Increased Bone Density Research Articles

Eruptive Process in Children with Osteogenesis Imperfecta.

Osteogenesis imperfecta (OI) is a hereditary disorder characterized by bone fragility and skeletal abnormalities. The administration of bisphosphonates (BPs) in children with OI increases bone density. This antiresorptive inhibits osteoclast action, thus altering physiological processes, in which osteoclasts play important roles, such as the eruptive process. The aim of this investigation was to study the eruptive process (dental development of permanent dentition, resorption of temporary dentition, and alveolar eruption of the first permanent molar) in children with OI medicated with BPs and to compare the results with those of a control group. In total, 34 panoramic radiographs of children with OI [mean chronological age of 8.43 (± 1.77)] who were medicated with BPs for a period of one year or more were studied and 367 panoramic radiographs of healthy children [mean chronological age of 9.19 (± 1.62)] were used as controls. The Demirjian method was used to study the dental development of the seven permanent teeth in the third quadrant. Alveolar eruption of the first permanent molar was considered when perforation of the alveolar bone was produced. The Haavikko method was used to study the root resorption of the five primary teeth in the third quadrant, and software (PixelStick®) was used to measure the lengths of the mesial and distal roots of the primary molars. The cumulative dose of BPs was obtained by mathematically calculating the total dosage received (mg)/weight (kg) and multiplying the relative potency of the medication. The Mann‒Whitney U test was used for comparisons, and p < 0.05 indicated statistical significance. A delay of 0.95 points in dental development and delayed exfoliation of primary dentition between 1.31 and 1.66years were described in the study group. A root resorption delay of 11.8% was described among the 5 primary teeth of 23.3% among the single-rooted teeth and of 5.6% among the two-rooted teeth in children with OI medicated with BFs (p < 0.05). Delayed alveolar eruption of the first permanent molar at 0.31years of age was found in children with OI medicated with BFs. We detected delayed tooth development at one stage of maturation in the study group, which was clinicallyimperceptible.The dental age (≤ 0.55years) was greater than the chronological age in both groups. We also reported delayed exfoliation of the primary dentition (from 1.31 to 1.66years), delayed root resorption of the primary dentition (11.8%), and delayed (from 1mm to 1.25mm) root resorption of the primary molars in the study group. Although the degree of dental development of the first permanent molar was similar between the two groups, we found delayed (0.31years) alveolar eruption in the study group and a greater delay (0.44years) in children whose cumulative dose of bisphosphonates exceeded 2000.

Neurosurgical aspects of marble bone disease: treatment modalities and outcome

BackgroundMarble bone disease or osteopetrosis is an extremely rare hereditary condition that causes abnormal bone density and fragility due to impaired osteoclastic action. This causes the body to produce an abnormal amount of bone that are evident in radiographic findings and cause problems with the body systems, particularly the nervous system. Osteopetrosis has 3 types of genetic inheritance either malignant autosomal recessive (ARO) which occur in childhood, intermediate ARO which occur in adolescence, and benign autosomal dominant osteopetrosis which occur in adults. Complications from increased bone density like elevated intracranial pressure (ICP), compressing neural tissues, especially the cranial nerves (CNs), spinal cord, and brainstem, are common problems.AimThe aim of this study is to evaluate neurosurgical problems caused by osteopetrosis focusing on the effectiveness of different treatment modalities and their outcomes.ConclusionMarble bone disease or osteopetrosis is a rare hereditary disorder with multiple neurological impacts. Increased ICP and CNs compression are the most common. We studied 5 cases of adult osteopetrosis, 3 of them treated surgically. Two of the surgically treated cases had lumbo-peritonieal shunt, while the third case treated by optic nerve decompression. The remaining 2 cases were treated conservatively. The outcome of the surgically treated cases wasn’t good.

Comparison of the Effect of Resistance, Swimming, and Combination Training Patterns on Bone Density in Female Osteoporotic Rats

Introduction: The aim of the study was to compare the effects of resistance, swimming, and combined training patterns on L5 vertebral mineral density in osteoporotic rats. Methods: In this experimental study, 36 female Wistar rats, each weighing between 170-190 grams, were selected as samples. To verify the induction of osteoporosis, 12 rats were randomly divided into two groups: healthy and alcohol-injected (6 rats). Osteoporosis induction was induced through intraperitoneal injection of a saline solution combined with ethanol over a period of 3 weeks. 24 rats were randomly divided into 4 groups (6 rats): 1. Resistance training, 2. Swimming training, 3. Combined training, and 4. Control. Swimming training (90 minutes per day, 5 days in 12 weeks) and resistance protocol (5 days in 12 weeks, each session 8 sets with 8-12 repetitions of climbing the ladder) and the combined group performed resistance training in 4 sets with 8-12 repetitions of climbing the ladder and swimming training with half the duration of the swimming group. After 12 weeks, samples were collected from the spine and the density of L5 was evaluated using a DEXA machine. Data were analyzed using independent t-test, one-way ANOVA, and Tukey's test with a significance threshold of less than 0.05 in SPSS-16 (P&lt;0.05). Results: In the intragroup comparison, resistance training and combined training significantly increased L5 density (P=0.00). In the intergroup comparison, L5 density of the combined group showed a significant increase compared to the training and control groups (P=0.00). The resistance group showed a significant increase in this variable compared to the swimming and control groups (P=0.00). Conclusion: Using combined exercise as a therapeutic approach can increase bone density; therefore, it serves as an effective strategy for improving osteoporosis.

The Impact of Body Mass Index and Benign Prostatic Hyperplasia on Bone Health of Middle-Aged and Older Men.

Osteoporosis significantly affects older adults by reducing bone mass and increasing fracture risk, thereby impacting morbidity and mortality. This study aimed to investigate the relationship between bone mineral density (BMD), body mass index (BMI), and trabecular bone score (TBS) among middle-aged and older men with or without benign prostatic hyperplasia (BPH). A retrospective study was conducted using health examination data from male participants aged 50-98years collected at a regional hospital in southern Taiwan. Simple and multiple linear regression analyses were employed to examine the relationships between TBS and the independent variables. A total of 3714 middle-aged and older men were included in the analysis. Findings indicated that higher BMI was associated with greater BMD; however, the relationship with TBS suggested potential bone quality degradation in cases of underweight and obesity. Multiple linear regression analysis demonstrated that age, waist circumference, BMD, underweight status, and obesity were significantly associated with TBS. This study revealed the associative relationship between BMI and bone health: higher BMI was associated with increased bone density but also related to a decline in bone quality as measured by TBS, particularly in cases of obesity. These results emphasized the importance of managing BMI to optimize both bone density and quality, especially in middle-aged and older men with or at risk of BPH.

P-17 THE HIDDEN CULPRIT: CELIAC DISEASE IN A POSTPARTUM OSTEOPOROSIS PATIENT

Abstract Introduction Pregnancy and lactation-associated osteoporosis is a rare type of osteoporosis that is often accompanied by vertebral fractures. It is considered to be a result of pregnancy-related factors, as well as due to underlying secondary causes. Here we present a case of severe hypocalcemia following parenteral zoledronic acid administration for postpartum osteoporosis, in which further evaluation for secondary causes had not been made and underlying Celiac disease was missed. Clinical Case A 34-year-old female patient had applied to an out-patient clinic with widespread bone pain at third month postpartum. She was diagnosed as postpartum osteoporosis based on examination with the dual X-ray absorptiometry (DXA) scan. Lumbar spine L1-L4 bone mineral density (BMD) and Z-score was found 0.614 g/cm²; and -3.9 respectively. No data was present regarding a fracture. She was referred to our clinic with severe muscle cramps and numbness following administration of Zolendronic acid 5 mg intravenously. The patient denied any chronic diseases, but she noted that she had undergone an intestinal operation due to ileus when she was 22 years old. She had a history of four pregnancies and had breastfed each of her children for at least a year. Family history was insignificant. On physical examination, symptoms of proximal myopathy, Chvostek and Trousseau signs were evident. Laboratory investigation revealed severe hypocalcemia; results of laboratory were as follows: Corrected-Ca: 5.5 mg/dL, P: 1.8 mg/dL, 25-Hydroxyvitamin D: 6.4 g/L, Parathormone (PTH): 1044 pg/mL, and Alkaline phosphatase (ALP): 269 U/L. In addition to parenteral and oral calcium, calcitriol and cholecalciferol treatments were started subsequently. Upon further evaluation for the secondary causes of osteoporosis, Celiac antibodies tested positive, additionally the appearance of the upper gastrointestinal system endoscopy and the biopsy of the second part of the duodenum were found to be compatible with Celiac disease. Thus, the patient's follow-up continued with calcium and vitamin D replacements, as well as dietary adjustments for celiac disease. The patient has been followed up in our clinic for approximately two years, a significant increase in bone density and improvement in biochemical values were detected with the current diet and replacements. DXA scans: 2022: Femoral neck BMD 0.694 g/cm², Z-score -1.5; Lumbar spine L1-L4 BMD: 0.614 g/cm², Z-score: -3.9 2024: Femoral neck BMD 1.080 g/cm², Z-score +1.2 Lumbar spine L1-L4 BMD 1.246 g/cm², Z-score: +0.8 Conclusion In patients presenting with postpartum osteoporosis, secondary causes should be investigated and treatment should be determined according to diagnosis. Bisphosphonate treatment in postpartum osteoporosis can be applied only to a group of individually selected patients and adequate calcium and vitamin D supplementation should be given prior to treatment.Table 1:Laboratory FindingsLaboratory findings during the two-year follow-up of the patient

A comprehensive report of the clinical and mutational profiles of 30 Iranian malignant infantile osteopetrosis patients.

Osteopetrosis is a group of genetically and clinically diverse inherited disorders characterized by an increase in bone density. The main known cause is an abnormality in the development or function of osteoclasts. Hence, the process of bone resorption is impaired, resulting in: 1- a reduction in bone marrow volume and, subsequently, a decrement in the hematopoietic capacity of bone marrow, which leads to anemia and compromised immunological function; 2- improper bone development, which leads to pressure on peripheral nerves, causing auditory, visual, and movement impairments; and 3- disturbance in the formation of bone microstructure that leads to susceptibility to bone fracture. This study aimed to evaluate the clinical symptoms and genetic causes of 30 patients (probands) who suffered from malignant infantile osteopetrosis, a subtype of this disorder. The Sanger sequencing technique was used to sequence four common genes (TCIRG1, CLCN7, SNX10, and OSTM1) in osteopetrosis. Subsequently, the selected variants were subjected to segregation analysis between the probands and their parents. Consequently, the sequencing of these four genes in probands revealed 16 pathogenic and likely pathogenic mutations, five of which had never been reported before. The TCIRG1 gene has three novel splice site variations and one frameshift variant. The CLCN7 gene had a novel missense variant. Also, a total of five variants of uncertain significance (VUSs) were identified in the analyzed sequences, of which three haven't been reported to date, and two were observed in osteopetrosis patients. Therefore, by documenting these novel likely pathogenic variants and VUS in known genes associated with this disease in patients, specialists can conduct more accurate genetic analysis and counseling when encountering these variants. Additionally, this documentation will facilitate the reclassification of these variants.

Basal implants as a treatment alternative for severely resorbed ridges.

The aim of this study was to evaluate the long-term treatment outcomes of basal implants in patients with severely resorbed ridges, including the survival and success rates, patient complaints, satisfaction, and Quality of Life. An extensive electronic search was conducted on the search engines: PubMed, Web of Science, and Google Scholar using Boolean Operators (AND, OR, NOT) and the key words (basal implants, Corticobasal implants, Strategic Implants, severely resorbed ridge, severely atrophic ridge, treatment outcome, patient satisfaction) within the last 10 years. A total of 21 articles were found, encompassing 9732 basal implants placed in 1219 patients. Thirteen studies had reported a success or survival rate with a range of 90.3-100% for intraoral basal implants and 88.2% and 92.9% for orbital and nasal implants, respectively. Four studies have reported failure rates with a range of 0.3-3.2%, while seven articles documented 0.3-2.4% mobility. The pain was reported in 6 studies (0.3-0.8), marginal bone loss (0.33-7.89 mm), an increase in bone density, and peri-implant bone contact were reported in 3 and 2 studies, respectively. Basal implant-supported prostheses can be a practical treatment modality with high predictable survival or success rates, positive impacts on patient satisfaction, and improved quality of life.

Is ADDM graft practical? A comparative study to evaluate ADDM graft in third molar surgery.

It has been outlined that LTM (Lower third molar) extracted from patients in which grinding, cleaning, sterilization & demineralization prove to be highly effective as graft material for filling the alveolar socket of the very same patient. These investigations aim to assess the efficiency of ADDM (Autogenous Demineralized Dentin Matrix) graft in third molar extraction sockets. To check the effectiveness of ADDM as graft material in extraction socket by evaluating pain, swelling, trismus, PD (Probing Depth) and bone density. A prospective, randomized control trial was conducted at our institute. The patients were haphazardly, non-blindly alienated into two groups. Group A (45 patients) on the test side after LTM impaction surgery will receive ADDM graft material with bio-collagen membrane and Group B (45 patients) on the control side underwent LTM removal, with the alveolus left to heal conventionally by forming a blood clot. Swelling showed significant difference between CG (Control Group) and TG (Test Group), the intergroup comparison of change in the swelling scores at seventh post-operative day (from pre-op level) was significantly higher in the TG (117.35) as compared to the CGs (115.92) (p = 0.001). A statistically significant difference in probing depth was also noted between the two groups, CG 4.46 ± 1.252 & TG 2.52 ± 0.641 in the post-operative examination at three months. In our study radiographical evaluation revealed progressive increase in bone density in TG (135.81 ± 8.73) when compared to CG (121.59 ± 13.83) over a period of three months. Pain and trismus evaluation did not reveal any significant difference between TG & CG. The clinical results of the ADDM graft procedure demonstrate satisfactory outcomes in extraction sockets. The findings of this study highlight the importance of preservation methods in maintaining the periodontal pocket depth distal to the second molar and the remaining alveolar ridge following extraction.

Therapeutic potential of bisphosphonates - review of medical indications, mechanism of action, interactions and adverse effects

Introduction: Bisphosphonates are pharmacological agents that inhibit bone resorption by targeting osteoclasts, thereby increasing bone density and reducing fracture risk. Although they were first synthesized in the 19th century, their clinical significance has only been recognized in the last 50 years. This study reviews the current understanding of bisphosphonates, their therapeutic advantages in various disorders, and their mechanism of action, potential interactions, and adverse effects. Aim of the study: The aim of this study is to provide an overview of the current understanding of bisphosphonates and familiarize readers with their mechanisms of action, interactions and adverse effects. It also aims to briefly introduce diseases that may be treated with bisphosphonates and how this class of medications can improve the course of each disorder. This study focuses on their therapeutic potential and associated risks, highlighting the need for further research in this area. Material and methods: Literature available in the PubMed database was reviewed using the following keywords: “bisphosphonates”; “bisphosphonates mechanism of action”; “bisphosphonates side effects”; “bisphosphonates interactions”; “bone tissue”; “skeletal system disorders”; “skeletal system”; “menopause”;” osteogenesis imperfecta”; “bone metastasis” Conclusions: The introduction of bisphosphonates represents a significant advancement in the management of conditions associated with increased bone turnover, offering clinically substantiated benefits that outweigh the associated risks. This review provides healthcare professionals with evidence-based, scientifically validated information on bisphosphonates, while also identifying critical areas for further investigation to optimize their safety and efficacy, ultimately improving patient outcomes and quality of life.

Loss of KAT6B causes premature ossification and promotes osteoblast differentiation during development.

The MYST family histone acetyltransferase gene, KAT6B (MYST4, MORF, QKF) is mutated in two distinct human congenital disorders characterised by intellectual disability, facial dysmorphogenesis and skeletal abnormalities; Say-Barber-Biesecker-Young-Simpson variant of Ohdo syndrome and Genitopatellar syndrome. Despite its requirement in normal skeletal development, the cellular and transcriptional effects of KAT6B in skeletogenesis have not been thoroughly studied. Here, we show that germline deletion of the Kat6b gene in mice causes premature ossification in vivo, resulting in shortened craniofacial elements and increased bone density, as well as shortened tibias with an expanded pre-hypertrophic layer, as compared to wild type controls. Mechanistically, we show that the loss of KAT6B in mesenchymal progenitor cells promotes transition towards an osteoblast-progenitor state with upregulation of gene targets of RUNX2, a master regulator of osteoblast development and concomitant downregulation of SOX9, a critical gene in chondrocyte development. Moreover, we find that compound heterozygosity at Kat6b and Runx2 loci partially rescues the reduction in ossification of Runx2 heterozygous, but not homozygous mice, suggesting that KAT6B may limit the action of RUNX2, possibly through a role in maintaining progenitors in an undifferentiated state. Moreover, our results show that KAT6B has essential roles in regulating the expression of a large number of genes involved in skeletogenesis and bone development.

Functionalized Periosteum-Derived Microsphere-Hydrogel with Sequential Release of E7 Short Peptide/miR217 for Large Bone Defect Repairing.

Large bone defects are still a persistent challenge in orthopedics. The availability limitations and associated complications of autologous and allogeneic bone have prompted an increasing reliance on tissue engineering and regenerative medicine. In this study, we developed an injectable scaffold combining an acellular extracellular periosteal matrix hydrogel with poly(d,l-lactate-co-glycol-acetate) microspheres loaded with the E7 peptide and miR217 (miR217/E7@MP-GEL). Characterization of the composites included morphological analysis by scanning electron microscopy, degradation and swelling tests, invitro and invivo biological evaluation, and the biological activity evaluation of mesenchymal stem cells (MSCs) through their effects on cell recruitment, proliferation, and osteogenic differentiation. The designed hydrogels demonstrated good physical and chemical properties that are cytocompatible and suitable for cell recruitment. Invitro studies confirmed the high biological activity of the release agent, which markedly enhanced the proliferation and osteogenic differentiation of MSCs. Invivo application to a rat model of a femur defect exhibited a significant increase in bone volume and density over 7 weeks, resulting in enhanced bone regeneration. Acellular periosteum-based hydrogels combined with the E7 peptide and miR217-loaded poly(d,l-lactate-co-glycol-acetate) microspheres can promote effective bone regeneration through the recruitment, proliferation, and osteogenic differentiation of MSCs, which provides a promising approach for the treatment of large bone defects.

The mechanism of action of indole-3-propionic acid on bone metabolism.

Indole-3-propionic acid (IPA), a metabolite produced by gut microbiota through tryptophan metabolism, has recently been identified as playing a pivotal role in bone metabolism. IPA promotes osteoblast differentiation by upregulating mitochondrial transcription factor A (Tfam), contributing to increased bone density and supporting bone repair. Simultaneously, it inhibits the formation and activity of osteoclasts, reducing bone resorption, possibly through modulation of the nuclear factor-κB (NF-κB) pathway and downregulation of osteoclast-associated factors, thereby maintaining bone structural integrity. Additionally, IPA provides indirect protection to bone health by regulating host immune responses and inflammation via activation of receptors such as the Aryl hydrocarbon Receptor (AhR) and the Pregnane X Receptor (PXR). This review summarizes the roles and signaling pathways of IPA in bone metabolism and its impact on various bone metabolic disorders. Furthermore, we discuss the therapeutic potential and limitations of IPA in treating bone metabolic diseases, aiming to offer novel strategies for clinical management.

Puerarin Promotes Tibial Shaft Fracture Healing in Rats and Its Relationship with BMP-Smad Pathway

Background Fracture healing involves multiple growth factors and the interaction between multiple signaling pathways. Pue (puerarin) is a natural compound with multiple biological activities, but its effect on fracture healing and its relationship with the bone morphogenic protein (BMP)-Smad pathway is not yet clear. Purpose This study intends to assess the effect of puerarin on fracture healing. Methods Seventy rats were used for the study to establish a tibial shaft fracture rat model. The experimental rats were divided into a tibial fracture group, Pue dose group (low, medium, and high), BMP-2 group, Noggin group, Pue + SY-LB-35 group, and Pue + Noggin group through the random number method. We observed the fracture healing through micro-CT and histology, observed the tibial stump tissue with hematoxylin and eosin (HE) staining, and detected the expression of genes related to the BMP-Smad pathway through quantitative real-time polymerase chain reaction (qPCR) and Western blot. Results We found that puerarin can promote tibial shaft fracture healing in rats in a dose-dependent manner; through micro-CT and histological analysis, we observed increased trabecular bone formation during fracture healing in rats treated with puerarin. Callus formation is accelerated, and bone density increases. In addition, puerarin also significantly increased the expression of genes related to the BMP-Smad pathway, including BMP2, Smad1, Smad5, and so on. Conclusion Puerarin can promote tibial shaft fracture healing in rats, and its mechanism is related to upregulating the expression of genes related to the BMP-Smad pathway. It further improves the fracture-healing mechanism and provides candidate drugs for the treatment of tibial shaft fracture healing in clinical medicine.

A Micro-CT Based Cadaveric Study Investigating Bone Density Changes During Hip Arthroplasty Surgery.

The impact of broaching and uncemented implantation on bone density during total hip arthroplasty (THA) remains unclear. Previous studies have typically examined extracted bone sections, which may not directly correlate with outcomes in human hip systems. This study aimed to evaluate bone density changes resulting from broaching and uncemented implantation using micro-computed tomography (μCT) on cadaveric samples. An in-house density calibration phantom (DCP) was developed by validating the densities of polymer inserts through mass and volume measurements. Its performance was then evaluated using lamb bone in comparison with a commercial DCP (QRM-50124). The sensitivity of density predictions to μCT scan parameters was also evaluated with the lamb bone. Additionally, density predictions from medical-CT and μCT scans were compared using the in-house DCP. Finally, uncemented THA procedures were performed on three cadaveric femurs, each undergoing three μCT scans at various surgical stages to assess changes in bone density. The density predictions obtained using the in-house DCP achieved an accuracy of ±0.097 g/cc compared to QRM-50124, with a precision of ±0.052 g/cc. The sensitivity to changes in μCT scan parameters was ±0.022 g/cc. Notably, density predictions from medical-CT and μCT scans were similar, particularly in cortical bone. Broaching and implantation led to an average increase in bone density of 0.137 g/cc, which was attributed to the accumulation of bone debris around the bone-implant interface. This accumulation raised the bone volume fraction, ranging from 3.31% to 20.69%, which acts as an autograft. These measurements have been made for the first time using a µCT and an in-house DCP.

Assessment of the Peri-implant Bone Density Following Bicortical Anchored Corticobasal Implants Placement in the Maxillary Arch: A Cross-sectional Prospective Study.

The aim of this cross-sectional prospective study was to evaluate the bone density changes around the bicortical corticobasal implant placed in the maxilla over 18 months of follow-up using cone-beam computed tomography (CBCT), focusing on the comparison between the anterior and posterior teeth and regions. Thirty-five subjects (20, 53.26%, were males, and 15, 46.73%, were females) received 380 implants (Basal Cortical Screwable implant, BCS®) at Narsinhbhai Patel Dental College and Hospital, India. Implant survival and success were assessed using Albrektsson criteria for implant success. The peri-implant bone density values were measured using CBCT (Vatech PaX-i 3d Smart) and InVivo software (Anatomage, San Jose, California, USA) at the baseline (immediate postoperative) and at the 18-month follow-up visit. For standardization purposes, the bone density values for only the maxillary implants were measured at the level of the second implant thread in four sites: buccal, mesial, distal, and palatal, respectively. The recorded data were tabulated and grouped according to the tooth's region (anterior/posterior) and sites (mesial, distal, buccal, and palatal). The implant's survival rate was 100%. After 18 months, the bone density increased significantly (p < 0.05) in all the sites in both anterior and posterior regions. The study's findings revealed a higher bone density increase in the posterior region compared to the anterior region after 18 months of follow-up, except for the palatal site. Within the limitations of this study, an increase in the peri-implant bone density has been associated with the use of corticobasal implants over time, with reported anterior/posterior regional variations. This study provides valuable insights into the bone density changes associated with bicortical corticobasal implants and emphasizes the importance of CBCT in evaluating bone density, as well as the significance of regional considerations in implant dentistry. By integrating these findings into clinical practice, clinicians can improve treatment outcomes and ensure long-term implant survival. How to cite this article: Doshi A, Patel J, Gaur V, et al. Assessment of the Peri-implant Bone Density Following Bicortical Anchored Corticobasal Implants Placement in the Maxillary Arch: A Cross-sectional Prospective Study. J Contemp Dent Pract 2024;25(9):820-829.

Impact of Platelet-Rich Fibrin (PRF) Versus Freeze-Dried Bone Allograft (FDBA) on Peri-Implant Soft and Hard Tissue in Alveolar Ridge Preservation

ABSTRACT Context: After tooth extraction, alveolar ridge preservation (ARP) is essential to maintain the hard and soft tissue dimensions for future implant placement. Two frequently employed biomaterials in ARP are freeze-dried bone allograft (FDBA) and platelet-rich fibrin (PRF), each possessing unique biological characteristics. Materials and Methods: In a randomized controlled study, sixty individuals requiring ARP after tooth extraction were included. The patients were divided into two groups: Group A (n = 30) received PRF, and Group B (n = 30) received FDBA. Clinical measurements, such as soft tissue thickness, keratinized tissue width, and radiographic bone density, were recorded at baseline, three months, and six months after surgery. Cone-beam computed tomography (CBCT) was used to assess changes in hard tissue, such as the width and height of the alveolar ridge. Results: Group A (PRF) showed a significant increase in soft tissue thickness over six months, with an average gain of 2.5 mm (P &lt; 0.01). In contrast, Group B (FDBA) showed a 30% increase in bone density compared to baseline (P &lt; 0.05). Group B experienced a decrease in alveolar ridge height and width of 1.2 mm and 1.8 mm, respectively, while Group A showed a reduction of 1.6 mm and 2.3 mm. Conclusion: In conclusion, peri-implant soft and hard tissues benefit from both PRF and FDBA during alveolar ridge maintenance. Soft tissue thickness can be improved more effectively with PRF, while FDBA is superior for preserving hard tissue.

The Degree of Cervical Intervertebral Disc Degeneration Is Associated With Denser Bone Quality of the Cervical Sub-endplate and Vertebral Body.

The relationship between cervical disc degeneration and bone quality of adjacent vertebral body remains controversial. This study aims to investigate the relationship between cervical disc degeneration and bone quality of the adjacent vertebral body and sub-endplate bone with a new MRI-based bone quality score in patients over 50 years with cervical spondylosis. We retrospectively reviewed 479 cervical disc segments from 131 patients. Disc degeneration at levels C3/C4-C6/C7 was graded using T2-weighted MRI. Vertebral body quality (VBQ) score and sub-endplate bone quality (EBQ) score from C3 to C7 were computed from T1-weighted MRI images. Additionally, bone mineral density (BMD) of the cervical vertebrae was measured in 52 patients using a novel phantom-less quantitative computed tomography (PL-QCT) system. The correlation between bone quality score and Pfirrmann grade was analyzed and risk factors for VBQ and EBQ were further evaluated. Significant differences were found in cranial VBQ among different Pfirrmann grades, with a score of 2.55 ± 0.54 for Grade 5 discs, which was lower compared to Grades 4 (2.70 ± 0.56) (p < 0.05) and 3 (2.81 ± 0.58) (p < 0.01). Caudal VBQ for Grade 5 discs (2.43 ± 0.52) was also significantly lower than for Grade 3 discs (2.66 ± 0.54) (p < 0.01). EBQ scores decreased with increasing Pfirrmann grades. Negative correlations were observed between both cranial and caudal VBQ and EBQ scores and Pfirrmann grades. Grades 4 and 5 discs were identified as independent risk factors for decreased caudal VBQ and EBQ, whereas only Grade 5 was a significant risk factor for decreased cranial EBQ. Additionally, a moderate correlation (0.4 < R < 0.6, p < 0.05) was noted between vertebral body BMD and VBQ at each cervical level. In individuals over 50 years with cervical spondylosis, the severity of disc degeneration was closely correlated with denser bone quality in both the caudal vertebral body and sub-endplate, as measured by VBQ and EBQ scores. These findings suggest that worsening disc degeneration is associated with increased bone density in specific areas of the cervical spine.

Effect of romosozumab administration on proximal junctional kyphosis in corrective spinal fusion surgery.

The effect of romosozumab administration in patients undergoing corrective spinal fusion surgery has not yet been analyzed. To examine the effect of romosozumab administration on reducing the incidence of proximal junctional kyphosis (PJK), particularly PJK due to fractures (PJK-Fx), in patients undergoing spinal corrective fusion surgery. Retrospective cohort study PATIENT SAMPLE: A total of 111 patients aged >50 years underwent corrective fusion surgery (>2 vertebrae) for adult spinal deformity or vertebral compression fracture between June 2010 and July 2023. The primary outcome was the incidence of PJK, whereas the secondary outcomes were changes in Hounsfield unit (HU) values, surgical complications, and clinical outcomes measured using the Japanese Orthopaedic Association (JOA) and visual analog scale scores. The patients were divided into the romosozumab (n=32) and non-romosozumab groups (n=79). Romosozumab was typically administered 2 months before surgery in the romosozumab group. Demographic data, surgery-related factors, and radiographic parameters were analyzed. HU values at the upper instrumented vertebra+1 (UIV+1) were measured preoperatively and at 1 year postoperatively. After the univariate analysis of preoperative factors associated with PJK, multivariate logistic regression was used to identify factors associated with PJK. Romosozumab significantly increased the HU values at UIV+1 (-1.22% vs. 13.60%, p<0.001) and reduced the incidence of PJK (39.24% vs. 18.75%, p=0.046), particularly PJK-Fx (26.58% vs. 6.25%, p=0.019) and osteoporosis-related complications (55.70% vs. 34.38%, p=0.011). The multivariate analysis showed a significantly lower incidence of PJK (adjusted odds ratio = 0.32, p=0.033), particularly PJK-Fx (adjusted odds ratio = 0.15, p=0.018). There was a tendency for better JOA scores at 1 year postoperatively in the romosozumab group (21.49 vs. 23.62, p=0.071). Romosozumab administration effectively increased bone density and reduced the risk of PJK, particularly PJK-Fx, and osteoporosis-related complications in patients undergoing corrective spinal fusion surgery. Administration of romosozumab 2 months before surgery enhanced bone mineral density and strength, leading to better surgical outcomes and fewer complications. Further long-term studies are needed to confirm these findings and optimize treatment protocols.

Pathomorphological &amp; Radiological Changes Following Denosumab Treatment In Giant cell tumours

Introduction:- The introduction of denosumab has significantly impacted the treatment approach for giant cell tumors (GCTs) of bone, a locally aggressive osteolytic neoplasm. This study aimed to comprehensively investigate the pathomorphological and radiological changes observed in GCT patients following neoadjuvant denosumab therapy. Material methods: - A retrospective analysis of 12 cases was conducted, encompassing primary and recurrent GCT cases treated with denosumab. Clinical, radiological, and histopathological features were thoroughly examined. All cases displayed Campanacci grade 3 lesions with ambiguous borders. Results: - Neoadjuvant denosumab treatment led to distinct clinical benefits, including reduced intraoperative bleeding and increased bone density, facilitating surgical procedures. Histopathologically, denosumab-treated cases exhibited enhanced cellularity, prominent fibroblastic proliferation, spindle cell arrangement, osteoid formation, and fibro-osseous components. The number of osteoclast-type giant cells significantly diminished, sometimes approaching absence. Immunohistochemical analysis using P63 corroborated the diagnosis. Radiologically, denosumab-induced changes included marked osteosclerosis, sclerotic rim formation, and increased intralesional osteosclerosis. Conclusion: - These findings emphasize the significance of recognizing the diverse morphological and radiological alterations in denosumab-treated GCTs.

Surgical Management of Adult Spinal Deformity Patients with Osteoporosis.

Adult spinal deformity (ASD) commonly affects older adults, with up to 68% prevalence in those over 60, and is often complicated by osteoporosis, which reduces bone mineral density (BMD) and increases surgical risks. Osteoporotic patients undergoing ASD surgery face higher risks of complications like hardware failure, pseudoarthrosis, and proximal junctional kyphosis (PJK). Medical management with antiresorptive medications (e.g., bisphosphonates, SERMs, and denosumab) and anabolic agents (e.g., teriparatide, abaloparatide, and romosozumab) can improve BMD and reduce complications. While bisphosphonates reduce fracture risk, teriparatide and newer agents like romosozumab show promise in increasing bone density and improving fusion rates. Surgical adaptations such as consideration of age-adjusted alignment, fusion level selection, cement augmentation, and the use of expandable screws or tethers enhance surgical outcomes in osteoporotic patients. Specifically, expandable screws and cement augmentation have been shown to improve fixation stability. However, further research is needed to evaluate the effectiveness of these treatments, specifically in osteoporotic ASD patients.