Bone Osteoporotic Fractures Research Articles

Osteoporotic bone fracture risk assessment in Latvian patients with newly diagnosed sarcoidosis.

Increased calcitriol synthesis in sarcoid granulomas with subsequent hypercalcaemia and hypercalciuria can affect bone metabolism in patients with sarcoidosis. Multiple factors can increase the fracture risk in patients with sarcoidosis. This study aimed to evaluate a 10-year osteoporotic and a 10-year hip fracture risk and to analyse factors affecting fracture risk for patients with newly diagnosed sarcoidosis compared to an age- and gender-matched control group from a real-world setting. The cross-sectional study included 171 patients with a histologically verified diagnosis of sarcoidosis who were hospitalised due to suspected sarcoidosis within two years and an age- and gender-matched control group of 178 hospitalised individuals. QFracture algorithm questions were asked during interviews. A cohort of 349 subjects was analysed. The median age in the patient group was 40 years (IQR:20), and 60.2% were female. 21.6% of patients with sarcoidosis had at least one comorbidity that could potentially influence the osteoporotic fracture risk. Both the median 10-year osteoporotic fracture risk (0.9% (IQR:2) vs 1.3% (IQR:2.3), p=0.005; U=12394) and a 10-year hip fracture risk (0.1% (IQR:0.3) vs 0.2% (IQR:0.5), p=0.003; U=12368.5) was lower in patients with sarcoidosis compared to control group subjects. As compared to the control group, individuals with sarcoidosis exhibited a lower frequency of both osteoporotic (2.4% vs 11.2%, OR=0.189 (95% CI:0.063-0.566), p=0.003) and low-energy trauma fractures (2.9% vs 11.8%, OR=0.225 (95% CI:0.083-0.612), p=0.003) in personal medical history. This was the first study to investigate osteoporotic fracture risk and related factors in Latvian patients with newly diagnosed sarcoidosis. Our data show a lower risk of a 10-year osteoporotic and a 10-year hip fracture risk in patients with sarcoidosis compared to age- and gender-matched control group subjects from a real-world setting.

A novel model of locking plate and locking spongious screw: a biomechanical in vitro comparison study with classical locking plate

BackgroundLocking plates are commonly used for the fixation of comminuted, periprosthetic and osteoporotic bone fractures. These plates are secured to the bone with screws, creating a stable connection with fixed angle between the plate and the screws. In this biomechanical in vitro study, our aim is to evaluate and compare the novel locking plate-locking spongious screw model with FDA approved classical locking plate.MethodsSawbone PCF-15 osteoporotic bone model was utilized to simulate osteoporotic bone conditions. Two screws were used to attach both the classical locking plate and the novel locking plate-locking spongious screw model to these bone models. The attachment strength of the screws to the bone blocks was measured by pull-out tests.ResultsNovel locking plate-locking spongious screw model exhibited an 84.38% stronger attachment to the osteoporotic bone model compared to the current locking plate model.ConclusionsIn conclusion, one of the important problems in the locking plates which is the high Pull-out risk of the locking spongious screws can been resolved with our proposed new model and has a chance of having a better purchase especially in osteoporotic bones.

Primary stability in locking plate fixation for proximal humeral fractures may be increased by using an additional nail osteosynthesis in combination with locking plate osteosynthesis—A biomechanical comparison

BackgroundStability is regarded as an important factor for proper healing and avoiding secondary dislocation in osteoporotic fractures of the proximal humerus. Several surgical techniques have been proposed for treatment, including intramedullary nail osteosynthesis and locking plate fixation. This study introduces a novel approach that combines both techniques and compares its primary stability with conventional methods. MethodsThe study involved 25 osteoporotic humeri with two-part fracture models, which were randomly assigned to locking-plate fixation, intramedullary nailing, or a combination of both techniques. The specimens were subjected to sinusoidal loading at 250 N in 20° abduction for 5000 cycles and then to quasi-static loading until failure. Fracture movement, failure mode, and failure load were measured and compared among the groups. FindingsThe groups fixated with intramedullary nailing and the groups fixated with intramedullary nailing and locking plate fixation showed significantly lower fracture motion than the group using locking plate fixation only (p < 0.005) and significantly higher load to failure (p = 0.007 and p = 0.0062, respectively). There was no significant difference between the group using intramedullary nailing and the group using locking-plate fixation and intramedullary nailing in fracture movement or load-to-failure (p > 0.005). InterpretationThe results indicate that locking plate fixation provides less primary stability than intramedullary nailing or the combined of both techniques. This combined approach may offer advantages as a treatment for complex proximal humeral fractures in osteoporotic bone, and specific implants should be developed to ensure optimal treatment.

Interfragmentary compression force and fixation stability of lateral tibial plateau fractures in normal and osteoporotic bones.

Lateral platform collapse in fixations of lateral tibial plateau fractures (TPFs) using either double-lag screws fixation (DSF) or locking-plate fixation (LPF) is not rare. This study aimed to explore the effect of enhancing the interfragmentary compression force (IFCF) on fixation stability in lateral TPFs in normal and osteoporotic bones using finite element analysis. Finite element models of DSF in normal bone and LPF in normal and osteoporotic bones were established to simulate the fixations of lateral TPF. After model validation, axial compressive forces of 500, 1000, 1500, and 2500 N to the tibial plateau along with an IFCF of 0, 100, 200, and 300 N were applied. The maximum axial micromotion of the lateral fragment (MAM-LF), maximal translational micromotion of the lateral fragment (MTM-LF), peak von Mises stress (VMS), and peak equivalent elastic strain of the lateral fragment (EES-LF) were evaluated. The MAM-LF showed a decreasing trend as the IFCF increased in all models. For DSF models, the peak VMS of implants increased as the IFCF increased when the axial loads were 500 and 1000 N. The peak EES-LF decreased as the IFCF increased under axial loads of 1000, 1500, and 2500 N. For the normal and osteoporotic LPF models, the peak VMS of the implants decreased as the IFCF increased. Peak EES-LF decreased as IFCF increased. In conclusion, enhancing IFCF was beneficial in improving the fixation stability of lateral TPF. The optimal IFCF for DSF and LPF should be as high as reasonably feasible.

Biomaterials for surgical repair of osteoporotic bone defects

As the global population ages, osteoporotic bone fractures leading to bone defects are increasingly becoming a significant challenge in the field of public health. Treating this disease faces many challenges, especially in the context of an imbalance between osteoblast and osteoclast activities. Therefore, the development of new biomaterials has become the key. This article reviews various design strategies and their advantages and disadvantages for biomaterials aimed at osteoporotic bone defects. Overall, current research progress indicates that innovative design, functionalization, and targeting of materials can significantly enhance bone regeneration under osteoporotic conditions. By comprehensively considering biocompatibility, mechanical properties, and bioactivity, these biomaterials can be further optimized, offering a range of choices and strategies for the repair of osteoporotic bone defects.

Linking bone marrow fat with decreased bone mineral density among Indian patients with osteoporotic fracture.

Osteoporosis is a systemic skeletal disorder with low-bone mass causing micro-architectural deterioration and an increase in bone fragility and susceptibility to fractures. According to a worldwide report by IOF, 1 in 3 females and 1 in 5 males will experience fractures due to the osteoporotic changes in their bones. Fractures may be the first clinical manifestation of the disease. They have been causes for morbidity and mortality imposing economic burden to osteoporosis. Bone marrow fat is a negative regulator of bone-turnover and a key integrator of bone and energy metabolism. Hence we assess the bone marrow fat and BMD in patients with osteoporotic bone fractures. This cross-sectional study was conducted in 30 patients from the department of orthopaedic surgery. Biopsy samples were received from excised bone during surgery. Biochemical parameters and bone marrow fat were quantified by established methods. A negative correlation between BMD versus serum adiponectin, FGF21 and similar observation with BMD versus bone marrow fat is seen. Therefore, increased bone-marrow fat and adiponectin, FGF21 levels and decreased BMD in osteoporosis. This observation might be useful for prevention, management and therapeutic potential of osteoporosis. Based on our study findings, understand the bone-fat relationship to implications with low BMD in patients with osteoporosis.

Secondary Displacement was Common in Healing Distal Femur Fractures in a Cohort of Elderly Patients.

Surgical treatment of distal femoral fractures (DFFs) in osteoporotic bone is challenging despite improvements in hardware and surgical techniques. The occurrence and degree of secondary displacement during healing after bridging plate fixation are still unknown. This study aimed to assess the occurrence and degree of secondary displacement in healing DFFs in elderly patients and correlate the secondary displacement to body mass index, bone density, and weight-bearing regimen. The study involved 32 patients, 65years or older, with a DFF of AO/OTA types 33 A2-3, B1-2, C1-2, and 32(c) A-C,1-3, including peri-prosthetic fractures with stable implants. Twenty-seven patients had at least 8weeks of follow-up, and 21 patients had a complete 1-year follow-up. Minimally invasive surgery was performed using a distal anatomical femoral plate as a long bridge-plating construct. Secondary displacement was assessed with computed tomography of the entire femur postoperatively and at 8, 16, and 52weeks. Femoral length, coronal angulation (varus/valgus), and subsidence as the change in distance between the distal joint surface and a specified locking screw were measured. There was a statistically significant mean femoral shortening at 52weeks of 4.7mm (SD 3.9, (95% CI 2.9-6.5), P < 0.001) mainly by subsidence of the distal fragment. Most patients experienced limited coronal angulation. There was no correlation between body mass index or bone density and secondary displacement. At the 1-year follow-up, no patient needed revision surgery for non-union or plate breakage. Restricted weight-bearing for 8weeks did not prevent secondary displacements or adverse events such as cut-outs. Modern dynamic plate osteosynthesis could not prevent commonly occurring fracture subsidence in DFF in an elderly cohort. Restricted weight-bearing for 8weeks did not prevent secondary displacements or mechanical adverse events.

The Potential Therapeutic Effects of Platelet-Derived Biomaterials on Osteoporosis: A Comprehensive Review of Current Evidence

Osteoporosis is a chronic multifactorial condition that affects the skeletal system, leading to the deterioration of bone microstructure and an increased risk of bone fracture. Platelet-derived biomaterials (PDBs), so-called platelet concentrates, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), have shown potential for improving bone healing by addressing microstructural impairment. While the administration of platelet concentrates has yielded positive results in bone regeneration, the optimal method for its administration in the clinical setting is still debatable. This comprehensive review aims to explore the systemic and local use of PRP/PRF for treating various bone defects and acute fractures in patients with osteoporosis. Furthermore, combining PRP/PRF with stem cells or osteoinductive and osteoconductive biomaterials has shown promise in restoring bone microstructural properties, treating bony defects, and improving implant osseointegration in osteoporotic animal models. Here, reviewing the results of in vitro and in vivo studies, this comprehensive evaluation provides a detailed mechanism for how platelet concentrates may support the healing process of osteoporotic bone fractures.

MRI Detection of Osteoporosis Bone Fractures Opposed to DEXA Scan

The study emphasizes the advancement achieved through Magnetic Resonance Imaging (MRI) technology in identifying bone fractures, particularly in cases such as osteoporosis. The paper explores the utilization of MRI in examining bone health to determine fracture risks, particularly those caused by osteoporosis while identifying the limitations of Dual-Energy X-ray absorptiometry (DEXA) scans for comprehensive insights. As evident, the utilization of DEXA scans permits the measurement of Bone Mineral Density (BMD) and the identification of fracture susceptibility. However, the depth of information provided by DEXA scans falls short of that attainable through MRI scans. The researcher's strategy involves a comprehensive evaluation of methods for assessing bone health, encompassing the significance of BMD and the limitations associated with DEXA scans. Moreover, the study delves into the potential utilization of MRI in offering a holistic measurement of bone health and mitigating the risk of osteoporotic fractures. As revealed, MRI meticulously examines bone properties via a process involving magnetic manipulation of protons, creating cross-sectional images that offer unique insights into internal structure. MRI surpasses DEXA in detecting Osteoporotic Bone Fractures, offering a comprehensive understanding essential for treatment planning and patient recovery. Its early detection prevents complications and guides interventions effectively. This technique employs T1-weighted, T2-weighted, and proton-density imaging to analyze complex bone webs. Therefore, the researcher strongly recommends further research to harness MRI's evolving capabilities, enabling more accurate, individualized assessments of fracture risks and treatment strategies, ultimately enhancing fracture care with precise diagnoses and tailored approaches for improved health outcomes.

Anterior column acetabulum fracture fixation with a screw-augmented acetabular cup—a biomechanical feasibility study

BackroundThe beneficial effects of unrestricted postoperative full weight bearing for elderly patients suffering hip fractures have been demonstrated. However, there is still existing disagreement regarding acetabular fractures.The aim of this biomechanical study was to evaluate the initial load bearing capabilities of different fixation constructs of anterior column fractures (ACFs) in osteoporotic bone. MethodsArtificial pelvises with ACFs were assigned to three groups (n = 8) and fixed with either a 7.3 mm partially threaded antegrade cannulated screw (group AASS), an anteriorly placed 3.5 mm plate (group AAPF), or a press-fit acetabular cup with screw augmentation (group AACF). All specimens underwent ramped loading from 20 N preload to 200 N at a rate of 18 N/s, followed by progressively increasing cyclic testing at 2 Hz until failure performed at a rate of 0.05 N/cycle. Relative displacements of the bone fragments were monitored by motion tracking. FindingsInitial stiffness (N/mm) was 118.5 ± 34.3 in group AASS, 100.4 ± 57.5 in group AAPF, and 92.9 ± 44.0 in group AACF, with no significant differences between the groups, p = 0.544. Cycles to failure were significantly higher in groups AACF (8364 ± 2243) and AAPF (7827 ± 2881) compared to group AASS (4440 ± 2063), p ≤ 0.041. InterpretationFrom a biomechanical perspective, the minimally invasive cup fixation with screw augmentation demonstrated comparable stability to plate osteosynthesis of ACFs in osteoporotic bone. The results of the present study do not allow to conclusively answer whether immediate full weight bearing following cup fixation shall be allowed. Given its similar performance to plate osteosynthesis, this remains rather an utopic wish and a more conservative approach deems more reasonable.

Metal-organic Zn-zoledronic acid and 1-hydroxyethylidene-1,1-diphosphonic acid nanostick-mediated zinc phosphate hybrid coating on biodegradable Zn for osteoporotic fracture healing implants.

Zn and its alloys are increasingly under consideration for biodegradable bone fracture fixation implants owing to their attractive biodegradability and mechanical properties. However, their clinical application is a challenge for osteoporotic bone fracture healing, due to their uneven degradation mode, burst release of zinc ions, and insufficient osteo-promotion and osteo-resorption regulating properties. In this study, a type of Zn2+ coordinated zoledronic acid (ZA) and 1-hydroxyethylidene-1,1-diphosphonic acid (HEDP) metal-organic hybrid nanostick was synthesized, which was further mixed into zinc phosphate (ZnP) solution to mediate the deposition and growth of ZnP to form a well-integrated micro-patterned metal-organic/inorganic hybrid coating on Zn. The coating protected noticeably the Zn substrate from corrosion, in particular reducing its localized occurrence as well as suppressing its Zn2+ release. Moreover, the modified Zn was osteo-compatible and osteo-promotive and, more important, performed osteogenesis in vitro and in vivo of well-balanced pro-osteoblast and anti-osteoclast responses. Such favorable functionalities are related to the nature of its bioactive components, especially the bio-functional ZA and the Zn ions it contains, as well as its unique micro- and nano-scale structure. This strategy provides not only a new avenue for surface modification of biodegradable metals but also sheds light on advanced biomaterials for osteoporotic fracture and other applications. STATEMENT OF SIGNIFICANCE: Developing appropriate biodegradable metallic materials is of clinical relevance for osteoporosis fracture healing, whereas current strategies are short of good balance between the bone formation and resorption. Here, we designed a micropatterned metal-organic nanostickmediated zinc phosphate hybrid coating modified Zn biodegradable metal to fulfill such a balanced osteogenicity. The in vitro assays verified the coated Zn demonstrated outstanding pro-osteoblasts and anti-osteoclasts properties and the coated intramedullary nail promoted fracture healing well in an osteoporotic femur fracture rat model. Our strategy may offer not only a new avenue for surface modification of biodegradable metals but also shed light on better understanding of new advanced biomaterials for orthopedic application among others.

Ascorbic acid reduces Ropivacaine-induced myotoxicity in cultured human osteoporotic skeletal muscle cells

BackgroundOsteoporosis is a worldwide health issue. Loss of bone mass is a potential risk factor for fragility fractures, and osteoporotic fractures place a considerable burden on society. Bone and muscle represent a functional unit in which the two tissues are intimately interconnected. Ropivacaine is a potent local anesthetic used in clinical practice for intraoperative anesthesia and postoperative pain management, in particular for hip surgery. When injected, Ropivacaine can diffuse locally through, in particular in surrounding skeletal muscle tissue, causing dose-dependent cytotoxicity, oxidative stress and myogenesis impairment. Based on those evidences, we focused our attention on Ropivacaine-induced cytotoxicity on cultured human myoblasts.MethodsPrimary human myoblasts and myotubes from healthy subjects, osteoarthritic and osteoporotic patients (OP) were cultured in the presence of Ropivacaine. In some experiments, ascorbic acid (AsA) was added as a potent antioxidant agent. Cell viability and ROS levels were evaluated to investigate the myotoxic activity and Real-Time PCR and Western blot analysis carried out to investigate the expression of proliferation and myogenic markers.ResultsA dose-dependent decrease of cell viability was observed after Ropivacaine exposure in both OP myoblasts and myotubes cultures, whereas those effects were not observed in the presence of Propofol, a general anesthetic. The adding of AsA reduced Ropivacaine negative effects in OP myoblast cultures. In addition, Ropivacaine exposure also increased ROS levels and upregulated Nox4 expression, an enzyme primarily implicated in skeletal muscle ROS generation. AsA treatment counteracted the oxidant activity of Ropivacaine and partially restored the basal condition in cultures. Positive myogenic markers, such as MyoD and Myf5, were downregulated by Ropivacaine exposure, whereas myostatin, a negative regulator of muscle growth and differentiation, was upregulated. The phenotypic deregulation of myogenic controllers in the presence of Ropivacaine was counteracted by AsA treatment.ConclusionsOur findings highlight the oxidative stress-mediated myotoxic effect of Ropivacaine on human skeletal muscle tissue cell cultures, and suggest treatment with AsA as valid strategy to mitigate its negative effects and allowing an ameliorated functional skeletal muscle recovery in patients undergoing hip replacement surgery for osteoporotic bone fracture.

Long-term outcomes of childhood steroid-sensitive nephrotic syndrome

Objective: To investigate the long-term outcomes and risk factors in children with steroid-sensitive nephrotic syndrome (SSNS). Methods: A retrospective cohort study was conducted on newly onset SSNS admitted to the Department of Pediatrics of the First Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2010 and 105 cases with follow-up for more than 10 years were included. Clinical data including general characteristics, clinical manifestation, laboratory tests, treatment and prognosis. The primary outcome was the clinical cure, and the secondary outcomes were relapse or ongoing immunosuppressive treatment within the last 1 year of follow-up and complications at the last follow-up. According to the primary outcome, the patients were divided into clinical cured group and uncured group. Categorical variables were compared between 2 groups using the χ2 or Fisher exact test, and continuous variables by t or Mann-Whitney U test. Multiple Logistic regression models were used for multivariate analysis. Results: Of the 105 children with SSNS, the age of onset was 3.0 (2.1, 5.0) years, and 82 (78.1%) were boys, 23(21.9%) were girls. The follow-up time was (13.1±1.4) years; 38 patients (36.2%) had frequently relapsing or steroid-dependent nephrotic syndrome (FRNS or SDNS) and no death or progression to end-stage kidney disease. Eighty-eight patients (83.8%) were clinically cured. Seventeen patients (16.2%) did not reach the clinical cure criteria, and 14 patients (13.3%) had relapsed or ongoing immunosuppressive treatment within the last year of follow-up. The proportion of FRNS or SDNS (12/17 vs. 29.5% (26/88), χ2=10.39), the proportion of treatment with second-line immunosuppressive therapy (13/17 vs. 18.2% (16/88), χ2=21.39), and the level of apolipoprotein A1 at onset ((2.0±0.5) vs. (1.7±0.6) g/L, t=2.02) in the uncured group were higher than those in the clinical cured group (all P<0.05). Multivariate Logistic regression analysis showed that patients treated with immunosuppressive therapy had an increased risk of not reaching clinical cure in the long term (OR=14.63, 95%CI 4.21-50.78, P<0.001). Of the 55 clinically cured patients who had relapsed, 48 patients (87.3%) did not relapse after 12 years of age. The age at last follow-up was 16.4 (14.6, 18.9) years, and 34 patients (32.4%) were ≥18 years of age. Among the 34 patients who had reached adulthood, 5 patients (14.7%) still relapsed or ongoing immunosuppressive treatment within the last year of follow-up. At the last follow-up, among the 105 patients, 13 still had long-term complications, and 8 patients were FRNS or SDNS. The proportion of FRNS or SDNS patients with short stature, obesity, cataracts, and osteoporotic bone fracture was 10.5% (4/38), 7.9% (3/38), 5.3% (2/38), and 2.6% (1/38), respectively. Conclusions: The majority of SSNS children were clinically cured, indicating a favorable long-term prognosis. History of treatment with second-line immunosuppressive therapy was the independent risk factor for patients not reaching the clinical cure criteria in the long term. While it is not uncommon for children with SSNS to persist into adulthood. The prevention and control of long-term complications of FRNS or SDNS patients should be strengthened.

Adiponectin overexpression promotes fracture healing through regulating the osteogenesis and adipogenesis balance in osteoporotic mice.

Osteoporosis invariably manifests as loss of bone, which is replaced by adipose tissue; this can easily lead to fractures, accompanied by delayed and poor healing. Adiponectin (APN) balances osteogenesis and adipogenesis in bone marrow mesenchymal stem cells (BMSCs). Therefore, this study explored whether adiponectin promotes bone fracture healing by regulating the balance between osteogenesis and adipogenesis. We used adenovirus overexpression vectors carrying APN (Ad-APN-GFP) to treat ovariectomized (OVX) mouse BMSCs and osteoporotic bone fractures to investigate the role of APN in bone microenvironment metabolism in osteoporotic fractures. We subsequently established an OVX mice and bone fracture model using Ad-APN-GFP treatment to investigate whether APN could promote bone fracture healing in osteoporotic mice. The experimental results showed that APN is a critical molecule in diverse differentiation directions in OVX mouse BMSCs, with pro-osteogenesis and anti-adipogenesis properties. Importantly, our study revealed that Ad-APN-GFP treatment facilitates bone generation and healing around the osteoporotic fracture ends. Moreover, we identified that Sirt1 and Wnt signaling were closely related to the pro-osteogenesis and anti-adipogenesis commitment of APN in OVX mouse BMSCs and femoral tissues. We demonstrated that APN overexpression facilitates bone fracture healing in osteoporosis. Furthermore, APN overexpression promoted bone formation in OVX mouse BMSCs and bone fracture ends by regulating the balance between osteogenesis and adipogenesis both in vitro and in vivo.

“DOUBLE TENSION BAND OSTEOSYNTHESIS IN DISTAL HUMERUS FRACTURE IN OSTEOPOROTIC ADULTS AND INFECTED NONUNIONS”

Background: It is a challenge for orthopedic surgeon to x osteoporotic distal humerus fracture rigidly for early mobilization because holding power of plate and screws is low in osteoporotic bone fracture and have higher failure rate. Second challenge is to x an infected nonunion of distal humerus fracture because of restriction to use plate and screw. To achieve a stable , pain free and mobile joint require appropriate planning , systematic approach and anatomical reduction. To evaluate effectiveness of double tension band osteosynthesis in distal hume Aim: rus fracture of osteoporotic adult bone and infected nonunions. Ten patients presenting six fractures and three Method: nonunion of the distal humeral ,treated with double tension band wiring between 2018 and 2023 were retrospectively evaluated , two fracture were type A2 , two were type C1, remaining two were type C2 and rest are previously operated infected nonunions. Patients age averaged about 55 years. There are 5 males and 5 females. Out of 10 cases treated with t Results: his method, rigid xation and union was achieved in all of them. Radiological union was achieved at an average of 10.8 weeks (8-14weeks). Average range of motion was 104.5 degrees with maximum range of motion 120 degrees (10-130) and minimum of 70 degrees (30-100). Excellent or good results were obtained in 80% of the patients in our study. Double tension b Conclusion: and is a reliable, less demanding and cost effective method of xation of distal fractures of humerus in osteoporitic adults and infected nonunions.

Bone modifying agents in postmenopausal breast cancer patients treated with aromatase inhibitors: beyond bone protection?

Estrogen-receptor positive tumours represent the majority of breast cancers in postmenopausal women. Adjuvant endocrine therapy with aromatase inhibitors (AIs), continued for up to 10 years in high-risk patients, reduces by 40% the risk of recurrence. However, this therapy, among other side effects, is burdened with a higher incidence of osteoporotic bone fractures. To date, both bisphosphonates and denosumab are recognized as first-line drugs in the primary prevention of osteoporotic fractures in patients treated with AIs. They have demonstrated their effectiveness in increasing bone mineral density and in reducing the incidence of fractures, but they have also been shown to improve disease free survival (DFS).

Selenium-modified bone cement promotes osteoporotic bone defect repair in ovariectomized rats by restoring GPx1-mediated mitochondrial antioxidant functions.

Over-accumulation of reactive oxygen species (ROS) causes mitochondrial dysfunction and impairs the osteogenic potential of bone marrow-derived mesenchymal stem cells (BMMSCs). Selenium (Se) protects BMMSCs from oxidative stress-induced damage; however, it is unknown whether Se supplementation can promote the repair of osteoporotic bone defects by rescuing the impaired osteogenic potential of osteoporotic BMMSCs (OP-BMMSCs). In vitro treatment with sodium selenite (Na2SeO3) successfully improved the osteogenic differentiation of OP-BMMSCs, as demonstrated by increased matrix mineralization and up-regulated osteogenic genes expression. More importantly, Na2SeO3 restored the impaired mitochondrial functions of OP-BMMSCs, significantly up-regulated glutathione peroxidase 1 (GPx1) expression and attenuated the intracellular ROS and mitochondrial superoxide. Silencing of Gpx1 completely abrogated the protective effects of Na2SeO3 on mitochondrial functions of OP-BMMSCs, suggesting the important role of GPx1 in protecting OP-BMMSCs from oxidative stress. We further fabricated Se-modified bone cement based on silk fibroin and calcium phosphate cement (SF/CPC). After 8 weeks of implantation, Se-modified bone cement significantly promoted bone defect repair, evidenced by the increased new bone tissue formation and enhanced GPx1 expression in ovariectomized rats. These findings revealed that Se supplementation rescued mitochondrial functions of OP-BMMSCs through activation of the GPx1-mediated antioxidant pathway, and more importantly, supplementation with Se in SF/CPC accelerated bone regeneration in ovariectomized rats, representing a novel strategy for treating osteoporotic bone fractures or defects.

Conservative Management of Varus/Valgus Stable Tibial Plateau Fractures in Osteoporotic Bone - Preliminary Results and Considerations.

While operative fixation is the current recommendation for treating significantly displaced tibial plateau fractures (DTPFs) in elderly patients, our research suggests that non-operative management may also be a viable option as the primary treatment for these individuals. Our study aimed to evaluate the clinical outcomes of patients with complex DTPFs who received non-operative management as their primary management. Our study involved a retrospective analysis of non-operatively treated DTPFs during the period of 2019 to 2020. We included all patients for the evaluation of fracture healing and range of motion (ROM). Additionally, we conducted functional outcome assessments on all patients, utilizing the Oxford Knee Score (OKS) both before their injury and at the 10-month mark after their injury. The study included 10 patients, comprising two males and eight females, with a mean age of 62.9 years (range: 46-74). Among them, four patients had Schatzker Type III DTPFs, two had Type V, and four had Type VI. Non-operative management was administered using hinged-knee braces, and patients progressed to weight-bearing gradually, with a minimum follow-up period of 10 months. The average time to bone union was 4.3 months (range: 2-7). The mean Oxford Knee Score (OKS) after the injury was 38.8 (range: 23-45), with an average reduction of 16.9% (p = 0.003). The average fracture depression was 11.41 mm (range: 4.2-29), and the average fracture split was 14.03 mm (range: 5.5-44). Based on our study, it appears that elderly patients with significantly displaced tibial plateau fractures (DTPFs) can be treated non-operatively as their primary management, despite the current consensus suggesting otherwise.

Hybrid Fixation of Failed Internally Fixed Distal Femoral Fracture with an Extramedullary Locking Plate and an Intramedullary Cortical Strut Allograft Construct- A Case Report

Abstract Introduction: Fractures in osteoporotic bones present a surgical challenge for fixation and are often associated with significant morbidity. Case presentation: We present a case of failed internal fixation of fracture femoral shaft in a 74-year-old patient with osteoporosis. Fracture fixation was undertaken using an extra medullary locking plate and an intramedullary cortical strut graft, a hybrid fixation technique, a Locking Plate Allograft Construct. Discussion: Bone grafts are often used to support the native bone. By using a hybrid technique, the locking plate allograft construct achieves an enhanced stability of fracture fixation compared to plate alone, thus improving the outcome of surgery in osteoporotic bone fractures. Conclusion: Hybrid fixation using locking plate allograft constructs are relatively easy to perform and provide superior fixation to routine methods in osteoporotic bone fractures.

Osteopontin as a Predictor of Adverse Events in Patients with Comorbid Pathology

Information about the results of the examination of 78 women aged 50 to 65 years is given. The nature of comorbid pathology was studied: chronic heart failure, type 2 diabetes mellitus and osteoporosis. It has been established that osteopontin is an independent risk factor for the development of adverse cardiovascular events and bone fractures in women with comorbid pathology. During 36 months of prospective follow-up, patients with comorbid pathology and OPN level &gt;21.4 ng/ml were significantly more likely to have adverse cardiovascular events and osteoporotic fractures. In patients of the 2nd group with an AKI level of &gt;21.4 ng/ml compared with the group with an AKI concentration of ≤21.4 ng/ml, the risk of cumulative (combined frequency of the combined end point of cardiovascular events) was increased (OR = 6.200 [95% CI 2.258-17.024; p=0.001]). Separate analysis showed a significant increase in the risk of adverse events within 36 months at an AKI concentration of &gt;21.4 ng/ml: progression of CHF (OR=4.073 [95% CI 1.575–10.531; p=0.023]) and osteoporotic bone fractures (OR=0 .81 [95% CI 0.72-0.90; p=0.01]); risks of MI (OR=4.343 [95% CI 0.463-40.751; p=0.162]), stroke (OR=1.178 [95% CI 0.315-31.860; p=0.498]), and decompensation of CHF (OR=1.938 [95% CI 0.696-5.391; p=0.083]) increased insignificantly. The level of acute renal failure &gt;21.4 ng/ml (sensitivity-83%, specificity-62%) makes it possible to predict the onset of adverse cardiovascular events in patients with coronary artery disease with type 2 diabetes and osteoporosis with a high probability.