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Karim L, Moulton J, Van Vliet M, Velie K, Robbins A, Malekipour F, Abdeen A, Ayres D, Bouxsein ML. Bone microarchitecture, biomechanical properties, and advanced glycation end-products in the proximal femur of adults with type 2 diabetes. Bone 2018; 114:32-39. [PMID: 29857063 PMCID: PMC6141002 DOI: 10.1016/j.bone.2018.05.030] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/03/2018] [Accepted: 05/29/2018] [Indexed: 12/23/2022]
Abstract
Skeletal fragility is a major complication of type 2 diabetes mellitus (T2D), but there is a poor understanding of mechanisms underlying T2D skeletal fragility. The increased fracture risk has been suggested to result from deteriorated bone microarchitecture or poor bone quality due to accumulation of advanced glycation end-products (AGEs). We conducted a clinical study to determine whether: 1) bone microarchitecture, AGEs, and bone biomechanical properties are altered in T2D bone, 2) bone AGEs are related to bone biomechanical properties, and 3) serum AGE levels reflect those in bone. To do so, we collected serum and proximal femur specimens from T2D (n = 20) and non-diabetic (n = 33) subjects undergoing total hip replacement surgery. A section from the femoral neck was imaged by microcomputed tomography (microCT), tested by cyclic reference point indentation, and quantified for AGE content. A trabecular core taken from the femoral head was imaged by microCT and subjected to uniaxial unconfined compression tests. T2D subjects had greater HbA1c (+23%, p ≤ 0.0001), but no difference in cortical tissue mineral density, cortical porosity, or trabecular microarchitecture compared to non-diabetics. Cyclic reference point indentation revealed that creep indentation distance (+18%, p ≤ 0.05) and indentation distance increase (+20%, p ≤ 0.05) were greater in cortical bone from T2D than in non-diabetics, but no other indentation variables differed. Trabecular bone mechanical properties were similar in both groups, except for yield stress, which tended to be lower in T2D than in non-diabetics. Neither serum pentosidine nor serum total AGEs were different between groups. Cortical, but not trabecular, bone AGEs tended to be higher in T2D subjects (21%, p = 0.09). Serum AGEs and pentosidine were positively correlated with cortical and trabecular bone AGEs. Our study presents new data on biomechanical properties and AGEs in adults with T2D, which are needed to better understand mechanisms contributing to diabetic skeletal fragility.
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Affiliation(s)
- Lamya Karim
- Department of Bioengineering, University of Massachusetts Dartmouth, Dartmouth, MA 02747, USA.
| | - Julia Moulton
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
| | - Miranda Van Vliet
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Kelsey Velie
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Ann Robbins
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
| | - Fatemeh Malekipour
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Biomedical Engineering, University of Melbourne, Victoria 3010, Australia
| | - Ayesha Abdeen
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA 02215, USA.
| | - Douglas Ayres
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA 02215, USA.
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA 02215, USA.
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Karim L, Van Vliet M, Bouxsein ML. Comparison of cyclic and impact-based reference point indentation measurements in human cadaveric tibia. Bone 2018; 106:90-95. [PMID: 25862290 PMCID: PMC7723015 DOI: 10.1016/j.bone.2015.03.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/20/2015] [Accepted: 03/31/2015] [Indexed: 01/22/2023]
Abstract
Although low bone mineral density (BMD) is strongly associated with increased fracture risk, up to 50% of those who suffer fractures are not detected as high-risk patients by BMD testing. Thus, new approaches may improve identification of those at increased risk for fracture by in vivo assessment of altered bone tissue properties, which may contribute to skeletal fragility. Recently developed reference point indentation (RPI) allows for assessment of cortical bone indentation properties in vivo using devices that apply cyclic loading or impact loading, but there is little information available to assist with interpretation of RPI measurements. Our goals were to use human cadaveric tibia to determine: 1) the associations between RPI variables, cortical bone density, and morphology; 2) the association between variables obtained from RPI systems using cyclic, slow loading versus a single impact load; and 3) age-related differences in RPI variables. We obtained 20 human tibia and femur pairs from female donors (53-97years), measured total hip BMD using dual-energy X-ray absorptiometry, assessed tibial cortical microarchitecture using high-resolution peripheral quantitative computed tomography (HR-pQCT), and assessed cortical bone indentation properties at the mid-tibial diaphysis using both the cyclic and impact-based RPI systems (Biodent and Osteoprobe, respectively, Active Life Scientific, Santa Barbara, CA). We found a few weak associations between RPI variables, BMD, and cortical geometry; a few weak associations between measurements obtained by the two RPI systems; and no age-related differences in RPI variables. Our findings indicate that in cadaveric tibia from older women RPI measurements are largely independent of age, femoral BMD, and cortical geometry. Furthermore, measurements from the cyclic and impact loading RPI devices are weakly related to each other, indicating that each device reflects different aspects of cortical bone indentation properties.
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Affiliation(s)
- Lamya Karim
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States; Department of Orthopedic Surgery, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States; Department of Bioengineering, University of Massachusetts Dartmouth, 285 Old Westport Road, Dartmouth, MA 02747, USA.
| | - Miranda Van Vliet
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States.
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States; Department of Orthopedic Surgery, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States.
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Ko FC, Van Vliet M, Ellman R, Grasso D, Brooks DJ, Spatz JM, Conlon C, Aguirre JI, Wronski TJ, Bouxsein ML. Treatment With a Soluble Bone Morphogenetic Protein Type 1A Receptor (BMPR1A) Fusion Protein Increases Bone Mass and Bone Formation in Mice Subjected to Hindlimb Unloading. JBMR Plus 2017; 1:66-72. [PMID: 30283882 PMCID: PMC6124165 DOI: 10.1002/jbm4.10012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/15/2017] [Accepted: 06/25/2017] [Indexed: 01/26/2023] Open
Abstract
Previous work has shown that the soluble murine BMPR1A-fusion protein (mBMPR1A-mFc) binds to BMP2 and BMP4 with high affinity, preventing downstream signaling. Further, treatment of intact and ovariectomized mice with mBMPR1A-mFc leads to increased bone mass, and improved bone microarchitecture and strength, via increased bone formation and reduced resorption. In this study, we tested the effects of mBMPR1A-mFc on disuse-induced bone loss caused by 21 days of hindlimb unloading (HLU) via tail suspension versus cage controls (CONs). Adult female C57BL/6J mice (12 weeks old) were assigned to one of four groups (n = 10 each): CON-VEH; CON-mBMPR1A-mFc; HLU-VEH; and HLU-mBMPR1A-mFc. Mice were injected subcutaneously with VEH or mBMPR1A-mFc (4.5 mg/kg, 2×/week). Leg BMD declined in the HLU-VEH group (-5.3% ± 1.3%), whereas it was unchanged in HLU-mBMPR1A-mFc (-0.3% ± 0.9%, p < 0.05 versus HLU-VEH). Leg BMD increased significantly more in CON-mBMPR1A-mFc than CON-VEH (10.2% ± 0.6% versus 4.4% ± 0.8%). In the femur, trabecular, and cortical bone microarchitecture was worse in the HLU-VEH compared to CON-VEH mice, whereas mBMPR1A-mFc treatment for 3 weeks led to greater Tb.BV/TV, Tb.Th, and midshaft Ct.Th in both the HLU and CON groups compared to comparable VEH-treated counterparts (p < 0.05). HLU-mBMPR1A-mFc mice also had 21% greater failure load (p < 0.05) compared to their VEH-treated counterparts. Dynamic histomorphometry indicated that treatment with mBMPR1A-mFc led to significantly greater mineralizing surface and mineral apposition rate, resulting in a 3.5-fold and fivefold higher bone formation rate in the mBMPR1A-mFc-treated CON and HLU animals versus VEH groups, respectively. mBMPR1A-mFc-treated mice had a similar osteoblast surface but significantly lower osteoclast surface than VEH-treated animals in both the CON and HLU groups. Altogether, these findings suggest that treatment with the soluble BMPR1A fusion protein may be useful for maintenance of skeletal integrity in the setting of disuse-induced bone loss.
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Affiliation(s)
- Frank C. Ko
- Center for Advanced Orthopedic StudiesBeth Israel Deaconess Medical CenterBostonMAUSA
- Endocrine UnitMassachusetts General HospitalBostonMAUSA
| | - Miranda Van Vliet
- Center for Advanced Orthopedic StudiesBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Rachel Ellman
- Center for Advanced Orthopedic StudiesBeth Israel Deaconess Medical CenterBostonMAUSA
- Massachusetts Institute of Technology (MIT) Health Sciences and Technology ProgramCambridgeMAUSA
| | - Daniel Grasso
- Center for Advanced Orthopedic StudiesBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Daniel J Brooks
- Center for Advanced Orthopedic StudiesBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Jordan M Spatz
- Center for Advanced Orthopedic StudiesBeth Israel Deaconess Medical CenterBostonMAUSA
- Massachusetts Institute of Technology (MIT) Health Sciences and Technology ProgramCambridgeMAUSA
| | - Chrissy Conlon
- Center for Advanced Orthopedic StudiesBeth Israel Deaconess Medical CenterBostonMAUSA
| | - J Ignacio Aguirre
- Department of Physiological SciencesUniversity of FloridaGainesvilleFLUSA
| | - Thomas J Wronski
- Department of Physiological SciencesUniversity of FloridaGainesvilleFLUSA
| | - Mary L Bouxsein
- Center for Advanced Orthopedic StudiesBeth Israel Deaconess Medical CenterBostonMAUSA
- Endocrine UnitMassachusetts General HospitalBostonMAUSA
- Department of Orthopedic SurgeryHarvard Medical SchoolBostonMAUSA
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