeks. A lower PRWE outcome, indicating better outcome, was significantly related to an early increase in trabecular bone mineral density (BMD) (β -0.96 [95% CI -1.75 to -0.16], R(2) = 0.37), in torsional stiffness (-0.14 [-0.28 to -0.004], R(2) = 0.31), and to an early decrease in trabecular separation (209 [15 to 402], R(2) = 0.33) and in ICTP (12.1 [0.0 to 24.1], R(2) = 0.34). Similar results were found for QuickDASH. Higher total dorsal and palmar flexion range of motion was significantly related to early increase in hsCRP (9.62 [3.90 to 15.34], R(2) = 0.52). This exploratory study indicates that the assessment of early changes in trabecular BMD, trabecular separation, calculated torsional stiffness, bone resorption marker ICTP, and hsCRP after a distal radius fracture provides valuable information regarding the 12-week clinical outcome in terms of pain, disability, and range of motion and validates its use in studies on the process of early fracture healing. © 2014 American Society for Bone and Mineral Research.
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Affiliation(s)
- Ursina Meyer
- Department of Human Movement Sciences, Maastricht University, Maastricht, The Netherlands; Research School NUTRIM, Maastricht University, Maastricht, The Netherlands; Centre on Aging and Mobility, University of Zurich, Zurich, Switzerland
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Changes of procollagen type III N-terminal propeptide (PIIINP) concentrations during healing of mandible fractures treated with biodegradable and titanium fixations. Adv Med Sci 2014; 58:434-41. [PMID: 24421219 DOI: 10.2478/ams-2013-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The aims of the study were to evaluate procollagen type III N-terminal propeptide (PIIINP) concentrations in blood serum of males in the course of normal healing of mandible fractures, and to determine the correlations between kinetic changes of PIIINP, stages of fracture healing and the applied treatment. MATERIAL AND METHODS We collected blood serum samples from 43 male patients aged between 20 and 30 years, treated for mandible fractures. The patients were divided into 2 groups depending on the type of osteosynthesis used for immobilization of the fragments. Group I (n=10) consisted of patients whose reduced bone fragments were fixed with biodegradable fixations, while group II (n=33) included patients with titanium osteosynthesis devices. The control group (n=25) consisted of healthy males at the same age. PIIINP concentrations were determined with the radioimmunological method (RIA). RESULTS We found a significant increase in PIIINP concentrations in both study groups (I and II) at defined stages of mandible fracture healing. Differences were noticed in the dynamics of the increase depending on the type of applied osteosynthesis devices. CONCLUSION The results point to the fact that the injury and/or mandible fracture increase the collagen type III metabolism and its dynamics depends on the type of the used bone fixation.
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Pountos I, Georgouli T, Pneumaticos S, Giannoudis PV. Fracture non-union: Can biomarkers predict outcome? Injury 2013; 44:1725-32. [PMID: 24075219 DOI: 10.1016/j.injury.2013.09.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2013] [Indexed: 02/02/2023]
Abstract
Delayed bone healing and non-union occurs in approximately 10-15% of long bone fractures. Both pathologies may result in prolonged period of pain, disability and repetitive operative interventions. Despite intense investigations and progress done in understanding the pathophysiologic processes governing bone healing, the diagnostic tools have not been altered. The clinical findings and radiographic features remain the two important landmarks of diagnosing non-union and even when the diagnosis is established there is debate on the ideal timing and mode of intervention. Emerging evidence suggest that there are certain molecules and genes that can serve as predictors of potentially unsuccessful fracture union. This article summarises the current evidence on the available 'bio-markers'to predict fracture non-union.
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Affiliation(s)
- I Pountos
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, UK; Leeds Biomedical Research Unit, Leeds, UK
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Yanovich R, Evans RK, Friedman E, Moran DS. Bone turnover markers do not predict stress fracture in elite combat recruits. Clin Orthop Relat Res 2013; 471:1365-72. [PMID: 23239391 PMCID: PMC3586020 DOI: 10.1007/s11999-012-2727-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 11/20/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND With bone resorption rates greater than formation, stress fracture pathogenesis plausibly involves bone remodeling imbalance. If this is the case, one would anticipate serum levels of bone turnover markers would be higher in patients with stress fractures than in those without. QUESTIONS/PURPOSES We therefore asked whether: (1) bone turnover markers differ between soldiers who will or will not have stress fractures during basic training; (2) bone turnover markers change during basic training; and (3) serial bone formation or bone resorption markers differ between subjects with and without stress fractures during basic training? METHODS We performed serial determinations of serum bone formation (bone alkaline phosphatase [BAP] and procollagen type I amino-terminal propeptide [PINP]), and resorption (tartrate-resistant acid phosphatase [TRAP5b] and cross-linked collagen telopeptide [CTx]) biomarkers, measured at 2- to 4-week intervals (during 18 weeks) in 69 male soldiers in the Israeli Defense Forces during elite basic training. Twenty-two soldiers (32%) were diagnosed with stress fractures. The mean training week at diagnosis was 8.0±2.0 weeks. RESULTS We observed no differences in bone turnover markers between soldiers with and without stress fractures. During basic training, the mean values of all subjects for bone turnover markers (BAP, PINP, and CTx) changed in comparison to their mean levels at induction (43.9 versus 37.3 μg/L, 110.4 versus 78.0 μg/L, 1.4 versus 1.1 ng/mL, respectively). We found no changes in bone formation and resorption markers between subjects with and without stress fractures. CONCLUSIONS These specific bone turnover markers cannot be considered as either diagnostic or predictive tools for stress fracture detection in young male military recruits. LEVEL OF EVIDENCE Level II prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ran Yanovich
- />Institute of Military Physiology, IDF Medical Corps, Tel-Hashomer, Israel
- />Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, 52621 Israel
| | - Rachel K. Evans
- />US Army Research Institute of Environmental Medicine, Natick, MA USA
| | - Eitan Friedman
- />Susanne Levy Gertner Oncogenetics Unit, Sheba Medical Center, Tel-Hashomer, Israel
- />Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel S. Moran
- />Institute of Military Physiology, IDF Medical Corps, Tel-Hashomer, Israel
- />Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, 52621 Israel
- />Ariel University Center of Samaria, Ariel, Israel
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Tracking growth hormone abuse in sport: Performance of marker proteins in a controlled setting. Anal Chim Acta 2012; 745:118-23. [DOI: 10.1016/j.aca.2012.07.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Revised: 06/22/2012] [Accepted: 07/27/2012] [Indexed: 11/20/2022]
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Pobel EA, Bengus LM, Dedukh NV. MARKERS OF BONE METABOLISM IN LONG BONE’S ADHESION. OSTEOPOROSIS AND BONE DISEASES 2012. [DOI: 10.14341/osteo2012225-32] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This review presents the current evidence about the use of markers of bone metabolism in the prediction of fracture healing, differences in concentrations of blood markers of bone metabolism in patients with normal and delayed consolidation of bone fragments. We analyze the relationship between the fracture site, time-stage features of its healing and urinary macromolecules, reflecting bone metabolism. Increase in bone turnover, which is observed after the fracture, is characterized by activation markers of bone resorption, with a subsequent increase in the concentration of blood markers of bone formation. However, there is a marked variability in data concerning the levels of bone markers in plasma at different stages of fracture healing. We show that in patients with delayed fracture healing there is a significant delay in raising osteocalcin levels. Prognostic features for determining fracture nonunion include low concentrations of N-terminal propeptide of procollagen type I. Determination of markers of bone metabolism in blood can serve as informative criterion for the course of reparative osteogenesis, but one must consider the nature of traumatic injury, time passed from injury, especially the state of bone tissue at the time of injury, age of the patient to identify the early stages of consolidation disturbances.
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Abstract
No standard criteria exist for diagnosing fracture nonunion, and studies suggest that assessment of fracture healing varies among orthopaedic surgeons. This variability can be problematic in both clinical and orthopaedic trauma research settings. An understanding of risk factors for nonunion and of diagnostic tests used to assess fracture healing can facilitate a systematic approach to evaluation and management. Risk factors for nonunion include medical comorbidities, age, and the characteristics of the injury. The method of fracture management also influences healing. Comprehensive evaluation includes an assessment of the patient's symptoms, signs, and immune and endocrine status as well as the biologic capacity of the fracture, presence of infection, and quality of reduction and fixation. Diagnostic tests include plain radiography, CT, ultrasonography, fluoroscopy, bone scan, MRI, and several laboratory tests, including assays for bone turnover markers in the peripheral circulation. A systematic approach to evaluating fracture union can help surgeons determine the timing and nature of interventions.
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A fracture does not adversely affect bone mineral density responses after teriparatide treatment. Clin Orthop Relat Res 2012; 470:927-36. [PMID: 21863393 PMCID: PMC3270178 DOI: 10.1007/s11999-011-2029-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 08/08/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fracture leads to local and systemic catabolic physiologic changes. As teriparatide is an agent used to treat osteoporosis in patients with fragility fractures, it is unclear whether teriparatide treatment alters bone mineral density (BMD) and bone markers when given to patients with fractures. QUESTIONS/PURPOSES We asked whether BMD and bone marker responses would be blunted in patients with fractures placed on teriparatide after fracture compared with patients without fractures on teriparatide. PATIENTS AND METHODS We retrospectively collected data from 141 patients treated with teriparatide for osteoporosis. Seventy-seven patients received teriparatide after fractures (fracture group), whereas 64 were treated for other indications (nonfracture group). We determined BMD at the lumbar spine and at the proximal femur before and 12 and 24 months posttreatment. Bone markers (urine N-telopeptide [urine NTX], bone-specific alkaline phosphatase [BALP]) were measured at baseline and 3, 12, and 24 months posttreatment. RESULTS Mean lumbar spine and hip BMDs at last followup increased from baseline with no differences between groups to approximately 9% and 4% at 24 months, respectively. Both bone markers increased from baseline in the nonfracture group, peaking at 12 months. For the fracture group, only urine NTX increased at 3 and 12 months posttreatment. Although the peak levels of both bone markers in the nonfracture group were greater, there was no difference between the two groups. CONCLUSIONS Fracture does not have a negative effect on the BMD and bone marker responses to teriparatide treatment. Clinicians should anticipate comparable BMD responses when treating patients with teriparatide for osteoporotic fractures and for other indications. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Moghaddam A, Müller U, Roth HJ, Wentzensen A, Grützner PA, Zimmermann G. TRACP 5b and CTX as osteological markers of delayed fracture healing. Injury 2011; 42:758-64. [PMID: 21168135 DOI: 10.1016/j.injury.2010.11.017] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 09/17/2010] [Accepted: 11/10/2010] [Indexed: 02/02/2023]
Abstract
Radiological studies are the standard method to monitor fracture healing but they do not allow a timely assessment of bone healing. Biochemical markers react rapidly to changes in bone metabolism during fracture healing and could be an additional tool to monitor this process. The goal of this study was to observe changes in serum biomarkers and evaluate the possible differences in the serum levels of tartrate-resistant acid phosphatase 5b (TRACP 5b), total N-terminal propeptide of type I collagen (PINP), bone-specific alkaline phosphatase (BAP), and C-terminal cross-linking telopeptide of type I collagen (CTX) in patients with normal and delayed fracture healing. Several serum samples were collected for one year after the surgical treatment of long bone fractures in 248 patients. From this large pool, 15 patients with atrophic nonunion were matched to 15 patients with normal bone healing. Post-operative changes in osteological markers were monitored during the 1st, 2nd, 4th, 8th, 12th and 52nd weeks. The patients were followed both clinically and radiologically for the entire one-year duration of the study. In the first week, the absolute values of CTX decreased significantly (p=0.0164) in cases of delayed fracture healing. The relative values of TRACP 5b were significantly decreased at weeks 4 (p=0.0066) and 8 (p=0.0043). BAP and PINP levels decreased in the first week followed by an increase, but there were no significant differences in the absolute or relative values during the healing process in both patient groups. For the first time, we have demonstrated changes in serum concentrations of TRACP 5b, PINP, BAP, and CTX during normal and delayed fracture healing. Characteristic changes in systemic TRACP 5b and CTX levels could reflect the initial process of successful fracture healing and may be used in clinical practice to monitor the healing process. Furthermore, it could be very important for determining the beneficial effects of additional treatments such as ultrasound or BMPs in clinical trials.
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Affiliation(s)
- A Moghaddam
- Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Klinik für Unfallchirurgie und Orthopädie, Unfallchirurgische Klinik an der Universität Heidelberg, Ludwig-Guttmann-Strasse 13, Ludwigshafen, Germany.
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Servin-Trujillo MA, Reyes-Esparza JA, Garrido-Fariña G, Flores-Gazca E, Osuna-Martinez U, Rodriguez-Fragoso L. Use of a graft of demineralized bone matrix along with TGF-β1 leads to an early bone repair in dogs. J Vet Med Sci 2011; 73:1151-61. [PMID: 21566397 DOI: 10.1292/jvms.10-0155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tibia fractures are common in small animal practice. Over the past decade, improvements to animal internal fracture fixation have been developed. TGF-β1 has been shown to be crucial in the development, induction and repair of bone. In present study, we investigate the effect of local application of a graft demineralized bone matrix (DBM) along with TGF-β1 in a model of open osteotomy induced experimentally in dogs. Tibia fracture was brought about by using an open osteotomy model in young male dogs. Fracture repair was evaluated by a histological and biochemical analysis. Collagen content, proteolytic activity and urokinase-type plasminogen activator (uPA) expression were analyzed at the end of the study. Radiographic analysis, alkaline phosphatase and hematological evaluation were performed weekly. At the fifth week, there was an improvement and restoration of bone architecture in animals treated with a graft containing TGF-β1 (5 ng/ml) compared with the control and graft groups, as was evidenced by the presence of an early formation of wide callus and bone regeneration. In addition, local application of TGF-β1 led to an increase in collagen and proteolytic activity. More immunopositive osteoclast and mesenchymal cells were found in bone tissue from animals treated with TGF-β1 as compared with the control group. No changes in alkaline phosphatase, hematological and clinical parameters were observed. This study shows that the combined use of DBM along with TGF-β1 is able to improve and accelerate the bone repair.
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Ominsky MS, Li C, Li X, Tan HL, Lee E, Barrero M, Asuncion FJ, Dwyer D, Han CY, Vlasseros F, Samadfam R, Jolette J, Smith SY, Stolina M, Lacey DL, Simonet WS, Paszty C, Li G, Ke HZ. Inhibition of sclerostin by monoclonal antibody enhances bone healing and improves bone density and strength of nonfractured bones. J Bone Miner Res 2011; 26:1012-21. [PMID: 21542004 DOI: 10.1002/jbmr.307] [Citation(s) in RCA: 196] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Therapeutic enhancement of fracture healing would help to prevent the occurrence of orthopedic complications such as nonunion and revision surgery. Sclerostin is a negative regulator of bone formation, and treatment with a sclerostin monoclonal antibody (Scl-Ab) results in increased bone formation and bone mass in animal models. Our objective was to investigate the effects of systemic administration of Scl-Ab in two models of fracture healing. In both a closed femoral fracture model in rats and a fibular osteotomy model in cynomolgus monkeys, Scl-Ab significantly increased bone mass and bone strength at the site of fracture. After 10 weeks of healing in nonhuman primates, the fractures in the Scl-Ab group had less callus cartilage and smaller fracture gaps containing more bone and less fibrovascular tissue. These improvements at the fracture site corresponded with improvements in bone formation, bone mass, and bone strength at nonfractured cortical and trabecular sites in both studies. Thus the potent anabolic activity of Scl-Ab throughout the skeleton also was associated with an anabolic effect at the site of fracture. These results support the potential for systemic Scl-Ab administration to enhance fracture healing in patients.
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Axelrad TW, Einhorn TA. Use of clinical assessment tools in the evaluation of fracture healing. Injury 2011; 42:301-5. [PMID: 21145548 DOI: 10.1016/j.injury.2010.11.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 11/12/2010] [Indexed: 02/02/2023]
Abstract
Fracture healing is an optimized biological process yet the ability to determine when a fracture is healed, or to measure the healing response can present a clinical challenge. This review will focus on the evidence for the implementation of imaging modalities as tools to assist in evaluating fracture union. This is particularly important for common fractures that have a propensity to have delayed union or non-union, where a diagnosis of non-union would alter the treatment. We also present methods, such as biochemical markers and clinical scores that are in development or have the potential to aid in the diagnosis of non-union. Ultimately, clinical exam combined with the available modalities can help the clinician judge the progression of healing with some confidence. There is still a need for continued development of new modalities and tests to improve accuracy of the diagnosis of non-union, as well as predict which fractures are at risk for non-union.
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Affiliation(s)
- T William Axelrad
- Department of Orthopaedic Surgery, Boston University Medical Center, Doctors Office Building, Suite 808, 720 Harrison Avenue, Boston, MA 02118, USA.
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Szulc P. Biochemical bone turnover markers and osteoporosis in older men: where are we? J Osteoporos 2011; 2011:704015. [PMID: 22220284 PMCID: PMC3246740 DOI: 10.4061/2011/704015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 11/08/2011] [Accepted: 11/12/2011] [Indexed: 11/20/2022] Open
Abstract
In men aged less than 60, the association of serum and urinary levels of biochemical bone turnover markers (BTMs) and bone mineral density (BMD) is weak or not significant. After this age, higher BTM levels are correlated weakly, but significantly, with lower BMD and faster bone loss. Limited data from the cohort studies suggest that BTM measurement does not improve the prediction of fragility fractures in older men in comparison with age, BMD, history of falls and fragility fractures. Testosterone replacement therapy (TRT) decreases bone resorption. During TRT, bone formation markers slightly increase (direct effect on osteoblasts), then decrease (slowdown of bone turnover). Bisphosphonates (alendronate, risedronate, ibandronate, zoledronate) induce a rapid decrease in bone resorption followed by a milder decrease in bone formation. In men receiving antiresorptive therapy for prostate cancer, zoledronate, denosumab and toremifene decrease significantly levels of bone resorption and bone formation markers. Teriparatide induced a rapid increase in serum concentrations of bone formation markers followed by an increase in bone resorption. We need more studies on the utility of BTM measurement for the improvement of the persistence and adherence to the anti-osteoporotic treatment in men.
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Yong TY, Li JYZ. Mediastinal parathyroid carcinoma presenting with severe skeletal manifestations. J Bone Miner Metab 2010; 28:591-4. [PMID: 20237944 DOI: 10.1007/s00774-010-0173-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 02/16/2010] [Indexed: 10/19/2022]
Abstract
Parathyroid carcinoma is a rare malignancy, accounting for about 1% of primary hyperparathyroidism. We report the case of a 23-year-old man who presented with poorly united mid-shaft fracture of the left femur with severe hypercalcaemia in the setting of 99 mTc sestamibi-avid lesions in the mediastinal and thoracic vertebrae. The patient underwent surgery, and histopathology revealed a low-grade parathyroid carcinoma. After surgery, the patient developed severe hungry bone syndrome requiring intensive calcium, magnesium and active vitamin D supplementation. A review of the literature was undertaken with regards to mediastinal parathyroid carcinoma, management of refractory hypercalcaemia in this setting and hungry bone syndrome.
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Affiliation(s)
- Tuck Y Yong
- Department of General Medicine, Flinders Medical Centre and School of Medicine, Flinders University, Bedford Park, Adelaide, SA, Australia.
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Giorgetti APO, César Neto JB, Ruiz KGS, Casati MZ, Sallum EA, Nociti FH. Cigarette smoke inhalation modulates gene expression in sites of bone healing: a study in rats. ACTA ACUST UNITED AC 2010; 110:447-52. [PMID: 20573527 DOI: 10.1016/j.tripleo.2010.02.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 02/09/2010] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to assess the effect of cigarette smoke inhalation (CSI) on gene expression in alveolar bone healing sites. STUDY DESIGN Wistar rats were randomly assigned to the groups: control [animals not exposed to CSI (n = 20)] and test [animals exposed to CSI, starting 3 days before teeth extraction and maintained until killing them (n = 20)]. First mandibular molars were bilaterally extracted, and the expression of alkaline phosphatase, bone morphogenetic protein (BMP) 2 and 7, receptor activator of nuclear factor κB ligand, osteoprotegerin, and d2 isoform of vacuolar adenosine triphosphatase V(0) domain were assessed by quantitative polymerase chain reaction in the newly formed tissue in the sockets. RESULTS Overall, data analysis demonstrated that CSI significantly affected the expression pattern of all of the studied genes except BMP-7. CONCLUSION The expression of key genes for bone healing may be affected by CSI in tooth extraction sites.
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Affiliation(s)
- Ana Paula Oliveira Giorgetti
- Periodontics Division, Department of Prosthodontics and Periodontics, School of Dentistry at Piracicaba, State University of Campinas, Piracicaba, São Paulo, Brazil.
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Cox G, Einhorn TA, Tzioupis C, Giannoudis PV. Bone-turnover markers in fracture healing. ACTA ACUST UNITED AC 2010; 92:329-34. [DOI: 10.1302/0301-620x.92b3.22787] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Biochemical markers of bone-turnover have long been used to complement the radiological assessment of patients with metabolic bone disease. Their implementation in daily clinical practice has been helpful in the understanding of the pathogenesis of osteoporosis, the selection of the optimal dose and the understanding of the progression of the onset and resolution of treatment. Since they are derived from both cortical and trabecular bone, they reflect the metabolic activity of the entire skeleton rather than that of individual cells or the process of mineralisation. Quantitative changes in skeletal-turnover can be assessed easily and non-invasively by the measurement of bone-turnover markers. They are commonly subdivided into three categories; 1) bone-resorption markers, 2) osteoclast regulatory proteins and 3) bone-formation markers. Because of the rapidly accumulating new knowledge of bone matrix biochemistry, attempts have been made to use them in the interpretation and characterisation of various stages of the healing of fractures. Early knowledge of the individual progress of a fracture could help to avoid delayed or nonunion by enabling modification of the host’s biological response. The levels of bone-turnover markers vary throughout the course of fracture repair with their rates of change being dependent on the size of the fracture and the time that it will take to heal. However, their short-term biological variability, the relatively low bone specificity exerted, given that the production and destruction of collagen is not limited to bone, as well as the influence of the host’s metabolism on their concentration, produce considerable intra- and inter-individual variability in their interpretation. Despite this, the possible role of bone-turnover markers in the assessment of progression to union, the risks of delayed or nonunion and the impact of innovations to accelerate fracture healing must not be ignored.
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Affiliation(s)
- G. Cox
- Academic Unit, Trauma and Orthopaedic Surgery, Clarendon Wing Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - T. A. Einhorn
- Department of Orthopaedic Surgery Boston University Medical Centre, 720 Harrison Avenue, DOB 808, Boston, Massachusetts, USA
| | - C. Tzioupis
- Academic Unit, Trauma and Orthopaedic Surgery, Clarendon Wing Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - P. V. Giannoudis
- Academic Unit, Trauma and Orthopaedic Surgery, Clarendon Wing Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
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Holt RIG, Bassett EE, Erotokritou-Mulligan I, McHugh C, Cowan D, Bartlett C, Sönksen PH. Moving one step closer to catching the GH cheats: The GH-2004 experience. Growth Horm IGF Res 2009; 19:346-351. [PMID: 19467613 DOI: 10.1016/j.ghir.2009.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2009] [Indexed: 01/04/2023]
Abstract
Growth hormone is abused by athletes for its anabolic and lipolytic properties. The detection of GH abuse is challenging because it is an endogenous hormone whose concentration varies widely in any one day. The GH-2000 project proposed a test based on the measurement of IGF-I and type III pro-collagen (P-III-P). When the results of the GH-2000 project were presented to an expert workshop, the method was supported but it was felt that several issues needed to be resolved before the method could be adopted. The first was a potential effect of ethnicity as most subjects in the GH-2000 were white Europeans and the second was a possible effect of injury as P-III-P is a marker of soft tissue turnover. The GH-2004 project was conceived to address these concerns. The GH-2004 project has shown that while there are minor differences in IGF-I and P-III-P between ethnicities, these are small and do not affect the performance of the test. Injury leads to a small rise in P-III-P but again this is not of sufficient magnitude to affect the performance of the test. The GH-2004 project has provided further support for the marker approach as a means of detecting GH abuse in athletes. As WADA have not developed their own immunoassays, however, further work is needed to validate newer commercial assays measuring IGF-I and P-III-P to establish reliable conversion factors to the original GH-2000 units to allow the published formulae to be used.
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Affiliation(s)
- Richard I G Holt
- Endocrinology and Metabolism Unit, Developmental Origins of Health and Disease Division, School of Medicine, University of Southampton, UK.
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