Decreased Bone Strength Research Articles

The Effect of the Hip Flexion Angle in Osteonecrosis of the Femoral Head Based on China-Japan Friendship Hospital Classification - A Finite Element Study.

The alteration in the mechanical environment of the necrotic area is the primary cause of the collapse observed in osteonecrosis of the femoral head (ONFH). This study aims to evaluate the biomechanical implications of the China-Japan Friendship Hospital (CJFH) classification system and hip flexion angles on the necrotic area in ONFH using finite element analysis (FEA). The goal is to provide valuable guidance for hip preservation treatments and serve as a reference for clinical diagnosis and therapeutic interventions. Hip tomography CT scan data from a healthy volunteer was used to create a 3D model of the left hip. The model was preprocessed and imported into Solidworks 2018, based on the CJFH classification. Material parameters and boundary conditions were applied to each fractal model in ANSYS 21.0. Von Mises stresses were calculated, and maximum deformation values were obtained to evaluate the biomechanical effects of the load on the necrotic area and post-necrotic femur, as well as assess each fractal model's collapse risk. (1) At the same hip flexion angle, maximum deformation followed this order: M Type < C Type < L Type. The L3 type necrotic area experienced the most significant deformation at 0, 60, and 110° angles (1.121, 1.7913, and 1.8239 mm respectively). (2) Under the same CJFH classification, maximum deformation values increased with hip flexion angle (0 < 60 < 110°), suggesting a higher risk of collapse at larger angles. (3) Von Mises stress results showed that the maximum stress was not located in the necrotic area but near the inner and outer edge of the femoral neck, indicating decreased stiffness and strength of the subchondral bone after osteonecrosis. The study found that femoral head collapse risk was higher when the necrotic area was located in the lateral column under the same stress load and flexion angle. Mechanical properties of the necrotic area changed, resulting in decreased bone strength and stiffness. Large-angle hip flexion is more likely to cause excessive deformation of the necrotic area; thus, ONFH patients should reduce or avoid large-angle hip flexion during weight-bearing training in rehabilitation activities.

Influence of Low-Intensity Pulsed Ultrasound Parameters on the Bone Mineral Density in Rat Model: A Systematic Review.

Bone recovery typically depends on the age of organisms or the prevalence of metabolic disorders such as osteoporosis, which is a metabolic condition characterized by decreased bone strength and bone mineral density (BMD). Therefore, low-intensity pulsed ultrasound (LIPUS), a non-invasive method for osteogenic stimulation, presents promising results. However, heterogeneity in animal study designs is a typical characteristic. Hence, we conducted a systematic review to evaluate the effectiveness of LIPUS in the recovery of experimental bone defects using rat models. We examined the areal and volumetric BMD to identify LIPUS doses to be applied and evaluated the accuracy reported by previous studies. The Virtual Health Library regional portal, PubMed, Embase, EBSCOhost, Scopus and CAPES were reviewed for animal studies that compared fracture treatments based on LIPUS with sham or no treatments using rat models and reported BMD as an outcome. The tool provided by the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) and the Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies (CAMARADES) checklist were used to assess the bias and quality of such studies. Of the six studies reviewed, the most frequently used LIPUS dose had an ultrasonic frequency of 1.0MHz, repetition rate of 0.1kHz and pulse duration of 2000μs. An intensity (ISATA) of 30mW/cm2 was the most preferred for bone recovery. However, the BMD could not solely irrefutably evaluate the effectiveness of LIPUS in bone recovery as the results were discordant with each other. The discrepancies in experimental methodologies, low-quality classifications and high risk of bias in the selected studies, however, did not validate the undertaking of a meta-analysis. On the basis of the BMD results, no sufficient evidence was found to recommend the use of LIPUS for bone recovery in rat models. Thus, this systematic review indicates that the accuracy of such reports must be improved to improve their scientific quality to facilitate a transition of LIPUS applications from pre-clinical research to clinic use.

The effects of BPA-BNCT on normal bone: determination of the CBE value in mice‡.

Boron neutron capture therapy (BNCT) with p-boronophenylalanine (BPA) is expected to have less effect on the decrease in normal bone strength than X-ray therapy. However, the compound biological effectiveness (CBE) value necessary to convert the boron neutron capture reaction (BNCR) dose into a bioequivalent X-ray dose has not been determined yet. The purpose of this study was to evaluate the influence of BNCT on normal bone in mice and to elucidate the CBE factor. We first searched the distribution of BPA in the normal bone of C3H/He mice and then measured the changes in bone strength after irradiation. The CBE value was determined when the decrease in bone strength was set as an index of the BNCT effect. The 10B concentrations in the tibia after subcutaneous injection of 125, 250 and 500mg/kg BPA were measured by prompt gamma-ray spectroscopy and inductively coupled plasma (ICP)-atomic emission spectrometry. The 10B mapping in the tibia was examined by alpha-track autoradiography and laser ablation-ICP-mass spectrometry. The 10B concentration increased dose-dependently; moreover, the concentrations were maintained until 120min after BPA administration. The administered 10B in the tibia was abundantly accumulated in the growth cartilage, trabecular bone and bone marrow. The bone strength was analyzed by a three-point bending test 12weeks after irradiation. The bending strength of the tibia decreased dose-dependently after the irradiation of X-ray, neutron and BNCR. The CBE factor was obtained as 2.27 by comparing these dose-effect curves; the value determined in this study will enable an accurate dosimetry of normal bone.

Association of age-related declined renal function and osteoporosis based on trabecular bone score in Bushehr Elderly Health (BEH) program

PurposeOsteoporosis is a systemic disease characterized by decreased bone strength and an increased risk of fracture in old age. Age and pathologic renal failure are independent risk factors for osteoporosis. However, it is not determined whether age-related decreased renal function, in the context of senescence, can be considered as an independent risk factor for osteoporosis. Therefore, this study was conducted to evaluate the effect of senescence-induced renal failure on bone quality and trabecular bone score.MethodsThis study used a cross-sectional design and was carried out based on data collected during the Bushehr Elderly Health (BEH) program, Phase II. A total of 2,125 elderly participants aged over 60 years old entered the study after meeting the inclusion criteria and providing informed consent. They underwent examinations for weight, height, abdominal and hip circumference, as well as blood pressure measurement. All participants also underwent DXA to assess bone mass density (BMD). Trabecular bone score (TBS) was calculated using the DXA apparatus software output. Univariate and adjusted multivariate linear regression analyses were used to evaluate the associations.ResultsIn the univariate linear regression analysis, there was a direct correlation between age-related renal failure and TBS (β = 0.038, p < 0.0001), neck of femur BMD (β = 0.047, p < 0.0001), and lumbar BMD (β = 0.055, p < 0.0001). However, after adjusting for BMI, age, sex, smoking, and physical activity, no significant association was observed for these variables.ConclusionIt is hypothesized that age-related renal failure cannot be considered as an independent risk factor for osteoporosis in elderly individuals aged over 60 years old.

What are the risk factors for a second osteoporotic vertebral compression fracture?

BACKGROUND CONTEXTOsteoporosis is characterized by decreased bone strength and an increased risk of fracture. Osteoporosis-related fractures are associated with increased morbidity, mortality, dysfunction, access to health care, health-care costs, and reduced quality of life. Therefore, preventing osteoporotic vertebral compression fractures (OVCF) is important. Secondary OVCFs often occur after the first OVCF. PURPOSEThis study aimed to identify risk factors for a second OVCF after a first OVCF. STUDY DESIGNRetrospective observational study. PATIENT SAMPLEOne hundred seventy-eight patients from a single institution who had their first OVCF between January 1, 2000 and December 31, 2019 were enrolled in this study. OUTCOME MEASURESThe following data were observed for all cases: patient demographics, bone mineral density, and pelvic parameters. METHODSWe retrospectively reviewed patients from a single institution who had their first OVCF between January 1, 2000 and December 31, 2019. Demographic factors, medication (oral bisphosphonate, zoledronic acid, denosumab), bone mineral density (BMD), body mass index (BMI), fat, and muscle amount of the trunk using dual-energy X-ray absorptiometry (DEXA), and pelvic parameters (lumbar lordosis, sacral slope, pelvic tilt, pelvic incidence minus lumbar lordosis) were investigated. RESULTSOf 178 patients who had an OVCF, 68 (38.2%) had a second OVCF. Patients were followed up for >2 years and wore braces for an average of 6 months. The mean age was 71.9±8.63 years, mean BMD T-score was −3.1±1.09, and mean BMI was 23.3±2.96. Comparing those with and without a second OVCF, the smaller the BMD T-score and trunk muscle mass to fat ratio, the more likely a second OVCF occurred (p<.05). There were fewer second OVCF cases in the injection medication group than in the peroral group (p<.05). There were no significant differences in radiologic parameters between these groups. CONCLUSIONSPatients who had a second OVCF had an average of 21.3 months after the first OVCF. Risk factors for a second OVCF are low T-scores in the femur, and low M/F ratio of the trunk, android, and gynoid regions. For patients with an OVCF, injection medications may be advisable.

Assessment of fracture risk among postmenopausal Sudanese women: Is the fracture risk assessment score beneficial?

Objectives: Osteoporosis leads to fragile bones with a high risk of fracture. Moreover, a bone mineral density test has low sensitivity to predict fractures. Alternatively, the World Health Organization fracture risk assessment (FRAX) tool helps improve the prediction of fractures in women even before they develop osteoporosis. This study aimed to assess the risk of developing fractures in Sudanese women using the FRAX tool by studying clinical risk factors that lead to decreased bone strength. Methods: A cross-sectional community-based study was conducted in the River Nile State, Sudan (Jan 2020–June 2020). A questionnaire comprising demographic data and clinical risk factors of fragility fracture was used to determine whether these factors met the FRAX criteria. Results: Participants were 350 postmenopausal women between the ages of 51–60 (36%), with a body mass index (BMI) &gt;25 in 61.4%. In addition, 11% were exposed to oral glucocorticoids, and premature menopause occurred among 20.3%. The risk of major osteoporotic fracture was highest (&gt;20%) in approximately 7% of the women, and 16.3% of them had a high risk of hip fracture (&gt;3%). The risk for fractures increases with age, and a lower BMI is significantly associated with minimal trauma fractures. This study observed significant relationships among systemic glucocorticoid use, insulin-dependent diabetes mellitus, premature menopause, and osteoporotic fractures. All significant associations had P &lt; 0.05. Conclusion: This study observed that multiple risk factors significantly correlated with osteoporotic fractures. Therefore, the FRAX tool is useful in 10-year fracture risk predictions.

Inhibition of Osteoclast Differentiation and Promotion of Osteogenic Formation by Wolfiporia extensa Mycelium.

Osteoporosis, Greek for "porous bone," is a bone disease characterized by a decrease in bone strength, microarchitectural changes in the bone tissues, and an increased risk of fracture. An imbalance of bone resorption and bone formation may lead to chronic metabolic diseases such as osteoporosis. Wolfiporia extensa, known as "Bokryung" in Korea, is a fungus belonging to the family Polyporaceae and has been used as a therapeutic food against various diseases. Medicinal mushrooms, mycelium and fungi, possess approximately 130 medicinal functions, including antitumor, immunomodulating, antibacterial, hepatoprotective, and antidiabetic effects, and are therefore used to improve human health. In this study, we used osteoclast and osteoblast cell cultures treated with Wolfiporia extensa mycelium water extract (WEMWE) and investigated the effect of the fungus on bone homeostasis. Subsequently, we assessed its capacity to modulate both osteoblast and osteoclast differentiation by performing osteogenic and anti-osteoclastogenic activity assays. We observed that WEMWE increased BMP-2-stimulated osteogenesis by inducing Smad-Runx2 signal pathway axis. In addition, we found that WEMWE decreased RANKL-induced osteoclastogenesis by blocking c-Fos/NFATc1 via the inhibition of ERK and JNK phosphorylation. Our results show that WEMWE can prevent and treat bone metabolic diseases, including osteoporosis, by a biphasic activity that sustains bone homeostasis. Therefore, we suggest that WEMWE can be used as a preventive and therapeutic drug.

Guidelines for diagnosis and treatment of glucocorticoid-induced osteoporosis

Glucocorticoid-induced osteoporosis (GIOP) is a skeletal disease characterized by decreased bone strength and increased fracture risk associated with long-term glucocorticoid use. GIOP is the most common secondary osteoporosis that critically affects the quality of life of patients. Currently, the incidence of GIOP in China remains high, with insufficient awareness and lack of prevention and treatment norms. Therefore, the Chinese Rheumatology Association has established this standard based on domestic and international experience, with the aim of raising awareness of prevention and treatment among clinicians, guiding the standardized diagnosis and treatment of this disease, and improving the overall prognosis of patients with GIOP.

Distal Radius Fracture: A Systematic Review of Observational Studies

The purpose of this research is to analyze prevalence and incidence studies on the seasonality of trauma epidemiology with regard to distal radius fractures through a systematic review, in which cross-sectional and longitudinal studies were selected regarding the analysis of clinical and epidemiological variables associated with fractures of the distal radius. For this, MEDLINE®, LILACS, SCIELO and PUBMED platforms were used. From a total of 45,634 articles, after applying the inclusion and exclusion criteria, 18 scientific publications were eligible among the 64 read in full. According to the review, it appears that there is seasonality in distal radius fractures according to the seasons of the year. The decreased bone strength of these patients was associated with an increased risk of fracture in 10 years and individuals from a rural environment with less hospital support have a greater chance of not having an adequate post- fracture follow-up.

Osteoporosis: Recent Advances

Osteoporosis is characterized by low bone mass, microarchitectural disruption, and skeletal fragility, resulting in decreased bone strength and an increased risk of fracture. Decreased bone strength is related to many factors in addition to bone mineral density (BMD), including rates of bone turnover, bone geometry, and microarchitecture.Osteoporosis has no clinical manifestations until there is a fracture. Complications of fractures include pain, deformity, disability, and loss of height. A clinical diagnosis of osteoporosis may be made in the presence of a fragility fracture, particularly at the spine, hip, wrist, humerus, rib, and pelvis, without measurement of BMD.In the absence of a fragility fracture, BMD assessment by dual-energy x-ray absorptiometry (DXA) is the standard test to diagnose osteoporosis, according to the classification of the World Health Organization. A DXA T-score d”-2.5 is consistent with osteoporosis, whereas a T-score between -1 and -2.5 isosteopenia.All postmenopausal women with osteoporosis should have a history, physical examination, and basic laboratory evaluation. Initial laboratory studies should include a complete blood count (CBC), biochemistry profile, and 25- hydroxyvitamin D (25[OH]D).The need for additional laboratory evaluation depends upon the initial evaluation and Z-score. Women who have abnormalities on initial laboratory testing, suspicious findings on history and physical examination suggesting a secondary cause of osteoporosis, or Zscores d”-2 may require additional evaluation for these secondary causes.Lifestyle measures should be adopted universally to reduce bone loss in postmenopausal women. Lifestyle measures include adequate calcium and vitamin D, exercise, smoking cessation, counseling on fall prevention, and avoidance of heavy alcohol use. In general, 1200 mg of elemental calcium daily, total diet plus supplement, and 800 international units of vitamin D daily are advised. Many patients require vitamin D supplementation as it is difficult to achieve goals with diet alone. Postmenopausal women with established osteoporosis (T-score d”-2.5) or fragility fracture be treated with a pharmacologic agent. For the treatment of high-risk postmenopausal women with T-scores between -1.0 and -2.5, better to start pharmacologic therapy. Most women, for the initial treatmentoral bisphosphonates is good choice.For severe osteoporosis, some experts prefer initial treatment with an anabolic agent, whereas other experts prefer initial treatment with bisphosphonates. Teriparatide and abaloparatide are good anabolic agent. Romosozumab is an alternative. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 194

LncRNA LINC00205 stimulates osteoporosis and contributes to spinal fracture through the regulation of the miR-26b-5p/KMT2C axis

BackgroundOsteoporosis (OP) is a common bone disease marked by decreased bone strength. Increasing evidence suggests that long non-coding RNA (lncRNAs) play important roles in the occurrence and progression of OP. This study aimed to investigate the role and mechanism of LINC00205 in the osteogenic differentiation of human mesenchymal stem cells (hMSCs) and OP.MethodsBone tissue samples were obtained from healthy controls and patients with osteoporosis with a spinal fracture (OP-Frx) or without a spinal fracture (OP-no-Frx). HMSCs were cultured and induced to undergo osteogenic differentiation. The expression of LINC00205, lysine (K)-specific methyltransferase 2C (KMT2C), and miR-26b-5p in bone tissues and cells was evaluated using western blotting and real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). The effects of LINC00205, miR-26b-5p, and KMT2C on calcium deposition, alkaline phosphatase (ALP) activity, and mRNA levels of the osteogenic differentiation marker genes [ALP, osteocalcin (OCN), and runt-related transcription factor 2 (RUNX2)] were investigated using alizarin red S staining, an ALP activity assay, and qRT-PCR, respectively. Dual-luciferase reporter assay was performed to ascertain the binding relationship between miR-26b-5p and LINC00205/KMT2C.ResultsLINC00205 and KMT2C were upregulated in patients with OP-Frx and OP-no-Frx, whereas miR-26b-5p was downregulated. Furthermore, LINC00205 and KMT2C expression decreased, whereas that of miR-26b-5p increased over time from day 7 to 21 of the osteogenic differentiation of hMSCs. The knockdown of LINC00205 and KMT2C significantly increased ALP activity, calcium deposition, and the expression of RUNX2, ALP, and OCN. In contrast, the inhibition of miR-26b-5p yielded the opposite result. These data suggest that LINC00205 inhibits the osteogenic differentiation of hMSCs by modulating the miR-26b-5p/KMT2C signaling axis.ConclusionLINC00205 promotes OP and is involved in spinal fractures. LINC00205 is also a potential negative regulator of the osteogenic differentiation of hMSCs.

Development of a personalized fall rate prediction model in community-dwelling older adults: a negative binomial regression modelling approach

BackgroundAround a third of adults aged 65 and older fall every year, resulting in unintentional injuries in 30% of the cases. Fractures are a frequent consequence of falls, primarily caused in individuals with decreased bone strength who are unable to cushion their falls. Accordingly, an individual’s number of experienced falls has a direct influence on fracture risk. The aim of this study was the development of a statistical model to predict future fall rates using personalized risk predictors.MethodsIn the prospective cohort GERICO, several fall risk factor variables were collected in community-dwelling older adults at two time-points four years apart (T1 and T2). Participants were asked how many falls they experienced during 12 months prior to the examinations. Rate ratios for the number of reported falls at T2 were computed for age, sex, reported fall number at T1, physical performance tests, physical activity level, comorbidity and medication number with negative binomial regression models.ResultsThe analysis included 604 participants (male: 122, female: 482) with a median age of 67.90 years at T1. The mean number of falls per person was 1.04 and 0.70 at T1 and T2. The number of reported falls at T1 as a factor variable was the strongest risk factor with an unadjusted rate ratio [RR] of 2.60 for 3 falls (95% confidence interval [CI] 1.54 to 4.37), RR of 2.63 (95% CI 1.06 to 6.54) for 4 falls, and RR of 10.19 (95% CI 6.25 to 16.60) for 5 and more falls, when compared to 0 falls. The cross-validated prediction error was comparable for the global model including all candidate variables and the univariable model including prior fall numbers at T1 as the only predictor.ConclusionIn the GERICO cohort, the prior fall number as single predictor information for a personalized fall rate is as good as when including further available fall risk factors. Specifically, individuals who have experienced three and more falls are expected to fall multiple times again.Trial registrationISRCTN11865958, 13/07/2016, retrospectively registered.

The effect of shock waves on mineralization and regeneration of distraction zone in osteoporotic rabbits

Objective Osteoporotic individuals suffer from various complications such as spontaneous bone fractures due to decreased bone strength and failure in bone healing as a result of decreased bone mineral density and deterioration of bone microstructure. In this study, the effects of Extracorporeal Shock Wave Therapy (ESWT) in a distraction osteogenesis model in osteoporotic rabbits were investigated to prevent these failures and improve bone microstructure. Material and Methods A total of 28 female New Zealand rabbits underwent mandibular distraction osteogenesis and were divided into four groups: non-ovariectomized control (Cont), ovariectomized control (O-Cont), ovariectomized ESWT1 (O-ESWT1) and ovariectomized ESWT2 (O-ESWT2). ESWT was only applied to the ESWT2 group before the osteotomy, and to both the ESWT1 and ESWT2 groups after the osteotomy. Dual-energy x-ray absorptiometry was used to determine bone mineral density on both the 7th and 28th day of the consolidation. Stereological methods were used to identify new bone formation, connective tissue and neoangiogenesis volume. Results According to the dual-energy x-ray absorptiometry examination both at the 7th and 28th day of the consolidation, lower bone mineral density was seen in the ESWT groups. However, the stereological examination showed that shock wave therapy significantly increased new bone formation both ESWT1 and ESWT2 compared with O-Cont, significantly increased neoangiogenesis in O-ESWT1 compared with O-Cont. Conclusions The application of ESWT in these parameters after osteotomy was beneficial for bone regeneration in mandibular distraction in osteoporotics. However, ESWT has been shown to be ineffective in improving bone mineral density. KEY MESSAGES The osteoporotic model can be successfully established in rabbits and the subjects can tolerate the distraction procedures. Stereology is a useful analysis method that can determine the volume of the new bone formation and neoangiogenesis. Extracorporeal shock wave therapy has biostimulatory effects on bone tissue.

A Scoping Review of the Recent Clinical Practice Regarding the Evaluation of Bone Mineral Density in Children and Adolescents with Neuromuscular Diseases

Introduction: Neuromuscular Diseases (NMD) are associated with decreased bone strength due to altered muscle-bone interaction. However, the evaluation of bone quality remains a certain challenge in these patients. The purpose of this scoping review is to investigate the recent literature regarding the assessment of Bone Mineral Density (BMD) in this population. Methods: An electronic search of the PubMed and Scopus database was performed considering studies published in the English literature after 2007 that evaluated BMD in pediatric and adolescent patients with NMD. We excluded studies that evaluated patients > 20 years, studies not involving humans, and studies investigating bone mineral density in various pediatric conditions, but without specific data on NMD. Results: Overall, 19 studies were included that evaluated BMD in 1983 patients with NMD. Duchenne Muscular Dystrophy was the most widely studied disease (n = 11 studies). Dual energy X-ray absorptiometry (DEXA) was the most common diagnostic modality for BMD evaluation, while the most frequent site for BMD measurement was the lumbar spine (89.4%, n = 17 studies), followed by total body BMD (68.4%, n = 13 studies). Low BMD in children with NMD was demonstrated in all studies, especially after loss of ambulation. Moreover, a positive correlation between lower BMD and older age was shown. Conclusions: BMD evaluation in NMD remains a clinical challenge, as indicated by the high heterogeneity regarding the optimal site and technique for the evaluation of bone quality in these patients. Although DXA is currently the diagnostic modality of choice, a consensus regarding the optimal site for BMD measurement, and the adjustment method for its obtained measurements for parameters such as age and height is needed.

The Effect of General Bone Mineral Density on the Quantity and Quality of the Edentulous Mandible: A Cross-Sectional Clinical Study

Osteoporosis is a disease which is characterized by a decrease in general bone mineral density (BMD), resulting in decreased bone strength and an increased risk of bone fractures. The effect of reduced BMD on the jawbones is still not fully understood. The purpose of the study was to evaluate the impact of BMD on the quality and quantity of the edentulous mandible. The present study included 127 edentulous postmenopausal women who underwent cone beam computed tomography (CBCT) examinations. BMD measurements of the lumbar spine and femoral necks were performed by dual-energy X-ray absorptiometry. In the cross-sectional CBCT images, three different areas of the mandible (lateral incisor, first premolar, and first molar) were selected. The complete mandibular, trabecular, and cortical bone volumes were measured. All measurements were performed on the total mandibular area, and the basal and alveolar parts of the mandible. The volume of the cortical bone was reduced for females with reduced BMD in the lateral incisor and first premolar regions, both in the total mandibular area and in the basal part of the mandible. The trabecular bone volume statistically significantly increased when the BMD decreased in the complete mandibular area and the basal part of the mandible (linear regression). The total bone volume significantly decreased with a decrease in BMD in the basal part of the mandible. Reduced BMD has a negative effect on the quantity and quality of bone in the basal part of the edentulous mandible.

СОВРЕМЕННЫЕ ПОДХОДЫ К ДИАГНОСТИКЕ И ЛЕЧЕНИЮ КОСТНЫХ КИСТ У ДЕТЕЙ

An analysis of the world literature on approaches to the diagnosis and treat-ment of bone cysts in children, as well as pathological fractures resulting from a decrease in bone strength associated with the thinning of its cortical layer, was carried out. To date, there is not enough clarity about the need to use one or an-other method of treatment, which indicates the relevance of this problem and the need to develop a differentiated approach to managing patients with this pathol-ogy. The main direction in the research and development of the approach is the combination of the puncture method of treatment with steroid injections in com-bination with elastically stable intramedullary reinforcement, which practically excludes the possibility of a pathological fracture, with simultaneous equalization of intracanal pressure and the creation of an additional drainage system using TEN (Titanium Elastic Nail).

Utility of bone turnover markers in metabolic bone diseases

Bone turnover markers (BTMs) are biochemical indicators that provide information about the rate of bone remodeling, which involves the continuous process of bone formation and bone resorption. BTMs are measured in blood or urine samples and are used in the diagnosis, monitoring, and management of various metabolic bone diseases. They aid in the diagnosis of metabolic bone diseases by providing information about the bone turnover status. Abnormal levels of BTMs can indicate increased bone resorption or decreased bone formation, which are characteristic of certain conditions such as osteoporosis, osteomalacia, or Paget's disease. BTMs can provide insights into the severity of metabolic bone diseases. For example, in osteoporosis, elevated levels of bone resorption markers such as C-terminal telopeptide of type I collagen (CTX) or tartrate-resistant acid phosphatase 5b (TRACP-5b) indicate increased bone breakdown and higher fracture risk. Similarly, low levels of bone formation markers like procollagen type I N-terminal propeptide (PINP) or osteocalcin can indicate reduced bone formation and decreased bone strength. BTMs are valuable tools for assessing the response to treatment in metabolic bone diseases. Changes in BTM levels over time can indicate the effectiveness of interventions such as pharmacotherapy, lifestyle modifications, or surgical interventions. Decreased levels of bone resorption markers or increased levels of bone formation markers suggest a positive response to treatment, whereas persistent abnormal BTM levels may indicate the need for treatment adjustment. It's important to note that BTMs should be interpreted in conjunction with other clinical factors and imaging studies. They provide valuable information about bone turnover dynamics but should not be relied upon as standalone diagnostic or prognostic tools.

Osteoporoza

Osteoporosis is the most frequent metabolic bone disease. It is characterized by decreased bone strength and bone fractures and consequently decreased quality of life with increased morbidity and mortality. It affects the population of postmenopausal women and older people of both gender, but also patients with other primary diseases. Modern diagnostic procedures such as bone mineral density measurement, trabecular bone score (TBS) measurement, and fracture assessment risk score (FRAX) enable early diagnosis and treatment in high-risk patients. The complex etiology and pathophysiology of osteoporosis require secondary causes to be differentiated from primary osteoporosis before the most optimal treatment is initiated. The treatment should be personalized. Two methods of treatment are antiresorptive treatment aimed toward the inhibition of bone degradation and anabolic treatment with stimulation of new bone formation. Ideally, the prevention of fractures should be the treatment of choice, otherwise, prevention of new fractures and improvement of life is the therapeutic goal. Bisphosphonates are the first line antiresorptive treatment together with denosumab, a monoclonal human antibody against RANK ligand (receptor activator of nuclear factor kappa B). Teriparatide, an N-terminal parathormone fragment, is the dominant anabolic drug. Vitamin D deficiency is a widespread problem and contributes to bone mass decrement and increased risk for fractures. With further advancements in understanding the biology of bone tissue, new therapeutic agents are expected in the treatment of patients with osteoporosis.

Fabrication, assessment, and optimization of alendronate sodium nanoemulsion-based injectable in-situ gel formulation for management of osteoporosis

Low bone mass, degeneration of bone tissue, and disruption of bone microarchitecture are all symptoms of the disease osteoporosis, which can decrease bone strength and increase the risk of fractures. The main objective of the current study was to use a phospholipid-based phase separation in-situ gel (PPSG) in combination with an alendronate sodium nanoemulsion (ALS-NE) to help prevent bone resorption in rats. The effect of factors such as concentrations of the ALS aqueous solution, surfactant Plurol Oleique CC 497, and Maisine CC oil on nanoemulsion characteristics such as stability index and globular size was investigated using an l-optimal coordinate exchange statistical design. Injectable PPSG with the best nanoemulsion formulation was tested for viscosity, gel strength, water absorption, and in-vitro ALS release. ALS retention in the rats’ muscles was measured after 30 days. The droplet size and stability index of the optimal nanoemulsion were 90 ± 2.0 nm and 85 ± 1.9%, respectively. When mixed with water, the optimal ALS-NE–loaded PPSG became viscous and achieved 36 seconds of gel strength, which was adequate for an injectable in-situ formulation. In comparison with the ALS solution–loaded in-situ gel, the newly created optimal ALS-NE–loaded PPSG produced the sustained and regulated release of ALS; hence, a higher percentage of ALS remained in rats’ muscles after 30 days. PPSG that has been loaded with an ALS-NE may therefore be a more auspicious, productive, and effective platform for osteoporosis treatment than conventional oral forms.

Investigation on physical exercise-induced interstitial fluid flow in bone tissue to mitigate osteoporosis and disuse bone loss

Osteoporosis and disuse bone loss in elderly individuals, bed-ridden patients, and astronauts are serious health issues. Severe bone loss increases bone porosity and thus decreases bone strength which further promotes bone fractures. Prophylactic exercise is beneficial in preventing bone loss as mechanical loading enhances bone modeling and remodeling activities. Loading-induced fluid flow within the bone tissue is considered as stimulus of excitation of mechanosensory bone cells, i.e., osteocytes, which regulate the osteoactivities related to bone remodeling. In vivo and in silico studies observed that bone loss adversely influences the bone microarchitecture, such as porosity and permeability, which reduces interstitial fluid flow required for the bone remodeling process. Physical exercise-induced mechanical loads on bone may enhance interstitial fluid flow above the osteogenic threshold. Nevertheless, how physiological loading associated with exercise influences interstitial fluid flow in osteoporotic/disused bone tissue is not well established. Thus, the present study computes the interstitial fluid flow in healthy and osteoporotic/disused cortical bone tissue as a function of gait loading waveforms of physical exercise using a poromechanical finite element model. The outcomes indicate that osteoporotic and disused cortical bone tissue with greater porosity and less permeability experience comparatively lower pore pressure and fluid velocity than healthy tissue. Moreover, physiological loading exercise enhances fluid flow in diseased tissue, which is helpful in exciting bone cells for improvement in bone remodeling. Overall, the findings of the present investigation may be beneficial in the design of potential physiological exercises to prevent osteoporotic and disuse bone loss.