Skeletal System Biology and Smoke Damage: From Basic Science to Medical Clinic

Causal association between smoke and the risk of chronic knee pain: A Mendelian randomization study

A plethora of research has identified a comorbid association between smoke and an elevated risk of knee pain. Despite these findings, the causal link between genetically influenced smoke and the risk of knee pain remains to be elucidated. Considering this knowledge gap, we undertook a Mendelian randomization (MR) study to delineate the potential causal relationship. The instrumental variables were derived from genome-wide association studies (GWAS). We procured summary statistics for ever smoked from a GWAS dataset (280,508 cases and 180,558 controls, dataset: ukb-b-20261) to represent the exposure. The outcome was determined by GWAS data for knee pain for 3+ months, encompassing 76,910 cases and 20,979 controls (dataset: ukb-b-8906). The primary MR method employed was the inverse-variance weighted approach. Assessments for pleiotropy and heterogeneity were conducted utilizing the MR pleiotropy residual sum and outlier test, the MR-Egger intercept test, the leave-one-out analysis, and the Cochran Q test. There was a statistically significant genetic causal effect of smoke on the increased risk of knee pain (odds ratio = 1.08, 95% confidence interval = 1.01-1.16, P = .014]. Cochran Q statistic showed no heterogeneity (Q P = .66). The leave-one-out analysis chart, the global test P value in MR-pleiotropy residual sum, and outlier revealed no significant pleiotropy (global test P = 0.53). The intercept P value in MR-Egger revealed no significant pleiotropy (intercept P = 0.66). Our MR study showed no pleiotropy or heterogeneity. The findings from our study point toward an association between genetic predisposition to smoke and the incidence of knee pain. This genetic association underscores the clinical relevance of our findings, indicating that interventions aimed at smoking cessation could be particularly beneficial for those individuals who are predisposed to smoking or are at risk of developing knee pain.

Prediction of abnormal bone mass with a pericoronary adipose tissue Attenuation model

BACKGROUND

The aim is to explore the value of pericoronary adipose tissue (PCAT) attenuation in predicting abnormal bone mass by establishing a prediction model.

MATERIALS AND METHODS

361 patients with coronary computed tomography angiography (CCTA) and quantitative computed tomography (QCT) scans were retrospectively recruited. 311 patients from institution 1 from July 2021 to January 2023 were divided into a training cohort (n = 217) and an internal cohort (n = 94). The external cohort comprised 50 patients from institution 2 from January 2023 to August 2023. Clinical variables and PCAT attenuation of the major epicardial vessels were obtained. Univariate and multivariate logistic regression analyses were used to identify factors with statistical significance. Model 1 was constructed based on clinical variables. Model 2 was constructed by combining the clinical variables with the PCAT attenuation. The performances of the models were assessed using receiver operating characteristic curve analysis, calibration curves and decision curve analysis (DCA).

RESULTS

Age, gender, coronary artery disease reporting and data system (CAD-RADS), statins and RCAPCAT were found to be significant predictors of abnormal bone mass. The area under the curve (AUC) of Model 2 was superior to that of Model 1 in the training cohort (AUC: 0.959 vs. 0.920), internal (AUC: 0.943 vs. 0.890) and external validation cohorts (AUC: 0.889 vs. 0.812). The calibration curves and DCA indicated that Model 2 had the higher clinical value.

CONCLUSION

The model incorporating clinical factors and RCAPCAT has good performance in predicting bone mass abnormalities.

TNF-Alpha Inhibitor Prevents Cigarette Smoke Extract-Induced Cell Death in Osteoarthritis-Derived Chondrocytes in Culture

Smoking has been associated, among other factors, with musculoskeletal disorders. Although there is no consensus about the effects of smoking on osteoarthritis (OA), the increase in TNF-alpha in smokers has been considered an important factor in OA induction or progression. However, studies on the effects of smoking on chondrocytes are lacking. Here we aimed to study the effects of cigarette smoke extract (CSE) associated with a TNF-alpha inhibitor on cell death of primary human chondrocytes derived from osteoarthritic patients. CSE at 10% led to cell death by apoptosis after 48 h of incubation, together with caspase 3/7 activation, decrease in mitochondrial transmembrane potential, ROS production, and improvement in syndercan-1, perlecan, and RUNX2 gene expression. All these effects promoted by CSE were reversed by TNF-alpha inhibitor. Collagen II, F-actin, and SOX9 were also analyzed, and CSE promoted alteration in the expression of these proteins. In conclusion, our results support the clinical impact of smoking on OA development by showing the detrimental action of CSE on osteoarthritis-derived chondrocytes and the protective effects of TNF-alpha inhibitors, reinforcing the importance of this cytokine in the cartilage injury process.

Computed tomography provides a "one-stop-shop" targeted analysis for coronary artery calcification and osteoporosis: a review

The global trend towards longer lifespans has led to an aging population and a rise in the prevalence of diseases that predominantly affect elderly people. Coronary artery calcification (CAC) and osteoporosis (OP) are common in elderly populations. CT scans provide a reliable method to assess and monitor the progression of these diseases. In this review, the relationship between OP and CAC in terms of pathophysiological mechanism, comorbidity risk factors and clinical manifestations is reviewed, with a focus on the advancements in CT imaging, clinical applications and the possibility for "one-stop-shop" for examination.

Functional Outcomes in Aseptic Humeral Shaft Nonunion Treated With Plate Osteosynthesis: A Retrospective Cohort Study

Introduction

Aseptic nonunion is prevalent in orthopedic practice, causing persistent pain and functional impairment. Humeral shaft fractures, accounting for 3-5% of all fractures, have nonunion rates of 2-33% in nonoperative and 5-10% in surgical management. This study, the largest case series on operative management of aseptic humeral shaft nonunion (AHSN), treated with plate osteosynthesis.

Materials and methods

This retrospective study, conducted at a referral center in eastern India, included 132 patients with aseptic humeral shaft nonunion from May 2002 to April 2012 and May 2015 to December 2020. Patients aged 20-70 years with nonunion more than 6 months post-trauma were included. Exclusions were open fractures, infections, gap nonunions, pathologic fractures, and concomitant upper limb injuries. Surgical techniques involved excising fibrous and unhealthy tissue, compressing the nonunion site, decorticating, shingling, autologous bone grafting, and stable fixation with dynamic or locking compression plates. Outcomes were assessed using Quick DASH, VAS, Constant Shoulder score at a minimum follow-up of 24 months.

Results

The study included 132 patients, 84 males and 48 females, with a mean age of 42.3 years. Fractures were due to high-energy trauma in 78 cases and low-energy trauma in 54 cases. All patients with atrophic type of AHSN received autologous bone grafts and plating techniques. Quick DASH scores improved from 77 to 5 on average. Constant Shoulder score improved from 22 to 88 and VAS score improved from 6.7 to 1.3. Union was achieved in 21 weeks on an average, with minimal complications. Despite variations in time intervals, treatments, and follow-up durations, consistent management strategies emphasize stable fixation, bone grafts, and careful management of complications to achieve high union rates and satisfactory outcomes. Complications included seven infections, one failure needed refixation and two case of transient radial nerve palsy.

Conclusion

Absolute stability using plate with or without autologous bone grafting for aseptic humeral shaft nonunion results in high union rates and satisfactory radiologic and functional outcome.

The potential link between the development of Alzheimer's disease and osteoporosis

Alzheimer's disease (AD) and osteoporosis (OP) pose distinct but interconnected health challenges, both significantly impacting the aging population. AD, a neurodegenerative disorder characterized by memory impairment and cognitive decline, is primarily associated with the accumulation of abnormally folded amyloid beta (Aβ) peptides and neurofibrillary tangles in the brain. OP, a skeletal disorder marked by low bone mineral density, involves dysregulation of bone remodeling and is associated with an increased risk of fractures. Recent studies have revealed an intriguing link between AD and OP, highlighting shared pathological features indicative of common regulatory pathophysiological pathways. In this article, we elucidate the signaling mechanisms that regulate the pathology of AD and OP and offer insights into the intricate network of factors contributing to these conditions. We also examine the role of bone-derived factors in the progression of AD, underscoring the plausibility of bidirectional communication between the brain and the skeletal system. The presence of amyloid plaques in the brain of individuals with AD is akin to the accumulation of brain Aβ in vascular dementia, pointing towards the need for further investigation of shared molecular mechanisms. Moreover, we discuss the role of bone-derived microRNAs that may regulate the pathological progression of AD, providing a novel perspective on the role of skeletal factors in neurodegenerative diseases. The insights presented here should help researchers engaged in exploring innovative therapeutic approaches targeting both neurodegenerative and skeletal disorders in aging populations.

Effect of coenzyme Q10 on tibial fracture resistance in nicotine-exposed rats

The study aimed to evaluate the potential protection against fractures of oral Q10 supplementation in the tibias of rats exposed to nicotine. Nicotine is known to negatively impact bone density and increase the risk of fractures, in addition to affecting other systems such as the gastrointestinal system, impairing its absorption capacity, negatively affecting bone health. To investigate this, eighty male rats were divided into four groups (n = 20) receiving either nicotine hemisulfate or saline solution (SS) for 28 days. Two daily subcutaneous applications were administered accordingly. Concurrently, vegetable glycerin and Q10 gavage began on day "0". SS: the animals in this group received two daily subcutaneous applications of sodium chloride solution during the entire trial period. 30 days after starting the SS applications subcutaneously, the animals received vegetable glycerin daily until the end of the experiment. SS-Q10: the animals received the SS protocol and daily supplementation with Q10 until the end of the experiment. NIC: The animals received the protocol for NIC and vegetable glycerin daily until the end of the experiment. NIC-Q10: The animals received the protocol for NIC and daily supplementation and Q10 until the end of the experiment. Euthanasia occurred at 7 and 28 days after the beginning the gavage. The tibiae collected were processed for morphometric, densitometric, mechanical, and microtomographic (micro-Ct) analysis. A complementary analysis of intestinal changes was performed. The groups that received Q10 showed slightly better results regarding the mechanical resistance and micro-Ct parameters and to intestinal histomorphometry, as compared with groups not supplemented with Q10. Thus, in rats, it can be concluded that coenzyme Q10 exhibited a protective property to the skeletal system and the gastrointestinal tract, even in the presence of nicotine.

Promoting musculoskeletal health and preventing ill health

Musculoskeletal conditions are highly prevalent among older adults and can have a significant impact on their quality of life. Musculoskeletal health is an important component of maintaining well-being and independence. A proactive approach is required, with nurses implementing strategies such as healthy diets and physical exercise that will support optimal health. This article considers the importance of musculoskeletal health, examines the risk factors for a decline in musculoskeletal health, and explores approaches that can improve outcomes and promote healthy ageing.

Operative Management of Aseptic Humeral Shaft Nonunion: A Retrospective Study from Eastern India

Aseptic nonunion is prevalent in orthopedic practice, causing persistent pain and functional impairment. Humeral shaft fractures, accounting for 3-5% of all fractures, have nonunion rates of 2-33% in nonoperative and 5-10% in surgical management. This study, the largest case series on operative management of humeral shaft nonunion, examines surgical techniques and outcomes. This retrospective study, conducted at a referral center in eastern India, included 132 patients with aseptic humeral shaft nonunion from 2002 to 2020. Cases were from May 2002 to April 2012 and May 2015 to December 2020. Patients aged 20-70 years with nonunion more than 6 months post-trauma were included. Exclusions were open fractures, infections, gap nonunions, pathological fractures, and concomitant upper limb injuries. Surgical techniques involved excising fibrous and unhealthy tissue, compressing the nonunion site, decorticating, shingling, autologous bone grafting, and stable fixation with dynamic or locking compression plates. Outcomes were assessed using DASH, VAS, and constant shoulder score scores at a minimum follow-up of 24 months. The study included 132 patients, 84 males and 48 females, with a mean age of 42.3 years. Fractures were due to high-energy trauma in 78 cases and low-energy trauma in 54 cases. All patients received autologous bone grafts and plating techniques. Quick DASH scores improved from 77 to 5 on average. Union was achieved in 21 weeks on average, with minimal complications. Despite variations in time intervals, treatments, and follow-up durations, consistent management strategies emphasize stable fixation, bone grafts, and careful complication management to achieve high union rates and satisfactory outcomes. Complications included seven infections, one failure needed refixation and one case of transient radial nerve palsy. Absolute stability using a plate with or without autologous bone grafting for aseptic humeral shaft nonunion results in high union rates and satisfactory radiological and functional outcome.

Impact of Particle Size and Sintering Temperature on Calcium Phosphate Gyroid Structure Scaffolds for Bone Tissue Engineering

Due to the chemical composition and structure of the target tissue, autologous bone grafting remains the gold standard for orthopedic applications worldwide. However, ongoing advancements in alternative grafting materials show that 3D-printed synthetic biomaterials offer many advantages. For instance, they provide high availability, have low clinical limitations, and can be designed with a chemical composition and structure comparable to the target tissue. This study aimed to compare the influences of particle size and sintering temperature on the mechanical properties and biocompatibility of calcium phosphate (CaP) gyroid scaffolds. CaP gyroid scaffolds were fabricated by 3D printing using powders with the same chemical composition but different particle sizes and sintering temperatures. The physicochemical characterization of the scaffolds was performed using X-ray diffractometry, scanning electron microscopy, and microtomography analyses. The immortalized human mesenchymal stem cell line SCP-1 (osteoblast-like cells) and osteoclast-like cells (THP-1 cells) were seeded on the scaffolds as mono- or co-cultures. Bone cell attachment, number of live cells, and functionality were assessed at different time points over a period of 21 days. Improvements in mechanical properties were observed for scaffolds fabricated with narrow-particle-size-distribution powder. The physicochemical analysis showed that the microstructure varied with sintering temperature and that narrow particle size distribution resulted in smaller micropores and a smoother surface. Viable osteoblast- and osteoclast-like cells were observed for all scaffolds tested, but scaffolds produced with a smaller particle size distribution showed less attachment of osteoblast-like cells. Interestingly, low attachment of osteoclast-like cells was observed for all scaffolds regardless of surface roughness. Although bone cell adhesion was lower in scaffolds made with powder containing smaller particle sizes, the long-term function of osteoblast-like and osteoclast-like cells was superior in scaffolds with improved mechanical properties.

Global, regional, and national burden and trends of Low back pain in middle-aged adults: analysis of GBD 1990-2021 with projections to 2050

OBJECTIVE

This study aims to systematically evaluate the burden of low back pain(LBP) in the middle-aged population across global regions and between genders, assess the major risk factors and their impacts, and project the burden to 2050, providing a scientific basis for global preventive actions.

METHODS

This study utilized The Global Burden of Disease(GBD) 2021 database. First, we integrated the population data of the 45-49, 50-54, and 55-59 age groups provided by the GBD using a weighted average method to calculate the Disability-adjusted life years(DALYs) rate for the middle-aged population aged 45 to 59 years. Subsequently, we analyzed the trends in the burden of LBP globally and across regions from 1990 to 2021, with a focus on stratified data by country, risk factors (e.g., high BMI), and gender. Finally, we employed the Bayesian Age-Period-Cohort(BAPC) model to predict future trends in LBP burden from 2021 to 2050.

RESULTS

Globally, from 1990 to 2021, the DALY rate for the 45-59 age group with LBP decreased from 875.45(95%UI: 534.57-1340.68) per 100,000 people to 747.92 (450.55-1,161.66), with an EAPC of -0.46 (95%UI: -0.50 to -0.43). Despite the decline in DALY rates, the total number of DALYs due to LBP increased from 5,515,080.64 (95%UI: 3,367,626.11-8,445,931.67) in 1990 to 9,816,401.64 (95%UI: 5,913,142.33-15,249,187.03) in 2021, a rise of 4,301,321. High Socio-Demographic Index (SDI) regions were the most affected, with a DALY rate of 933.03 (95%UI: 557.90-1,420.60) per 100,000 in 2021. Among risk factors, high BMI showed the most significant increase, with DALY rates rising from 153.64 (95%UI: 15.94-334.63) per 100,000 in 1990 to 209.09 (95%UI: 22.16-452.58) in 2021, and an EAPC of 1.08 (95%UI: 1.02 to 1.14). Gender differences revealed a DALY rate of 705.39 (95%UI: 431.21-1,078.96) per 100,000 for males and 803.62 (95%UI: 471.69-1,266.63) per 100,000 for females in 2021. Projections based on the BAPC model suggest that by 2050, global DALYs due to LBP will increase to 11,626,643.07, with females expected to account for 6,725,763.24 and males for 4,900,879.84, indicating a greater burden for females.

CONCLUSION

This study highlights the global burden and trends of LBP in the middle-aged population. Although the DALY rate for the 45-59 age group decreased from 1990 to 2021, the total number of DALYs increased significantly due to population aging. In this context, the burden of LBP in low-middle SDI regions has remained largely unchanged and remains substantial, while high-SDI regions, despite some decline, continue to bear the highest overall burden. High BMI continues to contribute significantly to the rising LBP burden, particularly in middle-aged populations, and demands urgent attention. Gender differences indicate that females bear a greater LBP burden than males, with the gap widening over time. Effective preventive and intervention measures are urgently needed to mitigate the future burden of LBP.

Determinants of bone mineral density in various regions of the skeleton among smokers and non-smokers: the role of physical activity

Background

The adult human skeleton is composed of cortical and cancellous bone. The proportions of these two types of bone tissue differ in various parts of the skeleton. The aim of this cross-sectional study was to quantify the determinants of bone mineral density (BMD) and bone mineral content in various regions of interest (ROIs) in smokers and never-smokers.

Methods

In this study, 4,332 bone scans of three regions of interest (ROIs) were analyzed: the forearm (distal and proximal), femur, and lumbar spine. Body composition and bone parameters were measured using dual-energy X-ray absorptiometry. Smoking was measured using the Global Adult Tobacco Survey questionnaire. Body mass index (BMI) was calculated, and physical activity (PA) was characterized by the metabolic equivalent of task (MET).

Results

Among women, the interaction between PA (positive β coefficient) and smoking (negative β coefficient) was a significant predictor of BMD in the distal and proximal forearm (adj. R2 = 0.40 and R2 = 0.58; p < 0.001). The interaction of three variables-age, smoking (negative β), and MET (positive β)-was significant for total hip BMD (adj. R2 = 0.54; p < 0.001). The interaction between BMI and MET (positive β) and smoking (negative β) was significant for BMD in the lumbar spine (adj. R2 = 0.62; p < 0.001). In men, the interaction between MET (positive β) and smoking (negative β) was significant for BMD in the forearm and lumbar spine (adj. R2 = 0.44, R2 = 0.46, and R2 = 0.49; p < 0.01). Smoking alone was a significant negative predictor of total hip BMD (adj. R2 = 0.34; p < 0.001).

Conclusion

Among both women and men, never-smokers had significantly better bone parameters than smokers. Smoking was a significant negative predictor for BMD in the various ROIs in both women and men. Physical activity was a significant positive predictor of BMD, with a strong association with bone parameters.

Effect of Cigarette Smoking on Postoperative Outcomes After Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus

BACKGROUND

Bone marrow stimulation (BMS) is presently considered first-line surgical treatment for osteochondral lesions of the talus (OLTs); however, some patients still experience pain or dysfunction after surgery, and the reasons for success or failure remain somewhat unclear. This study aimed to investigate the effect of smoking on postoperative outcomes after arthroscopic BMS for OLTs.

METHODS

Consecutive patients with OLTs who underwent BMS between January 2017 and January 2020 were included. Smokers were defined as patients who actively consumed cigarettes before surgery and postoperatively, whereas nonsmokers were patients who never smoked. Visual analog scale (VAS), American Orthopaedic Foot & Ankle Society ankle hindfoot score (AOFAS), Karlsson-Peterson, and Tegner scores were assessed preoperatively and at follow-up. Additionally, a general linear model (GLM) was performed, followed by the interaction analysis to explore the potential influence of smoking.

RESULTS

The study enrolled 104 patients with a mean follow-up of 30.91 ± 7.03 months, including 28 smokers and 76 nonsmokers. There were no significant differences in patient age (35.2 ± 10.0 years vs 37.6 ± 9.7 years, P = .282) or OLT area (63.7 ± 38.7 mm2 vs 52.8 ± 37.0 mm2, P = .782). Both univariate analysis and GLM revealed that smoking was associated with worse postoperative pain levels, Karlsson-Peterson, and AOFAS scores (P < .05). The interaction analysis showed a significant interaction between smoking and OLT area for postoperative Karlsson-Peterson scores (general ankle function) (P = .031). Simple main effects analysis revealed that the negative effect of smoking on Tegner score significantly increased among patients >32 years old or with OLT area>50 mm2 (P < .05).

CONCLUSION

Smoking was associated with worse clinical outcomes following BMS of OLTs. As the size of OLTs increased, the difference in general ankle function between smokers and nonsmokers also increased. Furthermore, smokers who were older than 32 years or had larger OLTs were less likely to resume participation in high-level activities.

The association of smoking on the increased risk of osteoporotic fracture: Results from a cross-sectional study and two-sample Mendelian randomization

INTRODUCTION

We conducted analyses of the association between smoking and osteoporosis and osteoporotic fractures using a secondary dataset analysis of the National Health and Nutrition Examination Survey (NHANES) database and the two-sample Mendelian randomization (MR) method.

METHODS

The associations between smoking and osteoporosis or osteoporotic fractures were analyzed using weighted logistic regression models for both univariate and multivariable analyses using pooled 1999-2018 NHANES data. The summary-level data of genome-wide association studies (GWAS) of smoking and osteoporosis were extracted from the IEU Open GWAS project. The inverse variance weighted method was used as the main method for the two-sample MR analysis.

RESULTS

We obtained the following main findings based on the NHANES data: smoking was associated with osteoporosis according to the analyses of 30856 participants (OR=1.21; 95% CI: 1.06-1.39, p=0.004); smoking was associated with hip osteoporotic fracture according to the analyses of 30928 participants (OR=1.47; 95% CI: 1.14-1.90, p=0.004); smoking was associated with wrist osteoporotic fracture according to the analyses of 30923 participants (OR=1.33; 95% CI: 1.18-1.49, p<0.001); and smoking was associated with spine osteoporotic fracture according to the analyses of 30910 participants (OR=1.43, 95% CI: 1.18-1.73, p<0.001). In addition, we confirmed the potential causal effect of smoking on the risk of osteoporotic fracture (OR=24.5; 95% CI: 1.11-539, p=0.043) by conducting two-sample MR analyses.

CONCLUSIONS

Smoking was associated with increased risks of both osteoporosis and osteoporotic fracture. Smoking showed a potential causal effect on the risk of osteoporotic fracture.

Tobacco toxins trigger bone marrow mesenchymal stem cells aging by inhibiting mitophagy

Smoking disrupts bone homeostasis and serves as an independent risk factor for the development and progression of osteoporosis. Tobacco toxins inhibit the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs), promote BMSCs aging and exhaustion, but the specific mechanisms are not yet fully understood. Herein, we successfully established a smoking-related osteoporosis (SROP) model in rats and mice through intraperitoneal injection of cigarette smoke extract (CSE), which significantly reduced bone density and induced aging and inhibited osteogenic differentiation of BMSCs both in vivo and in vitro. Bioinformatics analysis and in vitro experiments confirmed that CSE disrupts mitochondrial homeostasis through oxidative stress and inhibition of mitophagy. Furthermore, we discovered that CSE induced BMSCs aging by upregulating phosphorylated AKT, which in turn inhibited the expression of FOXO3a and the Pink1/Parkin pathway, leading to the suppression of mitophagy and the accumulation of damaged mitochondria. MitoQ, a mitochondrial-targeted antioxidant and mitophagy agonist, was effective in reducing CSE-induced mitochondrial oxidative stress, promoting mitophagy, significantly downregulating the expression of aging markers in BMSCs, restoring osteogenic differentiation, and alleviating bone loss and autophagy levels in CSE-exposed mice. In summary, our results suggest that BMSCs aging caused by the inhibition of mitophagy through the AKT/FOXO3a/Pink1/Parkin axis is a key mechanism in smoking-related osteoporosis.

A comprehensive meta-analysis of risk factors associated with osteosarcopenic obesity: a closer look at gender, lifestyle and comorbidities

This study reviewed the risk factors of Osteosarcopenic obesity (OSO), a condition linking weak bones, muscle loss, and obesity. Notable associations were found with female gender, physical inactivity, hypertension, and frailty. Recognizing these early can aid targeted prevention, emphasizing further research for improved understanding and strategies.

PURPOSE

Osteosarcopenic obesity (OSO) represents a confluence of osteopenia/osteoporosis, sarcopenia, and obesity, contributing to increased morbidity and mortality risks. Despite escalating prevalence, its risk factors remain under-explored, necessitating this comprehensive systematic review and meta-analysis.

METHODS

A diligent search of PubMed, Scopus, and Cochrane databases was conducted for pertinent studies until June 2023. The random-effects model was employed to compute pooled odds ratios (ORs) and 95% confidence intervals (CIs), scrutinizing various risk factors like age, gender, lifestyle factors, and common comorbidities.

RESULTS

Our meta-analysis incorporated 21 studies comprising 178,546 participants. We identified significant associations between OSO and factors such as female gender (OR 1.756, 95% CI 1.081 to 2.858), physical inactivity (OR 1.562, 95% CI 1.127-2.165), and hypertension (OR 1.482, 95% CI 1.207-1.821). Conversely, smoking (OR 0.854, 95% CI 0.672-1.084), alcohol consumption (OR 0.703, 95% CI 0.372-1.328), and dyslipidemia (OR 1.345, 95% CI 0.982-1.841) showed no significant associations. Remarkable heterogeneity was observed across studies, indicating considerable variation in effect sizes. Notably, OSO was strongly associated with frailty (OR 6.091; 95% CI 3.576-10.375).

CONCLUSIONS

Our study underscored the substantial role of female gender, physical inactivity, and hypertension in the development of OSO, whilst suggesting a strong link between OSO and frailty. These findings emphasize the importance of early risk factor identification and targeted interventions in these groups. Further research is warranted to decode the complex pathophysiological interplay and devise effective prevention and management strategies.

L-PRF Secretome from Both Smokers/Nonsmokers Stimulates Angiogenesis and Osteoblast Differentiation In Vitro

Leukocyte and Platelet-Rich Fibrin (L-PRF) is part of the second generation of platelet-concentrates. L-PRF derived from nonsmokers has been used in surgical procedures, with its beneficial effects in wound healing being proven to stimulate biological activities such as cell proliferation, angiogenesis, and differentiation. Cigarette smoking exerts detrimental effects on tissue healing and is associated with post-surgical complications; however, evidence about the biological effects of L-PRF derived from smokers is limited. This study evaluated the impact of L-PRF secretome (LPRFS) derived from smokers and nonsmokers on angiogenesis and osteoblast differentiation. LPRFS was obtained by submerging L-PRF membranes derived from smokers or nonsmokers in culture media and was used to treat endothelial cells (HUVEC) or SaOs-2 cells. Angiogenesis was evaluated by tubule formation assay, while osteoblast differentiation was observed by alkaline phosphatase and osterix protein levels, as well as in vitro mineralization. LPRFS treatments increased angiogenesis, alkaline phosphatase, and osterix levels. Treatment with 50% of LPRFS derived from smokers and nonsmokers in the presence of osteogenic factors stimulates in vitro mineralization significantly. Nevertheless, differences between LPRFS derived from smokers and nonsmokers were not found. Both LPRFS stimulated angiogenesis and osteoblast differentiation in vitro; however, clinical studies are required to determine the beneficial effect of LPRFS in smokers.

Pathophysiology and Therapeutic Management of Bone Loss in Patients with Critical Illness

Patients with critical illnesses are at higher risk of comorbidities, which can include bone mineral density loss, bone turnover marker increase, and fragility fractures. Patients admitted to intensive care units (ICUs) have a higher risk of bone fractures. Since hypermetabolism is a characteristic of ICU patients, such patients are often rapidly affected by systemic deterioration, which often results in systemic wasting disease. Major risk factors for ICU-related bone loss include physical restraint, inflammation, neuroendocrine stress, malnutrition, and medications. A medical history of critical illness should be acknowledged as a risk factor for impaired bone metabolism. Bone loss associated with ICU admission should be recognized as a key component of post-intensive care syndrome, and further research that focuses on treatment protocols and prevention strategies is required. Studies aimed at maintaining gut integrity have emphasized protein administration and nutrition, while research is ongoing to evaluate the therapeutic benefits of anti-resorptive agents and physical therapy. This review examines both current and innovative clinical strategies that are used for identifying risk factors of bone loss. It provides an overview of perioperative outcomes and discusses the emerging novel treatment modalities. Furthermore, the review presents future directions in the treatment of ICU-related bone loss.

Metabolic diseases and healthy aging: identifying environmental and behavioral risk factors and promoting public health

Aging is a progressive and irreversible pathophysiological process that manifests as the decline in tissue and cellular functions, along with a significant increase in the risk of various aging-related diseases, including metabolic diseases. While advances in modern medicine have significantly promoted human health and extended human lifespan, metabolic diseases such as obesity and type 2 diabetes among the older adults pose a major challenge to global public health as societies age. Therefore, understanding the complex interaction between risk factors and metabolic diseases is crucial for promoting well-being and healthy aging. This review article explores the environmental and behavioral risk factors associated with metabolic diseases and their impact on healthy aging. The environment, including an obesogenic environment and exposure to environmental toxins, is strongly correlated with the rising prevalence of obesity and its comorbidities. Behavioral factors, such as diet, physical activity, smoking, alcohol consumption, and sleep patterns, significantly influence the risk of metabolic diseases throughout aging. Public health interventions targeting modifiable risk factors can effectively promote healthier lifestyles and prevent metabolic diseases. Collaboration between government agencies, healthcare providers and community organizations is essential for implementing these interventions and creating supportive environments that foster healthy aging.

Is Corticalization in Radiographs Related to a Higher Risk of Bone Loss around Dental Implants in Smoking Patients? A 5-Year Observation of Radiograph Bone-Texture Changes

BACKGROUND

Currently, the topic of dental implants is widely researched. However, still compromising are the factors that can affect implant loss as a consequence of marginal bone loss. One of the factors is smoking, which has a devastating effect on human health and bone structure. Oral health and jaw condition are also negatively affected by smoking. The aim of this study was to evaluate the peri-implant jawbone corticalization phenomenon in tobacco smokers.

METHODS

A total of 2196 samples from 768 patients with an implant in the neck area were checked, and texture features were analyzed. The corticalization phenomenon was investigated. All analyses were performed in MaZda Software. The influence of corticalization was investigated as a factor on bone structure near the implant neck. The statistical analysis included a feature distribution evaluation, mean (t-test) or median (W-test) comparison, analysis of regression and one-way analysis of variance or Kruskal-Wallis test as no normal distribution or between-group variance was indicated for the significant differences in the investigated groups. Detected differences or relationships were assumed to be statistically significant when p < 0.05.

RESULTS

The research revealed that MBL was correlated with smoking after 5 years (0.42 mm ± 1.32 mm 0 mm ± 1.25 mm), the Corticalization Index was higher in the smoker group on the day of surgery, and it became higher after 5y of observation (185.98 ± 90.8 and 243.17 ± 155.47). The implant-loss frequency was higher in the group of smokers, too, compared to non-smokers (6.74% and 2.87%). The higher the torque value during the implant placement, the higher the Corticalization Phenomenon Index.

CONCLUSIONS

The research revealed a correlation between smoking and changes in bone structure in radio textures near the implants. The corticalization phenomenon is important, may be detected immediately after implant placement and may be one of the indicators of the implant success rate.

Prevalence of Osteopathy in Chronic Pancreatitis: A Systematic Review and Meta-Analysis

INTRODUCTION

Individuals with chronic pancreatitis (CP) are at increased risk for nutritional complications during their clinical course. We appraised the literature to provide updated estimates of the prevalence and predictors of osteoporosis, osteopenia, and osteopathy in CP using a systematic review and meta-analysis.

METHODS

Search strategies were developed for major databases from inception through October 2021. Outcomes of interest included rates of osteopenia and osteoporosis based on dual-energy X-ray absorptiometry scans and risk factors. A random-effects model was used for analysis, and results were expressed as pooled cumulative rates along with 95% confidence interval (CI).

RESULTS

From an initial total of 1,704 identified articles, we ultimately selected 17 studies that involved 1,659 subjects (n = 1,067 men) with CP. The pooled rate of osteopathy was 58% (95% CI: 49%-67%; P < 0.001; I 2 = 91.8%). The pooled rate of osteoporosis was 18% (95% CI: 12%-23%; P < 0.001; I 2 = 86.3%), and the pooled rate of osteopenia was 39% (95% CI: 31%-48%; P < 0.001; I 2 = 91.53%). In the systematic review, factors associated with decreased bone mineral density included smoking, alcohol consumption, older age, female sex, low body mass index, decreased vitamins D and K, and fecal elastase levels.

DISCUSSION

Patients with CP have high rates of osteopathy when assessed with dual-energy X-ray absorptiometry imaging. Additional studies with longitudinal follow-up are needed to understand the observed heterogeneity, the cumulative burden of disease, and rate of bone loss in CP.

Stability of Le Fort 1 osteotomy in patients with bilateral cleft lip and palate: A retrospective study of 71 patients

The aim of this study was to evaluate the sagittal and vertical relapses after Le Fort 1 osteotomy in bilateral cleft lip and palate (BCLP) patients. Lateral cephalograms before surgery, immediately after the procedure, at one year, and at least two years (when available) after surgery were superimposed. The positions of five landmarks were studied in a coordinate system. Uni- and multivariate analyses investigated the effect of various factors on the relapse. Of the 71 patients included for a BCLP, 54 presented complete data at one year, and 30 patients were included for the long follow-up study (mean of 55 months). The mean maxillary advancement was 6.2 mm on the sub-spinal point (A). Sagittal relapse occurred at one year (mean of 1.1 mm on point A, 0.7 mm on point prosthion (P); p < 0.0001) and progressed by 0.5 mm and 1.0 mm, respectively, on the same points at the last follow-up. The mean vertical relapse was 0.5 mm on point A (p = 0.044), 0.6 mm on point P (p = 0.16) and 0.5 mm on incisor (I) (p = 0.056). The vertical relapse was correlated to the degree of vertical movement. Three factors were associated to the recurrence including a prior pharyngeal flap, an associated mandibular osteotomy and smoking habits.

Smoking induces increased apoptosis in osteoblasts: changes in bone matrix organic components

Clinical studies demonstrate the impact of smoking on bone tissue fragility and higher incidence of fractures. However, it is not totally understood which physiological mechanisms could be involved in these events. Previously, we showed important changes in bone tissue components in experimental model of cigarette smoke (CS) exposure. CS exposure induces worsening in bone mineralization and a decrease in collagen type I deposition, leading to bone fragility. Considering that the majority of clinical studies described bone structural changes by radiographic images, in this study we performed analyses "in situ" using tissue samples from smokers, former smokers and non-smokers to better understand how the increase in inflammatory mediators induced by smoking exposure could interfere in bone cells activity leading bone structural changes. We observed increased levels of IL-1β, IL-6 and TNF-α in bone tissue homogenates with a concomitant increase in osteoblast apoptosis in smokers and former smokers compared with non-smokers. Histological changes in both smokers and former smokers were characterized by reduction in collagen type I. Only in smokers, it was observed decrease in trabecular area, suggesting increased bone resorption and increase in collagen type V. These results showed that osteoblasts apoptosis in association with increased bone resorption leads bone structural changes in smokers.

Osteoporosis and cardiovascular disease: a review

BACKGROUND

Osteoporosis and cardiovascular disease are common diseases encountered globally, especially with advancing age. Osteoporosis occurs when there is a loss of bone mineral density leading to increased predisposition to fragility fracture. The conventional perception of osteoporosis is purely as a metabolic bone disease. However, there are mounting reports from recent studies that osteoporosis could be seen as a risk factor for cardiovascular disease just like other traditional risk factors such as hypertension, dyslipidaemia and diabetes. This is a paradigm shift with regards to the outlook of osteoporosis. Osteoporosis and cardiovascular disease have similar risk factors, including diabetes, smoking, excess alcohol, sedentary lifestyle, ageing and dyslipidaemia. This may partly explain the link between osteoporosis and cardiovascular disease. In addition, both osteoporosis and atherosclerosis, which underlies most cardiovascular disease, are both characterized by low grade chronic inflammation. Moreover, the processes involved in the calcification of atheroma are similar to what is seen in bone remodeling. Both processes also involve similar regulators such as osteoprotegerin and related proteins such as osteonectin, osteopontin and type 1 collagen are found in bone matrix and atheromatous plaques.

CONCLUSION

There is emerging evidence that individuals with osteoporosis are also at an increased risk of coronary artery disease and stroke even after controlling for other factors. The traditional risk factors for cardiovascular disease also predispose people to developing osteoporosis, suggesting that the same mechanism may be causing the two. Moreover, a number of anti-osteoporotic drugs have also been largely linked with cardiovascular disease. This calls for a change in the view of osteoporosis as a metabolic disease but as a cardio-metabolic disorder thereby emphasizing the need for intensified preventive strategies for the disease.

Assessment of Osteoporosis Awareness and Osteoporosis Risk Level of Patients Admitted to a University Hospital

INTRODUCTION

We aimed to evaluate osteoporosis awareness and risk of osteoporosis in individuals by using the One-Minute Osteoporosis Risk Test and Osteoporosis Self-Assessment Tool for Asians score.

METHODOLOGY

This descriptive cross-sectional study included 591 volunteers who were admitted to the Internal Medicine outpatient clinic of the University Hospital. The One-Minute Osteoporosis Risk Test was applied through face-to-face interviews. Participants were classified as low, medium, and high osteoporosis risk groups in terms of the Osteoporosis Self-Assessment Tool for Asians scores.

RESULTS

Median score of the One-Minute Osteoporosis Risk Test was 1 (0-2) and the mean score of the Osteoporosis Self-Assessment Tool for Asians was 4.61 ± 3.80. In terms of the Osteoporosis Self-Assessment Tool for Asians score, 0.7% (n = 4) of the participants have a high risk of osteoporosis, 5.4% (n = 32) have a medium risk of osteoporosis and 93.9% (n = 555) have a low risk of osteoporosis. One-Minute Osteoporosis Risk Test scores of participants in terms of the osteoporosis risk levels were not significantly different (p = 0.432). The proportion of having information about osteoporosis in men was significantly lower than in women (21.0% vs. 33.4%, p = 0.004). The proportion of obtained information from medical staff was significantly higher in women than men (86.9% vs. 66.7%, p = 0.005). Informed participants have a significantly higher One-Minute Osteoporosis Risk Test score than non-informed participants (p = 0.004).

RESULTS

The risk of osteoporosis was found to be low in individuals admitted to the university hospital. The Osteoporosis Self-Assessment Tool for Asians score was more effective in determining the osteoporosis risk level compared to the One-Minute Osteoporosis Risk Test. Men should be given as much importance as women in informing about osteoporosis. Media tools should be used more effectively for this purpose.

Current Status of the Diagnosis and Management of Osteoporosis

Osteoporosis has been defined as the silent disease of the 21st century, becoming a public health risk due to its severity, chronicity and progression and affecting mainly postmenopausal women and older adults. Osteoporosis is characterized by an imbalance between bone resorption and bone production. It is diagnosed through different methods such as bone densitometry and dual X-rays. The treatment of this pathology focuses on different aspects. On the one hand, pharmacological treatments are characterized by the use of anti-resorptive drugs, as well as emerging regenerative medicine treatments such as cell therapies and the use of bioactive hydrogels. On the other hand, non-pharmacological treatments are associated with lifestyle habits that should be incorporated, such as physical activity, diet and the cessation of harmful habits such as a high consumption of alcohol or smoking. This review seeks to provide an overview of the theoretical basis in relation to bone biology, the existing methods for diagnosis and the treatments of osteoporosis, including the development of new strategies.

Probing combinational influence of design variables on bone biomechanical response around dental implant-supported fixed prosthesis

This study aimed to understand the effect of physiological and dental implant-related parameter variations on the osseointegration for an implant-supported fixed prosthesis. Eight design factors were considered (implant shape, diameter, and length; thread pitch, depth, and profile; cantilever [CL] length and implant-loading protocol). Total 36 implantation scenarios were simulated using finite element method based on Taguchi L₃₆ orthogonal array. Three patient-specific bone conditions were also simulated by scaling the density and Young's modulus of a mandible sample to mimic weak, normal, and strong bones. Taguchi method was employed to determine the significance of each design factor in controlling the peri-implant cortical bone microstrain. For normal bone condition, CL length had the maximum contribution (28%) followed by implant diameter (18%), thread pitch (14%), implant length (8%), and thread profile (5%). For strong bone condition, CL and implant diameter had equal contribution (32%) followed by thread pitch (7%) and implant length (5%). For weak bone condition, implant diameter had the highest contribution (31%) followed by CL length (30%), thread pitch (11%) and implant length (8%). The presence of distal CL in dental framework was found to be the most influential design factor, which can cause high strain in the cervical cortical bone. It was seen that implant diameter had more effect compared to implant length toward peri-implant bone biomechanical response. Implant-loading time had no significant effect towards peri-implant bone biomechanical response, signifying immediate loading is possible with sufficient mechanical retention.

Chronic Pain in Musculoskeletal Diseases: Do You Know Your Enemy?

Musculoskeletal pain is a condition that characterises several diseases and represents a constantly growing issue with enormous socio-economic burdens, highlighting the importance of developing treatment algorithms appropriate to the patient’s needs and effective management strategies. Indeed, the algic condition must be assessed and treated independently of the underlying pathological process since it has an extremely negative impact on the emotional and psychic aspects of the individual, leading to isolation and depression. A full understanding of the pathophysiological mechanisms involved in nociceptive stimulation and central sensitization is an important step in improving approaches to musculoskeletal pain. In this context, the bidirectional relationship between immune cells and neurons involved in nociception could represent a key point in the understanding of these mechanisms. Therefore, we provide an updated overview of the magnitude of the musculoskeletal pain problem, in terms of prevalence and costs, and summarise the role of the most important molecular players involved in the development and maintenance of pain. Finally, based on the pathophysiological mechanisms, we propose a model, called the “musculoskeletal pain cycle”, which could be a useful tool to counteract resignation to the algic condition and provide a starting point for developing a treatment algorithm for the patient with musculoskeletal pain.

Metabolic Bone Diseases and New Drug Developments

Metabolic bone diseases are serious health issues worldwide, since several million individuals over the age of 50 are at risk of bone damage and should be worried about their bone health. One in every two women and one in every four men will break a bone during their lifetime due to a metabolic bone disease. Early detection, raising bone health awareness, and maintaining a balanced healthy diet may reduce the risk of skeletal fractures caused by metabolic bone diseases. This review compiles information on the most common metabolic bone diseases (osteoporosis, primary hyperparathyroidism, osteomalacia, and fluorosis disease) seen in the global population, including their symptoms, mechanisms, and causes, as well as discussing their prevention and the development of new drugs for treatment. A large amount of research literature suggests that balanced nutrition and balanced periodic supplementation of calcium, phosphate, and vitamin D can improve re-absorption and the regrowth of bones, and inhibit the formation of skeletal fractures, except in the case of hereditary bone diseases. Meanwhile, new and improved drug formulations, such as raloxifene, teriparatide, sclerostin, denosumab, and abaloparatide, have been successfully developed and administered as treatments for metabolic bone diseases, while others (romososumab and odanacatib) are in various stages of clinical trials.