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Fratzl-Zelman N, Hartmann MA, Gamsjaeger S, Rokidi S, Paschalis EP, Blouin S, Zwerina J. Bone Matrix Mineralization and Response to Burosumab in Adult Patients With X-Linked Hypophosphatemia: Results From the Phase 3, Single-Arm International Trial. J Bone Miner Res 2022; 37:1665-1678. [PMID: 35775373 DOI: 10.1002/jbmr.4641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/20/2022] [Accepted: 06/25/2022] [Indexed: 11/06/2022]
Abstract
X-linked hypophosphatemia (XLH) is characterized by excess fibroblast growth factor 23 (FGF23) secretion, renal phosphate wasting, and low 1,25(OH)2 D3 . Adult patients present with osteomalacia, hypomineralized periosteocytic lesions, bone fragility, and pain. Burosumab is a fully human monoclonal FGF23 antibody approved for XLH treatment. UX023-CL304 was an open-label, phase 3 study investigating the effects of burosumab on osteomalacia in adults with XLH, who remained untreated at least 2 years prior enrollment. Here, we present the effect of burosumab on bone material properties. We analyzed transiliac bone biopsy samples from 11 individuals before and after 48 weeks of subcutaneous burosumab treatment (1.0 mg/kg administered every 4 weeks). We used quantitative backscattered electron imaging (qBEI) and Fourier transform infrared imaging (FTIRI) to assess bone mineralization density distribution (BMDD), mineralized bone volume, properties of the organic matrix, and size of periosteocytic lesions. The outcomes were compared with reference values from healthy adults and with four XLH patients either untreated or treated by conventional therapy. Prior to burosumab, the average mineralization in cancellous bone was lower than in healthy reference. CaLow, the fraction of lowly mineralized matrix, and CaHigh, the fraction of highly mineralized matrix, were both elevated resulting in a broad heterogeneity in mineralization (CaWidth). Burosumab resulted in a decrease of CaHigh toward normal range, whereas CaLow and CaWidth remained elevated. The mineralized bone volume was notably increased (+35.9%). The size of the periosteocytic lesions was variable but lower than in untreated XLH patients. FTIRI indicated decreased enzymatic collagen crosslink ratio heterogeneity. In summary, matrix mineralization in XLH is very heterogeneous. Highly mineralized regions represent old bone packets, probably protected from osteoclastic resorption by osteoid seams. The concomitant decrease of highly mineralized matrix, persistence of lowly mineralized matrix, and increase in mineralized bone volume after burosumab suggest a boost in mineralization of preexisting unmineralized or very lowly mineralized matrix, providing a potential explanation for previously observed improved osteomalacia. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Nadja Fratzl-Zelman
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med Department Hanusch Hospital, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
| | - Markus A Hartmann
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med Department Hanusch Hospital, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
| | - Sonja Gamsjaeger
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med Department Hanusch Hospital, Vienna, Austria
| | - Stamatia Rokidi
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med Department Hanusch Hospital, Vienna, Austria
| | - Eleftherios P Paschalis
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med Department Hanusch Hospital, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
| | - Stéphane Blouin
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med Department Hanusch Hospital, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med Department Hanusch Hospital, Vienna, Austria.,Vienna Bone and Growth Center, Vienna, Austria
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Leisser C, Paschalis E, Rokidi S, Behanova M, Ruiss M, Burgmüller W, Findl O. Fourier-Transform Infrared Spectroscopy of Epiretinal Membranes and Internal Limiting Membranes after Pars Plana Vitrectomy with Membrane Peeling. Ophthalmic Res 2021; 64:793-797. [PMID: 33951668 DOI: 10.1159/000516633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/02/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Christoph Leisser
- VIROS-Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria,
| | - Eleftherios Paschalis
- Ludwig Boltzmann Institute of Osteology at 1st Medical Department, Hanusch Hospital of Österreichische Gesundheitskasse (ÖGK) and Research funds of the Austrian workers compensation board (AUVA) Trauma Centre Meidling, Vienna, Austria
| | - Stamatia Rokidi
- Ludwig Boltzmann Institute of Osteology at 1st Medical Department, Hanusch Hospital of Österreichische Gesundheitskasse (ÖGK) and Research funds of the Austrian workers compensation board (AUVA) Trauma Centre Meidling, Vienna, Austria
| | - Martina Behanova
- Ludwig Boltzmann Institute of Osteology at 1st Medical Department, Hanusch Hospital of Österreichische Gesundheitskasse (ÖGK) and Research funds of the Austrian workers compensation board (AUVA) Trauma Centre Meidling, Vienna, Austria
| | - Manuel Ruiss
- VIROS-Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria
| | - Wilhelm Burgmüller
- VIROS-Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria
| | - Oliver Findl
- VIROS-Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria
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Paschalis EP, Dempster DW, Gamsjaeger S, Rokidi S, Hassler N, Brozek W, Chan-Diehl FW, Klaushofer K, Taylor KA. Mineral and organic matrix composition at bone forming surfaces in postmenopausal women with osteoporosis treated with either teriparatide or zoledronic acid. Bone 2021; 145:115848. [PMID: 33453443 DOI: 10.1016/j.bone.2021.115848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 01/05/2023]
Abstract
The ability of bone to resist fracture is dependent on the composite nature of its mineral and organic matrix content. Teriparatide (TPTD) and zoledronic acid (ZOL) are approved anabolic and antiresorptive therapies, respectively, to reduce fracture risk in women with postmenopausal osteoporosis. In the SHOTZ study, postmenopausal women with osteoporosis were treated with TPTD (20 μg daily, subcutaneous) or ZOL (5 mg/year, intravenous infusion) for 24 months. Iliac crest biopsies were obtained at 6 months and again at 24 months from approximately one third of the original study cohort. To investigate the early effects of these two drugs on the quality of newly formed bone, we used vibrational spectroscopic techniques to analyze tetracycline-labelled transiliac biopsies obtained from participants at the 6-month time point. Raman spectra were acquired at forming trabecular and intra-cortical surfaces (identified by fluorescent double labels), to determine mineral, organic matrix, glycosaminoglycan, and tissue water content, as well as mineral maturity/crystallinity at three specific tissue ages (1-5, 15, and ≥25 days). Fourier transformed infrared microspectroscopy was used to determine pyridinoline/divalent collagen cross-link ratios. At 6 months, treatment with TPTD versus ZOL resulted in lower mineral and higher organic matrix content, increased tissue water content, and lower mineral/matrix, mineral maturity/crystallinity, glycosaminoglycan content, and pyridinoline/divalent enzymatic collagen cross-link ratio. Our results suggest that TPTD and ZOL have differential effects on material properties of newly formed bone at individual remodeling sites, highlighting their different mechanisms of action.
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Affiliation(s)
- Eleftherios P Paschalis
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - David W Dempster
- Regional Bone Center, Helen Hayes Hospital, New York State Department of Health, West Haverstraw, NY, USA; Department of Pathology and Cell Biology, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Sonja Gamsjaeger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Stamatia Rokidi
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Norbert Hassler
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Wolfgang Brozek
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
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Rokidi S, Andrade VFC, Borba V, Shane E, Cohen A, Zwerina J, Paschalis EP, Moreira CA. Bone tissue material composition is compromised in premenopausal women with Type 2 diabetes. Bone 2020; 141:115634. [PMID: 32927103 DOI: 10.1016/j.bone.2020.115634] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/23/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022]
Abstract
Type 2 diabetes mellitus (T2DM) patients are at an increased risk of fracture despite normal to high bone mineral density (BMD) values. In this cross-sectional study we establish bone compositional properties in tetracycline labeled iliac crest biopsies from premenopausal women diagnosed with T2DM (N = 26). Within group comparisons were made as a function of tissue age (TA), presence of chronic complications (CC), glycosylated haemoglobin (HbA1c) levels, and morphometric fracture (MFx). We also compared these data at actively trabecular bone forming surfaces against sex- and age-matched healthy controls (N = 32). The bone quality indices determined by Raman microspectroscopic analysis were: mineral/matrix (MM), tissue water content (nanoporosity; NanoP), mineral maturity/crystallinity (MMC), and glycosaminoglycan (GAG), pyridinoline (Pyd), N-(carboxymethyl)lysine (CML), and pentosidine (PEN) content. Within the T2DM group, at the oldest tissue, CML and PEN contents were significantly elevated in the cancellous compared to cortical compartment. The outcomes were not dependent on MFx. On the other hand, both were significantly elevated in patients with CC, as well as those with HbA1c levels > 7%. At actively forming surfaces, the cortical compartment had higher NanoP compared to cancellous. Still within the T2DM group, patients with MFx had significantly elevated MM and GAGs compared to the ones that did not. At actively forming trabecular surfaces, compared to healthy women, T2DM patients had elevated GAGs content and MMC. The results of this study indicate increased AGEs in those with poor glycation control and chronic complications. Additionally, T2DM patients had elevated MMC and decreased GAGs content compared to healthy controls. These alterations may be contributing to the T2DM inherent elevated fracture risk and suggest a role for hyperglycemia on bone quality.
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Affiliation(s)
- Stamatia Rokidi
- Ludwig Boltzmann Institute for Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Vicente F C Andrade
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil
| | - Victoria Borba
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil
| | - Elizabeth Shane
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Adi Cohen
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jochen Zwerina
- Ludwig Boltzmann Institute for Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Eleftherios P Paschalis
- Ludwig Boltzmann Institute for Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria.
| | - Carolina A Moreira
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil; Lab PRO, Bone Histomorphometry, Pro Renal Foundation, Curitiba, Brazil
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Rokidi S, Bravenboer N, Gamsjaeger S, Chavassieux P, Zwerina J, Paschalis E, Papapoulos S, Appelman-Dijkstra N. Impact microindentation assesses cortical bone material properties in humans. Bone Rep 2020. [DOI: 10.1016/j.bonr.2020.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Rokidi S, Bravenboer N, Gamsjaeger S, Chavassieux P, Zwerina J, Paschalis E, Papapoulos S, Appelman-Dijkstra N. Impact microindentation measurements correlate with cortical bone material properties measured by Fourier transform infrared imaging in humans. Bone 2020; 137:115437. [PMID: 32473316 DOI: 10.1016/j.bone.2020.115437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 11/27/2022]
Abstract
Bone Material Strength index (BMSi) measured by Impact Microindentation is generally lower in subjects with fragility fractures independently of BMD values. We recently reported that in humans, BMSi values are strongly associated with material properties of subperiosteal mineralized bone surface (local mineral content, nanoporosity, pyridinoline content). In the present study we investigated the relationship of BMSi with material properties of the whole bone cortex, by analyzing thin sections of iliac crest biopsies (N = 12) from patients with different skeletal disorders and a wide range of BMD with or without fractures, by Fourier transform infrared imaging (FTIRI). The calculated parameters were: i) mineral and organic matrix content and their ratio (MM), ii) mineral maturity/crystallinity (MMC) and iii) the ratio of pyridinoline (Pyd) and divalent collagen cross-links (XLR). Results were expressed as images, which were converted to histogram distributions. For each histogram the characteristics recorded were: mean value, mode (most often occurring value), skewness, and kurtosis and their association with BMSi values was examined by correlation analysis. BMSi values were significantly correlated only with MM mean and mode values (r = 0.736, p = 0.0063, and r = 0.855, p = 0.0004, respectively), and with XLR mode values (r = -0.632, p = 0.0274). The results of the present study demonstrate that BMSi values are strongly associated with MM, a metric that corrects the mineral content for the organic matrix content, and may also depend on organic matrix quality. These and our previous observations strongly suggest that BMSi assesses material properties of cortical bone.
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Affiliation(s)
- Stamatia Rokidi
- Ludwig Boltzmann Institute of Osteology at 1st Medical Department, Hanusch Hospital of Österreichische Gesundheitskasse (ÖGK) and Research Funds of the Austrian Workers Compensation Board (AUVA) Trauma Centre Meidling, Vienna, Austria
| | - Natalie Bravenboer
- Leiden Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
| | - Sonja Gamsjaeger
- Ludwig Boltzmann Institute of Osteology at 1st Medical Department, Hanusch Hospital of Österreichische Gesundheitskasse (ÖGK) and Research Funds of the Austrian Workers Compensation Board (AUVA) Trauma Centre Meidling, Vienna, Austria
| | | | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at 1st Medical Department, Hanusch Hospital of Österreichische Gesundheitskasse (ÖGK) and Research Funds of the Austrian Workers Compensation Board (AUVA) Trauma Centre Meidling, Vienna, Austria
| | - Eleftherios Paschalis
- Ludwig Boltzmann Institute of Osteology at 1st Medical Department, Hanusch Hospital of Österreichische Gesundheitskasse (ÖGK) and Research Funds of the Austrian Workers Compensation Board (AUVA) Trauma Centre Meidling, Vienna, Austria.
| | - Socrates Papapoulos
- Leiden Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
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Fratzl-Zelman N, Gamsjaeger S, Blouin S, Kocijan R, Plasenzotti P, Rokidi S, Nawrot-Wawrzyniak K, Roetzer K, Uyanik G, Haeusler G, Shane E, Cohen A, Klaushofer K, Paschalis EP, Roschger P, Fratzl P, Zwerina J, Zwettler E. Alterations of bone material properties in adult patients with X-linked hypophosphatemia (XLH). J Struct Biol 2020; 211:107556. [PMID: 32619592 DOI: 10.1016/j.jsb.2020.107556] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023]
Abstract
X-linked hypophosphatemia (XLH) caused by PHEX mutations results in elevated serum FGF23 levels, renal phosphate wasting and low 1,25-dihydroxyvitamin D. The glycophosphoprotein osteopontin, a potent inhibitor of mineralization normally degraded by PHEX, accumulates within the bone matrix. Conventional therapy consisting of supplementation with phosphate and vitamin D analogs is burdensome and the effects on bone material poorly characterized. We analyzed transiliac bone biopsies from four adult patients, two of them severely affected due to no diagnosis and no treatment until adulthood. We used light microscopy, qBEI and FTIRI to study histology, histomorphometry, bone mineralization density distribution, properties of the organic matrix and size of hypomineralized periosteocytic lesions. Non-treatment resulted in severe osteomalacia, twice the amount of mineralized trabecular volume, multiple osteon-like perforations, continuity of lamellae from mineralized to unmineralized areas and distinctive patches of woven bone. Periosteocytic lesions were larger than in treated patients. The latter had nearly normal osteoid thicknesses, although surface was still elevated. The median calcium content of the matrix was always within normal range, although the percentage of lowly mineralized bone areas was highly increased in non-treated patients, resulting in a marked heterogeneity in mineralization. Divalent collagen cross-links were evident independently of the mineral content of the matrix. Broad osteoid seams lacked measurable pyridinoline, a mature trivalent cross-link and exhibited considerable acidic lipid content, typically found in matrix vesicles. Based on our results, we propose a model that possibly integrates the relationship between the observed mineralization disturbances, FGF23 secretion and the known osteopontin accumulation in XLH.
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Affiliation(s)
- Nadja Fratzl-Zelman
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria.
| | - Sonja Gamsjaeger
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Stéphane Blouin
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Roland Kocijan
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria; 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Stamatia Rokidi
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Kamilla Nawrot-Wawrzyniak
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Katharina Roetzer
- Center for Medical Genetics, Hanusch Hospital, Vienna, Austria; Medical School, Sigmund Freud Private University, Vienna, Austria
| | - Gökhan Uyanik
- Center for Medical Genetics, Hanusch Hospital, Vienna, Austria; Medical School, Sigmund Freud Private University, Vienna, Austria
| | - Gabriele Haeusler
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria
| | - Elizabeth Shane
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Adi Cohen
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Eleftherios P Paschalis
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Paul Roschger
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria
| | - Peter Fratzl
- Max Planck Institute of Colloids and Interfaces, Department of Biomaterials, Potsdam, Germany
| | - Jochen Zwerina
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria; 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Elisabeth Zwettler
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria; Medical Directorate, Hanusch Hospital, Vienna, Austria
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Rokidi S, Bravenboer N, Gamsjaeger S, Misof B, Blouin S, Chavassieux P, Klaushofer K, Paschalis E, Papapoulos S, Appelman-Dijkstra N. Impact microindentation assesses subperiosteal bone material properties in humans. Bone 2020; 131:115110. [PMID: 31655220 DOI: 10.1016/j.bone.2019.115110] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/07/2019] [Revised: 09/14/2019] [Accepted: 10/14/2019] [Indexed: 11/19/2022]
Abstract
Impact microindentation (IMI) is a Reference Point Indentation technique measuring tissue-level properties of cortical bone in humans in vivo. The nature, however, of the properties that can affect bone strength is incompletely understood. In the present study we examined bone material properties in transiliac bone biopsies obtained concurrently with measurements of Bone Material Strength index (BMSi) by IMI in 12 patients with different skeletal disorders and a wide range of BMD, with or without fractures (8 males, 4 females, mean age 48±12.2 (SD) years, range 15-60 years). IMI was performed in the mid-shaft of the right tibia with a hand-held microindenter (OsteoProbe). Cancellous and cortical bone mineralization density distributions (BMDD) were measured in the entire biopsy bone area by quantitative backscattered electron imaging. Raman measurements were obtained right at the outer edge of the cortex, and 5, 50, 100, 500μm inwards. The calculated parameters were: i) Mineral and organic matrix content as well as the mineral / matrix ratio. ii) Nanoporosity. iii) Glycosaminoglycan content. iv) Pyridinoline content. v) Maturity/crystallinity of the apatite crystallites. There was no relationship between BMSi values with any measurement of mineral content of whole bone tissue (BMD, BMDD) or maturity/crystallinity of bone mineral. On the other hand, a positive correlation between BMSi and local mineral content, and an inverse correlation between BMSi and nanoporosity at the mineralized subperiosteal edge of the sample and at 5μm inwards was found. A positive correlation was also observed between BMSi and pyridinoline content at the same locations. These results indicate that local mineral content, nanoporosity and pyridinoline content at the subperiosteal site in the transiliac bone biopsy are linked to the BMSi values measured in the tibia. As both high porosity at the nano level and low pyridinoline content of the bone matrix can negatively impact bone strength, our findings suggest that BMSi most likely assesses subperiosteal bone material properties.
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Affiliation(s)
- Stamatia Rokidi
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Viennese sickness insurance funds (WGKK) and Research funds of the Austrian workers compensation board (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital Vienna, Austria
| | - Natalie Bravenboer
- Leiden Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
| | - Sonja Gamsjaeger
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Viennese sickness insurance funds (WGKK) and Research funds of the Austrian workers compensation board (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital Vienna, Austria
| | - Barbara Misof
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Viennese sickness insurance funds (WGKK) and Research funds of the Austrian workers compensation board (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital Vienna, Austria
| | - Stéphane Blouin
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Viennese sickness insurance funds (WGKK) and Research funds of the Austrian workers compensation board (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital Vienna, Austria
| | | | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Viennese sickness insurance funds (WGKK) and Research funds of the Austrian workers compensation board (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital Vienna, Austria
| | - Eleftherios Paschalis
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of Viennese sickness insurance funds (WGKK) and Research funds of the Austrian workers compensation board (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital Vienna, Austria.
| | - Socrates Papapoulos
- Leiden Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
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Rokidi S, Paschalis EP, Klaushofer K, Vennin S, Desyatova A, Turner JA, Watson P, Lappe J, Akhter MP, Recker RR. Organic matrix quality discriminates between age- and BMD-matched fracturing versus non-fracturing post-menopausal women: A pilot study. Bone 2019; 127:207-214. [PMID: 31229674 DOI: 10.1016/j.bone.2019.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 04/02/2019] [Revised: 06/16/2019] [Accepted: 06/20/2019] [Indexed: 12/29/2022]
Abstract
Women with similar areal Bone Mineral Densities (BMD) may show divergent fracture incidence due to differences in bone quality. The hypothesis tested in the present pilot study is that postmenopausal (PM) women who have sustained osteoporotic fractures have altered organic matrix quality compared to those who have not. We used Raman microspectroscopy to analyze transiliac biopsies collected from fracturing (n = 6, mean age 62.5 ± 7.4 yrs; Cases) and non-fracturing PM women (n = 6, age- and BMD-matched; mean age 62.2 ± 7.3 yrs; Controls). Previous results show differences in intrinsic material properties by nanoindentation that are more homogenously distributed and could facilitate microcrack propagation in Cases, along with lower mineral carbonate/phosphate ratio by Fourier transform infrared spectroscopic imaging, and no differences in bone tissue mineralization by digitized microradiography. No differences between groups were seen by conventional histomorphometry. Spectra were acquired 2 μm away from previously performed nanoindents, in cortical and cancellous compartments. The determined parameters were: mineral to matrix ratio (MM), and nanoporosity (a surrogate for tissue water (TW)), glycosaminoglycan (GAG), pyridinoline (Pyd; trivalent enzymatic collagen cross-link), N(6)-carboxymethyllysine (CML; advanced glycation endproduct), and pentosidine (PEN; advanced glycation endproduct) content. ANCOVA indicated no differences in any of the spectroscopic outcomes between cancellous and cortical compartments. On the other hand, Cases had lower nanoporosity (TW) and GAG, and elevated Pyd, and CML content compared to Controls. In conclusion, the results of the present study indicate significant differences in organic matrix quality in PM women that sustain fragility fractures versus age- and BMD-matched controls, highlighting its importance as a potential independent determinant of fracture incidence.
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Affiliation(s)
- S Rokidi
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Heinrich Collin Str. 30, A-1140 Vienna Austria
| | - E P Paschalis
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Heinrich Collin Str. 30, A-1140 Vienna Austria.
| | - K Klaushofer
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Heinrich Collin Str. 30, A-1140 Vienna Austria
| | - S Vennin
- Iniversity of Nebraska-Lincoln, NE, USA
| | | | | | - P Watson
- Osteoporosis Research Center, Creighton University, Omaha, NE, USA
| | - J Lappe
- Osteoporosis Research Center, Creighton University, Omaha, NE, USA
| | - M P Akhter
- Osteoporosis Research Center, Creighton University, Omaha, NE, USA
| | - R R Recker
- Osteoporosis Research Center, Creighton University, Omaha, NE, USA
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10
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Shboul M, Roschger P, Ganger R, Paschalis L, Rokidi S, Zandieh S, Behunova J, Muschitz C, Fahrleitner-Pammer A, Ng AYJ, Tohari S, Venkatesh B, Bonnard C, Reversade B, Klaushofer K, Al Kaissi A. Bone matrix hypermineralization associated with low bone turnover in a case of Nasu-Hakola disease. Bone 2019; 123:48-55. [PMID: 30316000 DOI: 10.1016/j.bone.2018.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 01/14/2023]
Abstract
Analysis of tissue from a 34-years-old male patient from Austrian origin with a history of multiple fractures associated with painful episodes over the carpal, tarsal and at the end of the long bones respectively is presented. Radiographic images and axial 3DCT scans showed widespread defects in trabecular bone architecture and ill-defined cortices over these skeletal sites in the form of discrete cystic-like lesions. Family history indicated two sisters (one half and one full biological sisters) also with a history of fractures. Whole exome sequencing revealed two heterozygous missense mutations in TYROBP (MIM 604142; NM_003332.3) gene encoding for a cell-surface adaptor protein, which is part of a signaling complex triggering activation of immune responses. It is expressed in cells of the ectoderm cell linage such as NK and dendritic cells, macrophages, monocytes, myeloid cells, microglia cells and osteoclasts. The phenotype and genotype of the patient were consistent with the diagnosis of Nasu-Hakola disease (NHD) (OMIM 221770). Investigations at the bone material level of a transiliac bone biopsy sample from the patient using polarized light microscopy and backscatter electron imaging revealed disordered lamellar collagen fibril arrangement and extensively increased matrix mineralization. These findings are the first bone material data in a patient with NHD and point toward an osteoclast defect involvement in this genetic condition.
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Affiliation(s)
- Mohammad Shboul
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan; Institute of Medical Biology, Immunos, Singapore
| | - Paul Roschger
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Med. Dept. Hanusch Hospital, Vienna, Austria.
| | - Rudolf Ganger
- Orthopedic Hospital of Speising, Pediatric Department, Vienna, Austria
| | - Lefteris Paschalis
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Med. Dept. Hanusch Hospital, Vienna, Austria
| | - Stamatia Rokidi
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Med. Dept. Hanusch Hospital, Vienna, Austria
| | - Shahin Zandieh
- Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Vienna, Austria
| | - Jana Behunova
- Institute of Medical Genetics, Medical University of Vienna, Austria
| | - Christian Muschitz
- St. Vincent Hospital - Medical Department II, The VINFORCE Study Group, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria
| | | | - Alvin Yu Jin Ng
- Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | - Sumanty Tohari
- Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | - Byrappa Venkatesh
- Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | - Carine Bonnard
- Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | | | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Med. Dept. Hanusch Hospital, Vienna, Austria
| | - Ali Al Kaissi
- Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Med. Dept. Hanusch Hospital, Vienna, Austria; Orthopedic Hospital of Speising, Pediatric Department, Vienna, Austria
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11
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Mouzakis D, Zaoutsos SP, Bouropoulos N, Rokidi S, Papanicolaou G. Influence of artificially-induced porosity on the compressive strength of calcium phosphate bone cements. J Biomater Appl 2016; 31:112-20. [DOI: 10.1177/0885328216636762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The biological and mechanical nature of calcium phosphate cements (CPC's) matches well with that of bone tissues, thus they can be considered as an appropriate environment for bone repair as bone defect fillers. The current study focuses on the experimental characterization of the mechanical properties of CPCs that are favorably used in clinical applications. Aiming on evaluation of their mechanical performance, tests in compression loading were conducted in order to determine the mechanical properties of the material under study. In this context, experimental results occurring from the above mechanical tests on porous specimens that were fabricated from three different porous additives, namely albumin, gelatin and sodium alginate, are provided, while assessment of their mechanical properties in respect to the used porous media is performed. Additionally, samples reinforced with hydroxyapatite crystals were also tested in compression and the results are compared with those of the above tested porous CPCs. The knowledge obtained allows the improvement of their biomechanical properties by controlling their structure in a micro level, and finds a way to compromise between mechanical and biological response.
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Affiliation(s)
- Dionysios Mouzakis
- Department of Mechanical Engineering, Technological Educational Institute of Thessaly, Larissa, Greece
| | | | - Nikolaos Bouropoulos
- Department of Materials Science, University of Patras, Rion, Greece
- Institute of Chemical Engineering and High Temperature Chemical Processes FORTH, Patras, Greece
| | - Stamatia Rokidi
- Department of Materials Science, University of Patras, Rion, Greece
| | - George Papanicolaou
- Composite Materials Group, Department of Mechanical and Aeronautics Engineering, University of Patras, Rion, Greece
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12
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