Abstract

Objectives: To evaluate the radiological, histological and mechanical effects on osteoporotic fracture healing of single-dose zoledronic acid (ZA) applied to an animal model with an experimentally created osteoporotic bone fracture. Methods: A total of 14 adult, female New Zealand rabbits, aged 5-6 months were used in the study. Bone mineral density (BMD) values were calculated from bone densitometry measurements and recorded. Bilateral ovariectomy was then applied to all the rabbits. At 10 weeks after ovariectomy, bone densitometry was again performed on all the animals and the BMD values were compared. Osteoporosis was accepted as having developed in animals determined with a reduction of 28% in BMD values. After the placement of a K-wire intramedullarly in the femurs of the rabbits, a closed fracture was created with the standard method. The animals were then randomly separated into 2 groups as the zoledronic acid group (ZAG) and the control group (CG). An infusion of 0.1 mg/kg ZAwas administered to the ZAG animals from the ear vein. With visualisation of bone union rabbits were sacrificed by decapitation. Radiological, mechanical and histological assesments were then applied. Results: In the histological evaluation, the mean histological score was determined as 5.00 in the ZAG and 3.00 in the CG. The difference between the groups was found to be statistically significant (p < 0.001). In the radiological evaluation, the mean score was 7.00 in the ZAG and 6.25 in the CG. Even though higher points were obtained by the ZAG in the inter-observer evaluations, the difference between the groups was not statistically significant (p = 0.073). In the mechanical evaluation, the elasticity collapse in negative proportion to rigidity was measured as 2.91 mm in the ZAG and 3.96 mm in the CG (p = 0.686). The rigidity data of the ZAG were higher in the mechanical tests but the difference between the groups was not statistically significant (p = 0.086). Conclusion: As the results of the study showed that the ZAG had higher values than those of the CG in all the histological, mechanical and radiological evaluations, the application of a single dose of ZA can be considered to increase the healing of osteoporotic fractures.

Highlights

  • Bisphosphonates, which are the most commonly used medications in the treatment of osteoporosis, inhibit bone resorption, creating an anti-catabolic effect

  • As the results of the study showed that the zoledronic acid group (ZAG) had higher values than those of the control group (CG) in all the histological, mechanical and radiological evaluations, the application of a single dose of Zoledronic acid (ZA) can be considered to increase the healing of osteoporotic fractures

  • Histological State Mature bone Immature bone and small amount of mature bone Completely immature bone present Mostly immature bone and little cartilage present Cartilage and immature bone of equal amounts Mostly cartilage and small amount of immature bone Cartilage tissue present Fibrous tissue and cartilage tissue of equal amounts Mostly fibrous tissue and small amount of cartilage tissue Fibrous tissue is present in the callus tissue of the histological section examined and mean Bone mineral density (BMD) value found as 255 ± 25 mg/cm2. 28% fall was observed between the initial BMD values of the rabbits and the BMD values at the 10th week following the ovariectomy

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Summary

Introduction

Bisphosphonates, which are the most commonly used medications in the treatment of osteoporosis, inhibit bone resorption, creating an anti-catabolic effect. Zoledronic acid (ZA) is the most potent of these medications [1]. Due to this anti-catabolic property, the ZA effect on bone healing has been examined in many experimental studies [2, 3, 4]. The healing of an osteoporotic bone is different from normal fracture healing [5]. ZA, which is frequently used in osteoporosis treatment, is known to reduce the risk of new fracture formations, its effect on fracture healing in osteoporotic patients is as yet unknown

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