Increased Bone Density Research Articles

The effect of the Hiroshima GENKI Exercise on the bone strength and cognitive function in elderly people

Introduction: In Japan, women account for 66% of those requiring nursing care, mainly due to bone weakening such as bone fractures and joint diseases, and dementia (MHLW, 2021). Exercise trainings in elderly people increase bone density and improve cognitive function, contributing preventions in these diseases. Therefore, the purpose of this study was to verify the effects of

PSAT187 Bone Mineral Density Normalization in a Young Patient With a Physician Guided Nutrition and Exercise Intervention.

Abstract Lack of consensus on the type and amount of exercise to safely increase bone mineral density (BMD) prevents many clinicians from providing detailed recommendations on how to increase physical activity. We present a young man with low bone density, who was initiated on a non-pharmacologic regimen of physician-directed high intensity resistance exercise (HIRE) and adequate nutrition support. A 28-year-old male was found to have a low bone density attributed to autoimmune hepatitis, chronic systemic glucocorticoids used for 7 years and poor lifestyle habits. Despite stopping steroids since 2014, his BMD was worsening in the femoral neck (FN) to 0.723 g/cm2 (Z-score -2.7) in 2018, representing a 3% loss from the prior year. His BMD in the total hip (TH) site also decreased from 0.775 g/cm2 (Z-score -2.1) to 0.751 g/cm2 (Z-score -2.3) in the same 1-year period (3.1% loss). The patient had no personal or family history of fractures, smoking or alcohol use, but did have a sedentary lifestyle and ate highly processed foods with poor nutritional value. After unremarkable evaluation for further causes of ongoing bone loss, in 09/2018 we initiated a tailored progressive high intensity resistance exercise (HIRE) program. Major compound movements such as squats, deadlifts, military press, and dynamic impact exercises such as medicine ball throws, jumps and farmers carry were performed 3 times a week, maintaining an intensity of >80% 1-repetition maximum with 5 repetitions. The HIRE program was modified every 3 months at endocrinology clinics. After the first year, one on one training with expert kinesiologist was introduced to correct exercise form. Nutrition recommendations were simple, focused on increasing weight, adequate dairy intake, and protein intake at 1.6g/kg of body mass. He maintained adherence to exercise and diet throughout 2018-2021. BMD measured by the same Lunar iDXA increased by 10.8% at the FN from 09/2018 to 09/2019. As often occurs in clinical practice, the patient had bone density scans performed at various centers throughout his years of care. Using BMD standardization algorithms, we estimate that after initiation of our HIRE and nutrition intervention, BMD increased at all sites (LS +9.7%, FN +17.7%, TH +12.7%) when compared to pre-intervention values. His most recent DXA scan on 12/2020 (Hologic Discovery) revealed a Z-score of -1.7 (LS), -1.5 (FN) and -1.5 (TH). We conclude that our HIRE and nutrition intervention lead to clinically significant bone density increases which are expected to lead to a reduction in fracture risk. Additionally, improved lifestyle habits and nutrition are expected to have multiple benefits beyond bone health. It is important that clinicians learn about different types of exercise programs to properly guide patients which could benefit. A HIRE program should be considered in select, able bodied patients with low bone density. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Effect of Osteoblast-Specific Deletion of the Proton Receptor OGR1.

Metabolic acidosis (MET) stimulates bone resorption through inhibition of osteoblast (OB) bone formation and stimulation of osteoclast (OC) bone resorption. We found that OGR1, a G protein-coupled proton (H+)-sensing receptor, was critical for initial H+ signaling in the OB. In mice with a global deletion of OGR1, we demonstrated that loss of OGR1 impairs H+-induced bone resorption, leading to increased bone density through effects on both the OB and OC. Using an OC-specific deletion of OGR1, we found that MET directly activates OGR1 in the OC. To determine if the response of OGR1 to MET in the OB is independent of a response in OCs and to characterize direct activation of OGR1 in the OB, we studied female mice with an OB-specific deletion of OGR1 (OB-cKO) and differentiated osteoblasts derived from marrow of OB-cKO and wild-type (WT) mice. In OB-cKO mice, we found increased bone area in both tibial and femoral cortical bone. Specific loss of OB OGR1 increased in vitro mineralization, alkaline phosphatase activity, and expression of osteoblast-specific genes compared with WT with no alteration in OC activity. MET stimulation of OB cox2 and fgf23 gene expression was inhibited in OB-cKO OB. These results indicate that MET activation of OGR1 in the OB is independent of the response in the OC and that OGR1 in both cell types is required for a complete response to MET. Characterization of the role of OGR1 in MET-induced bone resorption will improve our understanding of bone loss associated with metabolic acidosis in patients with chronic kidney disease. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Spectrum of Skeletal Imaging Features in Osteopetrosis: Inheritance Pattern and Radiological Associations.

Osteopetrosis (from the Greek "osteo": bone; "petrosis": stone) is a clinically and genetically heterogeneous group of rare diseases of the skeleton, sharing the same main characteristic of an abnormally increased bone density. Dense bones in radiological studies are considered the hallmark of these diseases, and the reason for the common term used: "Marble bone disease". Interestingly, a radiologist, Dr. Albers-Schonberg, described this disease for the first time in Germany in 1904. Indeed, radiology has a key role in the clinical diagnosis of osteopetrosis and is fundamental in assessing the disease severity and complications, as well as in follow-up controls and the evaluation of the response to treatment. Osteopetrosis includes a broad spectrum of genetic mutations with very different clinical symptoms, age onset, and prognosis (from mild to severe). This diversity translates into different imaging patterns related to specific mutations, and different disease severity. The main recognized types of osteopetrosis are the infantile malignant forms with autosomal recessive transmission (ARO-including the rarer X-linked recessive form); the intermediate autosomal recessive form (IAO); and the autosomal dominant ones ADO, type I, and type II, the latter being called 'Albers-Schonberg' disease. Imaging features may change among those distinct types with different patterns, severities, skeletal segment involvement, and speeds of progression. There are several classical and well-recognized radiological features related to osteopetrosis: increased bone density (all types with different degrees of severity assuming a 'Marble Bone Appearance' especially in the ARO type), different metaphyseal alterations/enlargement including the so-called 'Erlenmeyer flask deformity' (particularly of femoral bones, more frequent in ADO type 2, and less frequent in ARO and IAO), 'bone in bone' appearance (more frequent in ADO type 2, less frequent in ARO and IAO), and 'rugger-jersey spine' appearance (typical of ADO type 2). After conducting an overview of the epidemiological and clinical characteristic of the disease, this review article aims at summarizing the main radiological features found in different forms of osteopetrosis together with their inheritance pattern.

A novel homozygous splice site variant in the CLCN7 causes osteopetrosis

ObjectivesOsteopetrosis is a monogenic disorder represented by disturbed osteoclast resorption or osteoclastogenesis differentiation. Clinical symptoms are intensive and brittle bones, recurrent fractures, thrombocytopenia, impaired immune function, optic nerve compression, and anemia. Several osteopetrosis-causing genes have been identified and reported. MethodsThe present study describes two consanguineous Saudi families segregating a severe autosomal recessive osteopetrosis disease. A single proband (II-2) in family A and two probands (II-2; II-4) in family B exhibited increased bone density, multiple fractures, teeth abnormalities, bilateral optic atrophy with nystagmus, and progressive blindness. DNA of the affected individuals was exposed to whole-exome sequencing (WES) and Sanger sequencing. Further, reverse transcriptase-polymerase chain reaction (RT-PCR) and western blotting analysis were done to investigate the impact of the identified mutation. ResultsWES revealed a novel homozygous splice site variant (c.739-18G > A) in theCLCN7gene on chromosome 16p13.3, segregating perfectly with the disorder phenotype. RT-PCR resulted in the retention of a 50 bp sequence of intron 8 in the mutated sequence. As a result, this variant resulted in a large size exon 9 compared to the wild type.In addition, the western blot revealed the heteromeric form of ClC-7 disappeared in the patient’s fibroblasts versus the control, indicating identified variant pathogenicity. ConclusionThe present research provides certain proof that homozygous variants in the CLCN7 gene are responsible for intense osteopetrosis disorders with diverse phenotypes. These findings have significant implications for decisions regarding the clinical therapeutic regimen, prognosis assessment, and antenatal diagnosis.

Treating osteoporosis: risks and management.

Osteoporosis, osteopenia and minimal trauma fractures are becoming increasingly common in the ageing population. Fractures cause increases in morbidity and mortality and have a significant financial impact on the healthcare system and society Addressing risk factors for osteoporosis early may prevent or delay the onset of fractures and use of drugs. Calcium and vitamin D supplementation may benefit people with a high risk of deficiency (e.g. institutionalised older people) but may not be required in people without risk factors. Impact and resistance exercises and physical activity can increase bone density and prevent falls Antiresorptive drugs such as bisphosphonates and denosumab remain first-line treatment options for osteoporosis. The ongoing need for bisphosphonates should be assessed after five years and treatment may then be interrupted in some patients. Progressive bone loss will recur slowly. Denosumab therapy should not be interrupted without switching to another therapy, as post-treatment bone loss can progress rapidly. All patients will need ongoing monitoring and most will require some long-term therapy once started Raloxifene may be considered in women who do not tolerate first-line antiresorptive drugs. Romosozumab is a new anabolic treatment for osteoporosis and, together with teriparatide, is subsidised as second-line therapy for individuals with severe disease and multiple fractures. Specialist referral should be considered for patients who sustain fractures while undergoing osteoporosis therapy.

Ghosal hematodiaphyseal dysplasia (GHDD) diagnosis and treatment: case report

Ghosal hematodiaphyseal dysplasia syndrome (GHDD) is a rare authosomal ressesive disorder characterized by increased bone density and regenerative corticosteroid-sensitive anemia.We describe GHDD in an 11-year old Azerbaijani boy with refractory anemia,mild thrombocytopenia and radiological metadiaphyseal dysplasia.The diagnosis was made based on clinical and laboratory examinations and genetic analysis.We have observed a significant improvement of anemia after administration of steroids. An 11-year-old boy with long-standing anemia, complained of fatigue,delayed physical development,and limited range of motion in the joint.Physical examination did not reveal LAP and hepatosplenomegaly.Among the dysmorphic craniofacial changes mentioned in the literature, has a tower-shaped skull,micrognotia,drooping ears,a long and wide philtrum,and a thin upper lip.Skeletal X-ray imaging showed fibrotic changes and varying degrees of osteopenia in the metaphysis of the long tubular bones. The blood count: Hb 7.0 g/dl,HCT 24.5%,reticulocytes 5.6%,MCV 78fL,MCHC 28.6 g/dl,WBC count 6860/mm3,platelets 165000/mm3,ESR 75 mm/h,anisocytosis in erythrocytes and platelets were observed in a peripheral blood smear.Hemoglobin electrophoresis,iron studies,vitamin B12 and folic acid were normal.Coombs test was negative.Bone marrow examination showed hypoplasia in erythroid and megakaryocytic series and dysgranulocytopoiesis. After detection of exon 12 ((p.Gly473Trp),rs149988492,CM215867) in the genetic panel analysis of anemia,steroid treatment at a dose of 1 mg/kg/day was started and anemia improved at 1-month follow-up (Hb level 6.8 g/dL to 11.9 g/dL),but mild thrombocytopenia was noted to persist.The clinically insignificant CRP elevation normalized during the treatment. GHDD should be considered in patients with clinical and radiographic evidence of diaphyseal dysplasia as well as hematological abnormalities. In addition, bone dysplasia should be investigated in treatment-resistant hematological pathologies of unknown origin. Although GHDD is rare, clinicians should be informed that it responds well to steroid therapy.

Експериментальне дослідження щільності кісткової тканини у хворих з уродженим псевдоартрозом кісток гомілки до та після операції за даними комп’ютерної томографії

Surgical treatment of congenital pseudarthrosis of the tibia bones is accompanied by a significant percentage of complications and refractions. One of the main reasons for the unsatisfactory results of treatment is the violation of the quality of bone tissue in the area of pseudoarthrosis, which is an obstacle to the normal process of fusion of the shin bones. Рurpose - use computed tomography to examine bone density in patients with congenital pseudoarthrosis of the tibia before and after surgery. Materials and methods. CT scans of the tibia of three patients with congenital pseudoarthrosis of the tibia, aged 5 to 7 years. The density in the Hounsfield units of the cortical layer above and below the nonunion zone was determined. Results. Prior to treatment, a significant decrease (p=0.001) in the density of the cortical layer of the tibia of the injured limb along its entire length was determined. One year after surgery, a statistically significant difference in the density of the cortical layer of the tibia remains. The optical density of the cortical layer of the damaged tibia is statistically significantly less than healthy (p=0.001). One year after surgical treatment by osteosynthesis with an intramedullary rod with axial mobility, the difference in the density of the cortical layer of the tibia of the healthy and operated limbs remains statistically significant (p=0.001) less than the bone density of the healthy limb. On the unoperated limb, a significant (p<0.05) increase in optical density of bones was observed in all studied areas. Conclusions. As a result of surgical treatment of congenital pseudoarthrosis of the tibia, there is a statistically significant increase in the density of the cortical layer. The density of the cortical layer of the bones of the operated shin a year after surgery is close to the density of the bones of a healthy limb. The increase in bone density of the operated limb is due not only to the growth of patients, but also occurs due to the possibility of loading the operated limb. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

A comparison between the effect of systemic and coated drug delivery in osteoporotic bone after dental implantation.

The increased life expectancy has boomed the demand of dental implants in the elderly. As a consequence, considering the effect of poorer bone quality, due to aging or associated diseases such as osteoporosis, on the success of dental restoration is becoming increasingly important. Bisphosphonates are one of the most used drugs to overcome the effect of osteoporosis as they increase bone density. Bisphosphonates modify the physiological bone remodeling process by adhering to the bone surface, reducing the activity of osteoclasts. This study aims at comparing the effect on bone remodeling of two drug delivery methods of Bisphosphonates: local delivery by coating the implant surface and systemic delivery. A chemo-mechano-biological bone remodeling model validated in a previous paper was used here. The two drug delivery schemes were modeled by means of a finite element approach. In the systemic drug delivery case, the amount of drug that reaches the bone compartment was calculated using a pharmacokinetic model while in the local drug delivery system, the dose was calculated using Fickean diffusion. In particular, the effect of Zoledronate is studied here. The two drug delivery approaches are compared between them and with a control case with no drug. The results show that the use of Bisphosphonates increases the mechanical strength of bone, thus improving the implant fixation along time. Systemic drug delivery affects the entire skeleton, while local drug delivery only affects the area around the dental implant, which reduces the side effects of Bisphosphonates, such as increasing the mineral content, which may promote bone brittleness and microdamage far from the implant. These results support the conclusion that dental implants coated with Bisphosphonates can be a good solution for osteoporotic or low bone density patients without the long-term side effects of systemic drug delivery.

ROS-responsive resveratrol-loaded cyclodextrin nanomicelles reduce inflammatory osteolysis

Bone loss in inflammatory disorders such as osteomyelitis, septic arthritis, and periodontitis is caused by excessive osteoclastic activity. Meanwhile, reactive oxygen species (ROS) have been identified as contributors to osteoclast differentiation, and the application of ROS scavengers has emerged as a promising strategy to protect against bone loss. Recently, resveratrol (RSV), a polyphenolic phytoalexin, has been demonstrated to inhibit osteoclastogenesis by scavenging ROS; however, the application of RSV as an antioxidant is limited by its low water solubility, structural instability, and short elimination half-life. In this study, we developed a PEGylated cyclodextrin (CD)-based nanoplatform (PCP) for local delivery of RSV as nanomicelles (RSV-NMs). In addition, polymer functionalization with phenylboronic acid ester in RSV-NMs successfully achieved ROS-responsive release of RSV. The RSV-NMs in a well-dispersed state possessed good biocompatibility as well as improved solubility and stability compared with RSV compound. In vitro, RSV-NMs significantly inhibited the formation of tartrate-resistant acid phosphatase (TRAP)-positive multinuclear cells and suppressed F-actin (filamentous actin) ring formation. Additionally, the mRNA expressions of osteoclastic marker genes, including matrix metalloprotein-9 (MMP-9), nuclear factor of activated T cells 1 (NFATc1), TRAP, and cathepsin K, were consequently downregulated in the presence of RSV-NMs. In vivo, RSV-NMs provided protection against LPS-induced bone destruction, as evidenced by a decreased number of osteoclasts, increased bone density, and reduced area of bone resorption. Taken together, these results indicate that our ROS-responsive RSV-NMs can be employed as a potential therapeutic agent for the treatment of inflammatory osteolysis.

P8.033: Teriparatide in Kidney Transplant Patients With Bisphosphonate-Resistent Osteoporosis

Introduction: Bisphosphonates increase Bone mineral density (BMD) by suppressing bone turnover inhibiting osteoclastic function with risk of inducing adynamic bone disease. Teriparatide is a fragment of the natural human parathyroid hormone (PTH) consisting of the first 34 amino acids counting from the N-terminus end of the natural PTH. Is anabolic drugs stimulate bone formation by increasing osteoblast activity and regulates both bone formation and resorption reducing the risk of vertebral and nonvertebral fractures. Arm: Teriparatide (Parathormone 1-34) treatment in renal trasplant patients with bisphosphonate-resistent osteoporosis.Metods: observational describe study of cases series of 10 kidney transplant patients with bone fragility without response to prolonged treatment with bisphosphonates (greater than 3 years). They were treated with daily subcutaneous injections of 20 microg teriparatide (PTH 1-34) by 18 months. All the patients had 6 months of bisphosphonate wash out. Measurements: we investigated bone turnover markers and effect of teriparatide over BMD of the femoral neck and lumbar spine as well also fractures, graft rejection, cardiovascular events, death and drug related adverse event. Results: 10 patients 9 women, mean age 64.4±14.15 years, BMI 24.3 ±2.64, etiology 3GMN, 3 PKD, 3 unknown, 1 NDBT, HD 9, preempive 1, transplant Time 10.12±5.21 years, 1 preemptive, 8 DBD and 1 LRD, Induction: 8 thymoglobulin, 2 basiliximab, Maintenance 5 belatacept/mycophenolate/MTP, 2 rapamune/mycophenolate/MTP, 3 tacrolimus/mycophenolate/MTP, 6 patients with fractures prior to treatment. Mean of treatment with bisphosphonates 4.1±1.79 years. It is observed at 18 months of treatment with 1-34 PTH increased levels of bone alkaline phosphatase (13.26 UI/L ± 5.75 vs 17.90 ± 7.28, p = 0.045), with NS changes in the rest of the analytes (Table 1) and increase of lumbar bone density of 11.27% (0.8816 gr/cm2 (TS-2.6) vs 0.9941 gr/cm2 (TS-1.38)) and femoral neck of 7.07% (0.6752 gr/cm2(TS-2.5) vs 0.7230 gr/cm2(TS-2.19)). 2 patients presented wrist fractures during treatment with low response(lumbar BMD) to treatment. No cardiovascular events, rejections, deaths were reported. Adverse Events: 1 patient presented hypotension during the first month of treatment. Conclusion: In this group of patients, and adequate response to teriparatide treatment was observed however our limitation were small number of patients and bone biopsy prior teriparatide treatment.

Combined Regenerative and Mucogingival Treatment of Intraosseous Defects with Buccal Gingival Recession: A Case Series

<p>Abstract: Regenerative surgery is an effective treatment of intraosseous defects, however, subject with thin gingival tissue phenotype and bone dehiscence defect tends to have more post-surgery gingival recession. The gingival recession is considered as soft tissue loss, which may affect the result of periodontal regeneration. Therefore, this case series aimed to describe a periodontal regenerative surgery combined with subepithelial connective tissue graft (SCTG) in intraosseous defects associated with buccal gingival recession would make periodontal regeneration more predictable. Materials and Methods: The case series describes a surgical approach to improve regenerative parameters in deep intraosseous defects associated with buccal gingival recession. Teeth with buccal bone dehiscence or furcation involvement were included. The surgical technique consisted of an SCTG placed on the buccal dehiscence defect or furcation area to thicken the soft tissue wall, then treated with enamel matrix derivative and biomaterials as regenerative scaffolds inside the intraosseous component of the defect. Results: In all cases, there were buccal gingival margin thickness increased, significant clinical attachment level gain, bone level gain, reduced probing pocket depth, and partial root coverage at least one year after the surgery. The radiographs demonstrated increased bone density of the deep intraosseous defects associated with buccal gingival recession in both single root and furcation-involved teeth. Conclusion: The combination of regenerative treatment and SCTG in intraosseous defects associated with buccal gingival recession in a single root or furcation-involved molar supports the stability of the gingival profile and improves root coverage outcome as well as periodontal regeneration.</p> <p> </p>

Assessment of narrow alveolar ridge expansion by ossiodensification vs. ridge splitting technique for dental implant placement

Objectives: Comparing osseodensification vs. ridge splitting techniques in dental implant placement regarding implant stability, insertion torque, bone width and density. Patients and Method: Twenty individuals with a narrow ridge width of 3-6 mm at crestal bone level were included in this study. They were divided into two groups: Group I Osseodensification technique, Group II Ridge splitting technique with bone expanders and sticky bone augmentation. Implant stability, insertion torque, surgical procedure duration, bone width, and density were all evaluated by CBCT. Results: Group (I) had showed higher statistically significant Insertion torque than group (II). While group (II) had showed statistically significant increase in mean ISQ reading after 6 months (p<0.001). Group (II) showed statistically significant higher surgical time than group (I). Group (II) showed a higher increase in bone gain than group (I). Group (I) had showed statistically significant increase in mean bone density postoperatively, after 3 and 6 months (p<0.001*). While group (II) had showed statistically significant increase in mean bone density postoperatively, after 3 and 6 months (p<0.001). Conclusion: Osseodensification technique had been shown to increase ridge width while maintaining primary implant stability and bone density around dental implants without sacrificing bone.

How zoledronic acid improves osteoporosis by acting on osteoclasts.

Osteoporosis is called a silent disease, because it is difficult to detect until comprehensive examinations for osteoporosis are performed or osteoporotic fractures occur. Zoledronic acid is currently the first-line anti-osteoporotic drug, with good efficacy and treatment compliance. A major advantage of zoledronic acid is that intravenous zoledronic acid often guarantees a therapeutic effect for up to 1 year after infusion. The reasons why zoledronic acid is effective in improving osteoporosis are that it can inhibit osteoclast differentiation and induce osteoclast apoptosis, thus suppressing bone resorption and increasing bone density. The story between zoledronic acid and osteoclasts has been written long time ago. Both the canonical receptor activator of the receptor activator of nuclear factor-κB ligand (RANKL) pathway and the non-canonical Wnt pathway are the main pathways by which zoledronic acid inhibits osteoclast differentiation. Farnesyl pyrophosphate synthase (FPPS), reactive oxygen species (ROS), and ferroptosis that was first proposed in 2012, are all considered to be closely associated with zoledronic acid-induced osteoclast apoptosis. Here, we provide a brief review of the recent progress on the study of zoledronic acid and osteoclasts, and hope to elaborate how zoledronic acid improves osteoporosis by acting on osteoclasts.

Indapamide Effects on Hypercalciuria and Bone Mineral Density

Idiopathic hypercalciuria is associated to urinary stone formation and bone loss and should be treated not only to prevent kidney stone formation but also to prevent fragility fractures. Thiazide diuretics are traditionally used to control hypercalciuria. indapamide, a sulfonamide thiazide diuretic, with some differences in structure is similar in its mechanisms of action such as its hypocalciuric effect, and bone density protection, with less adverse metabolic consequences than other thiazides such as less hypokalemia and hypotension. We evaluated efficacy and adverse effects of indapamide in 88 idiopathic hypercalciuric consecutive patients and only those who reached normal calciuria in the first 9 months, were followed during two years. Changes in bone turn-over markers and bone density were evaluated. Since year one, there was a significant lowering of urine calcium to normal values in 77 patients, with no change in sodium excretion. There were changes in bone turn over markers and gains in bone mineral density according to the groups analyzed. In 25 hypercalciuric osteoporotic patients, there was a significant increment in lumbar spine bone density at year 2 of follow-up, (p<0.05). Those hypercalciuric osteoporotic stone former patients had a significant increase in femoral neck bone density since year one. Adverse effects were not significant, no changes found in blood pressure, glycemia, cholesterol, serum uric acid, sodium and potassium. Two patients needed potassium supplementation for mild hypokalemia and did not stop indapamide. In conclusion indapamide is an effective alternative treatment to Idiopathic hypercalciuria, controlling calcium loss and bone density for at least two years.

Biomechanical Comparison of Salvage Pedicle Screw Augmentations Using Different Biomaterials

Allograft bone particles, hydroxyapatite/β-hydroxyapatite-tricalcium phosphate (HA/β-TCP), calcium sulfate (CS), and polymethylmethacrylate (PMMA) bone cement are biomaterials clinically used to fill defective pedicles for pedicle screw augmentation. Few studies have systematically investigated the effects of various biomaterials utilized for salvage screw stabilization. The aim of this study was to evaluate the biomechanical properties of screws augmented with these four different materials and the effect of different pilot hole sizes and bone densities on screw fixation strength. Commercially available synthetic bones with three different densities (7.5 pcf, 15pcf, 30 pcf) simulating different degrees of bone density were utilized as substitutes for human bone. Two different pilot hole sizes (3.2 mm and 7.0 mm in diameter) were prepared on test blocks to simulate primary and revision pedicle screw fixation, respectively. Following separate specimen preparation with these four different filling biomaterials, a screw pullout test was conducted using a material test machine, and the average maximal screw pullout strength was compared among groups. The average maximal pullout strength of the materials, presented in descending order, was as follows: bone cement, calcium sulfate, HA/β-TCP, allograft bone chips and the control. In samples in both the 3.2 mm pilot-hole and 7.0 mm pilot-hole groups, the average maximal pullout strength of these four materials increased with increasing bone density. The average maximal pullout strength of the bone cement augmented salvage screw (7.0 mm) was apparently elevated in the 7.5 pcf test block. Salvage pedicle screw augmentation with allograft bone chips, HA/β-TCP, calcium sulfate, and bone cement are all feasible methods and can offer better pullout strength than materials in the non-augmentation group. Bone cement provides the most significantly augmented effect in each pilot hole size and bone density setting and could be considered preferentially to achieve larger initial stability during revision surgery, especially for bones with osteoporotic quality.

Use of L-PRF in the Treatment of Osteomyelitis Associated With Osteopetrosis

Osteopetrosis is a disorder characterized by an increase in bone density and a reduction in spinal cord spaces. This change results in a defect in osteoclast function and consequent decrease in bone turnover. One of the possible local bone complications is osteomyelitis, which affects up to 10% of patients with this disorder. Platelet concentrates (L-PRF) have been used in cases of bone defects and areas of tissue necrosis, as it has the characteristic of releasing growth factors after activation. The aim of this paper is to present a clinical case of a patient with mandibular osteopetrosis, who underwent dental implantation and subsequent recurrent osteomyelitis and was treated by partial resection associated with L-PRF bone defect coverage. After 1 year of follow-up, the patient presented definitive soft tissue healing, no exposure of bone tissue or phlogistic signs at the site, and good bone repair on computed tomography scan. The present study demonstrated that the association of L-PRF with resection techniques can be a viable method for the management of patients with difficult to treat osteomyelitis, especially in cases of mandibular osteopetrosis.

Остеоид-остеома головчатой кости кисти (клинический случай)

Introduction Osteoid osteoma (OO) is a rare bone pathology of the hand. OO localization and pain syndrome associated with it may present a challenging diagnosing problem as its symptoms are nonspecific and the X-ray pattern is unclear. Our research is aimed at presenting the findings of the clinical and instrumental examination, and the outcome of successive surgical management of a patient with OO of the capitate. Material and methods We examined a 46-year-old male patient to verify the diagnosis of OO; he had the ultrasonic examination of his hand soft tissues and joints, biplane radiography of the wrist joint, computed tomography (СТ), and magnetic resonance imaging (MRI) of his left hand. A 0.6-cm defect of the capitate bone along with its increased bone density was visible in the X-rays of the patient’s left hand. In CT and MRI images, a 0.65 × 0.65 cm and up to 0.45-cm deep marginal bone defect on the capitate dorsum was identified. A 0.55 × 0.45 cm loose bone fragment was also found at that level. The examination was followed up by surgical management that involved marginal excision and extraction of the nidus of the left capitate bone. Results The patient reported the absence of pain in his hand and the increase in the range of motion in his wrist joint right after the surgery. The check-up X-ray images after three months revealed the signs of bone remodeling in the area of surgical intervention. The capitate defect was not found. Discussion OO in the hand may resemble a grainy remodeling of the osseous structure. A comprehensive examination that includes CT and MRI is crucial for revealing this rare OO localization. Conclusion The atypical localization and the patient’s age unusual for the liaison challenge the diagnosis and provide for the wrong choice of the treatment strategy.

Effect of amniotic membrane versus collagen membrane on sticky bone graft in lateral sinus lifting with simultaneous implant placement

Objectives: to compare of effect amniotic membrane versus collagen membrane on sticky bone with simultaneous implant placement after lateral sinus lifting procedure. Patients and methods: Seven patients with bilateral sever bone resorption undergone immediate implant after lateral sinus lifting and placement of sticky bone. In G (I): Collagen membrane covered sticky bone and implant while in G (II): Amniotic membrane covered sticky bone and implant. Surgical sites were evaluated clinically for any signs of infection, wound dehiscence, or exposure of implant threads. Also, Implant stability and bone density were obtained at 0, 3, 6 and 9 months. Results: Amniotic group revealed statistically significant value in percentage increase of bone density. Conclusion: The application of sticky bone with amniotic membrane was more likely proved to have the ability to assist and accelerate bone healing and osseointegration.

Injectable hydrogel with immobilized BMP-2 mimetic peptide for local bone regeneration.

Osteoporosis is a disease characterized by a decrease in bone mineral density, thereby increasing the risk of sustaining a fragility fracture. Most medical therapies are systemic and do not restore bone in areas of need, leading to undesirable side effects. Injectable hydrogels can locally deliver therapeutics with spatial precision, and this study reports the development of an injectable hydrogel containing a peptide mimic of bone morphogenetic protein-2 (BMP-2). To create injectable hydrogels, hyaluronic acid was modified with norbornene (HANor) or tetrazine (HATet) which upon mixing click into covalently crosslinked Nor-Tet hydrogels. By modifying HANor macromers with methacrylates (Me), thiolated BMP-2 mimetic peptides were immobilized to HANor via a Michael addition reaction, and coupling was confirmed with 1H NMR spectroscopy. BMP-2 peptides presented in soluble and immobilized form increased alkaline phosphatase (ALP) expression in MSCs cultured on 2D and encapsulated in 3D Nor-Tet hydrogels. Injection of bioactive Nor-Tet hydrogels into hollow intramedullary canals of Lewis rat femurs showed a local increase in trabecular bone density as determined by micro-CT imaging. The presented work shows that injectable hydrogels with immobilized BMP-2 peptides are a promising biomaterial for the local regeneration of bone tissue and for the potential local treatment of osteoporosis.