Left Femur Research Articles

Ischiofemoral Impingement, An Atypical Cause of Gluteal Pain: A Case Report

BACKGROUND: This is a case of unilateral gluteal pain in a 54-year-old woman. CASE REPORT: The patient presented with a 4-month history of left buttock pain after a traumatic fall. Her pain was exacerbated primarily while sitting. Pelvic x-rays showed bilateral acetabular dysplasia. Magnetic resonance imaging of the left femur without contrast was significant for ischiofemoral impingement (IFI), including compression of the quadratus femoris (QF). The QF space displayed a minimum dimension of 0.7 cm. The patient was scheduled for an ultrasound-guided QF injection, but cancelled the procedure due to symptomatic improvement with supportive care. CONCLUSIONS: IFI has become increasingly recognized as an uncommon cause of posterior hip, gluteal, or groin pain. Diagnosis of IFI can be challenging given the broad differential and potential for multiple etiologies of pain. Acetabular dysplasia leads to increased femoral anteversion. Thus, patients with acetabular dysplasia may be vulnerable to the development of IFI. KEY WORDS: Ischiofemoral impingement, acetabular dysplasia, ischiofemoral impingement, buttock pain, gluteal pain, case report

GCTRP3 inhibits oophorectomy‑induced osteoporosis by activating the AMPK/SIRT1/Nrf2 signaling pathway in mice.

C1q/tumor necrosis factor‑related protein 3 (CTRP3) expression is markedly reduced in the serum of patients with osteoporosis. The present study aimed to investigate whether CTRP3 reduces bone loss in oophorectomy (OVX)‑induced mice via the AMP‑activated protein kinase (AMPK)/sirtuin 1 (SIRT1)/nuclear factor E2‑related factor 2 (Nrf2) signaling pathway. Female C57BL/6J mice and MC3T3‑E1 cells were used to construct in vivo and in vitro models of osteoporosis, respectively. The left femurs of mice were examined using micro‑computed tomography scans and bone‑related quantitative morphological evaluation was performed. Pathological changes and the number of osteoclasts in the left femurs of mice were detected using hematoxylin and eosin, and tartrate‑resistant acid phosphatase (TRAP) staining. Runt‑related transcription factor‑2 (RUNX2) expression in the left femurs was detected using immunofluorescence analysis, and the serum levels of bone resorption markers (C‑telopeptide of type I collagen and TRAP) and bone formation markers [osteocalcin (OCN) and procollagen type 1 N‑terminal propeptide] were detected. In addition, osteoblast differentiation and calcium deposits were examined in MC3T3‑E1 cells using alkaline phosphatase (ALP) and Alizarin red staining, respectively. Moreover, RUNX2, ALP and OCN expression levels were detected using reverse transcription‑quantitative PCR, and the expression levels of proteins associated with the AMPK/SIRT1/Nrf2 signaling pathway were detected using western blot analysis. The results revealed that globular CTRP3 (gCTRP3) alleviated bone loss and promoted bone formation in OVX‑induced mice. gCTRP3 also facilitated the osteogenic differentiation of MC3T3‑E1 cells through the AMPK/SIRT1/Nrf2 signaling pathway. The addition of an AMPK inhibitor (Compound C), SIRT1 inhibitor (EX527) or Nrf2 inhibitor (ML385) reduced the osteogenic differentiation of MC3T3‑E1 cells via inhibition of gCTRP3. In conclusion, gCTRP3 inhibits OVX‑induced osteoporosis by activating the AMPK/SIRT1/Nrf2 signaling pathway.

Technical note: Capturing shape-Linear measurements and geometric morphometrics of the immature femora.

Growth and developmental studies have been a prominent theme in bioarchaeology. These works traditionally focus on metric measurements of long bone length and age-at-death or cross-sectional geometric studies with the use of computed tomography scans for questions on growth and mobility. However, teasing apart aspects of size and shape have been difficult due to the cylindrical nature of immature long bones. This research investigates the methodological use of surface geometries from linear measurements and geometric morphometric methods (GMM) to answer questions on mobility and allometry during childhood. Left femora were selected from 42 individuals ranging from fetal to 12 years of age from medieval St Gregory's Priory, Canterbury, UK. Femora were digitized with structured-light-scanning for auto3dgm analysis and measurements were obtained from physical caliper measurements. Individuals were put into age groups based on biomechanical milestones during this age range. Ratio and GMM confirm hypotheses of allometry and biomechanical milestones. Geometric morphometrics, however, detects more subtle differences in mobility at each age group. The findings of this preliminary study support the potential use of GMM of immature femora, while indicating that the extent in range of mobility that can occur varies at different biological milestones.

Estimation of population affinity using proximal femoral measurements based on computed tomographic images in the Japanese and western Australian populations

The present study analyzes morphological differences femora of contemporary Japanese and Western Australian individuals and investigates the feasibility of population affinity estimation based on computed tomographic (CT) data. The latter is deemed to be of practical importance because most anthropological methods rely on the assessment of aspects of skull morphology, which when damaged and/or unavailable, often hampers attempts to estimate population affinity. The study sample comprised CT scans of 297 (146 females; 151 males) Japanese and 330 (145 females; 185 males) Western Australian adult individuals. A total of 10 measurements were acquired in two-dimensional CT images of the left and right femora; two machine learning methods (random forest modeling [RFM]) and support vector machine [SVM]) were then applied for population affinity classification. The accuracy of the two-way (sex-specific and sex-mixed) model was between 71.38 and 82.07% and 76.09–86.09% for RFM and SVM, respectively. Sex-specific (female and male) models were slightly more accurate compared to the sex-mixed models; there were no considerable differences in the correct classification rates between the female- and male-specific models. All the classification accuracies were higher in the Western Australian population, except for the male model using SVM. The four-way sex and population affinity model had an overall classification accuracy of 74.96% and 79.11% for RFM and SVM, respectively. The Western Australian females had the lowest correct classification rate followed by the Japanese males. Our data indicate that femoral measurements may be particularly useful for classification of Japanese and Western Australian individuals.

Relationship between Femoral Proximal Bone Quality Assessment by MRI IDEAL-IQ Sequence and Body Mass Index in Elderly Men.

Bone assessment using the MRI DEAL-IQ sequence may have the potential to serve as a substitute for evaluating bone strength by quantifying the bone marrow hematopoietic region (R2*) and marrow adiposity (proton density fat fraction: PDFF). Higher body mass index (BMI) is associated with increased bone mineral density (BMD) in the proximal femur; however, the relationship between BMI and R2* or PDFF remains unclear. Herein, we investigated the correlation between BMI and MRI IDEAL-IQ based R2* or PDFF of the proximal femur. A retrospective single-cohort study was conducted on 217 patients diagnosed with non-metastatic prostate cancer between September 2019 and December 2022 who underwent MRI. The correlation between BMI and R2* or PDFF of the proximal femur was analyzed using Spearman's rank correlation test. Among 217 patients (median age, 74 years; median BMI, 23.8 kg/m2), there was a significant positive correlation between BMI and R2* at the right and left proximal femur (r = 0.2686, p < 0.0001; r = 0.2755, p < 0.0001, respectively). Furthermore, BMI and PDFF showed a significant negative correlation (r = -0.239, p = 0.0004; r = -0.2212, p = 0.001, respectively). In elderly men, the increased loading on the proximal femur due to elevated BMI was observed to promote a decrease in bone marrow adiposity in the proximal femur, causing a tendency for a transition from fatty marrow to red marrow with hematopoietic activity. These results indicate that the MRI IDEAL-IQ sequence may be valuable for assessing bone quality deterioration in the proximal femur.

Primary extranodal lymphoma: a report of six cases in a private cancer centre in Nigeria

Primary extra-nodal lymphoma (PENL) refers to lymphomas which present with disease in any organ or tissue other than lymph nodes or spleen. Symptoms at initial presentation are mainly from extra nodal involvement and after routine staging procedures, the extra nodal involvement remains the clinically dominant site of disease with little or no nodal disease [1, 2]. About 25–40% of lymphomas arise at extra nodal sites and with clinical presentation similar to solid tumors [3, 4] creating ambiguity in diagnosis and delays in treatment especially in resource poor settings. We report six cases of PENL seen at a private cancer centre in Lagos, Nigeria between 2021 and 2022. The age range was 32–95 years with five females and one male. Two patients were HIV positive. Five patients had initial symptoms of vague abdominal pain with one patient investigated multiple times for peptic ulcer disease. One patient presented with pathological fracture of left femur. Another patient had previously been diagnosed with an inoperable cholangiocarcinoma. All patients had non-Hodgkin’s lymphoma, DLBCL being most common (83.37%). Four patients started chemotherapy. All treated patients showed good outcomes with complete or good partial response highlighting the importance of accurate diagnosis. Initial histological diagnosis in most of the cases did not suggest lymphoma until immunohistochemistry (IHC) results were received. Cancer care in Nigeria is fraught with difficulties obtaining accurate diagnosis due in part to the limited availability of IHC and molecular testing facilities required to characterize the malignant cells leading to delays in treatment and poorer prognosis [6–8].

Challenges in the Surgical Orthopedic Treatment of Long Bone Fracture in a Rare Case of Pycnodysostosis

Pycnodysostosis is a rare autosomal recessive disorder caused by an inactivating mutation in cathepsin K (CTSK) and characterized by dysmorphic facial features, a short stature, acro-osteolysis, osteosclerosis with increased bone fragility, and delayed closure of cranial sutures. Although the satisfying healing potential, many issues exist in managing fractures in pycnodysostosis patients. In this paper, we report the challenges faced in managing a fracture of the femoral shaft in a 14-year-old boy coming from a low-income family. The patient was administered to the Paediatric Surgical Emergency Department of the Children's Hospital in Rabat for the management of a closed fracture of the left femur. Despite being of small stature with dysmorphic facial features, a prominent forehead, and brachydactyly, he never had a medical consultation before. The patient then underwent a surgical reduction. We attempted titanium elastic nail fixation, but metaphyseal drilling was not feasible due to the high bone density, and the narrow medullary canal eliminated this option. Therefore we opted for the palate fixation. Sclerotic bone made drilling extremely difficult. The postoperative fracture was successfully healed.

Unusual soft tissue metastases in a patient with chondrosarcoma: a case report.

Chondrosarcoma (CS) is the second most frequent primary malignant bone tumour, characterized by production of non-osteoid cartilage matrix. Up to more than 30% of patients with CS present distant metastases, and the lungs represent the preferred site. Hence, CS soft tissue metastases and superficial cutaneous lesions are extremely rare. We report the case of a female who developed unusual multiple soft tissue CS metastases. This patient underwent left hindquarter amputation for recurrent grade 3 chondrosarcoma of the femoral neck with extension to the pelvis approximately 4years after internal fixation with an intramedullary nail for pathological fracture of left proximal femur and subsequent total proximal femoral endoprosthetic replacement for grade 1-2 chondrosarcoma. In the following years, she underwent metastasectomy for several grade 2 pulmonary metastatic chondrosarcomas. More than 14years after the amputation, she presented with multiple unusual superficial cutaneous lesions, and a whole-body magnetic resonance imaging demonstrated multiple soft tissue foci of metastatic disease. The histology of multiple soft tissue lesions excised confirmed metastatic chondrosarcoma. Then, she underwent marginal excision of further multifocal soft tissue metastatic high-grade chondrosarcoma. Unlike the poor survival from the onset of these metastases in the other cases reported in the literature, our patient is still alive 2years after the first multiple soft tissue excision of metastatic chondrosarcoma, and approximately 20years after the diagnosis of chondrosarcoma. Soft tissue CS metastases are a rare entity with few cases described in literature. This study aims to make the reader aware of this lesser-known CS manifestation.

Dynamic intramedullary crosspinning technique for the treatment of distal femoral metaphyseal fracture in a free‐ranging jaguarundi (Herpailurus yagouaroundi)

AbstractAn approximately 3‐month‐old female free‐ranging jaguarundi (Herpailurus yagouaroundi) was admitted for evaluation of swelling near the right stifle and inability to use the right hindlimb. Radiographic examination revealed a closed, short oblique fracture of the right distal femoral metaphysis, and the bone cortex appeared thin. Because of the poor body condition, the surgical procedure was performed 6 days after admission. The fracture was stabilised using a dynamic intramedullary crosspinning technique. Two 1.5 mm diameter Kirschner (K) wires were introduced at an approximately 20° angle to the sagittal plane of the femur. Radiographic evaluation 3 months after surgery revealed an open distal physis, fracture healing in the remodelling phase and K‐wires engulfed by the bone, which made removal impossible. At the 6‐month follow‐up, a length discrepancy of 0.8 cm in the right femur compared to the left femur was noted. Despite this complication, the locomotion pattern was considered normal according to visual gait analysis.

Assessment of regional and total skeletal metabolism using 18F-NaF PET/CT in patients with chronic kidney disease.

The study aims to assess regional and total bone metabolic activity in patients with chronic kidney disease using Na[18F]F PET and correlation between semi-quantitative indices and blood parameters. Seventy-two subjects (mean age 61.8 ± 13.8years) were included. Of these 24/72 patients had end-stage renal disease (ESRD) (GFR < 15mL/min/1.73 m2), 38/72 had chronic kidney disease (CKD) (GFR between 60 and 15mL/min/1.73 m2), and 10/72 were controls with normal renal function. All subjects underwent Na[18F]F PET-CT with a dose activity of 0.06mCi/Kg. Regional and total skeletal metabolism were assessed with mean SUVs in a skeletal volume of interest (VOI), bone to soft tissue index (B/S), global SUV mean (GSUV mean) of the whole bone, and uptake in the femoral neck. Statistically significant differences were observed in a number of 18F-NaF metrics like femoral neck metabolism in CKD and ERSD groups in comparison to control in right (P = 0.003) and left femur (P = 0.006), bone to soft tissue index in the femur (P = 0.016) and GSUV5 (P = 0.006). There is also a significant difference in SUV mean in lumbar vertebrae (L1-L4) among CKD, ESRD, and controls. There was a moderate correlation between 18F-NaF PET scan uptake and blood parameters such as ALP and PTH. Na[18F]F uptake parameters were significantly different in low versus high bone turnover state. The assessment of total skeleton and regional metabolism and bone turnover in CKD patients is feasible with Na[18F]F PET. Na[18F]F can help to detect early changes in bone metabolism and assess the progression of bone disease in this complex condition. Quantification with Na[18F]F PET might provide better assessment of the bone turnover. The difference in Na[18F]F uptake in CKD compared to controls is likely related to a change in bone turnover which, however, requires further validation.

An Innovative Plate Concept for Rotational Guided Growth: A Porcine Pilot Study.

Background Rotational deformities in children are currently treated with an osteotomy, acute de-rotation, and surgical fixation. Meanwhile, guided growth is now the gold standard in pediatric coronal deformity correction. This study aimed to evaluate the feasibility of a novel implant intended for rotational guided growth (RotOs Plate) in a large porcine animal model. Methodology A submuscular plate was inserted on the medial and lateral aspect of the distal femoral physis of the left femur in 6 pigs. Each plate was anchored with a screw in the metaphysis and epiphysis respectively. The plates were expected to rotate the femur externally. The right femur acted as a control in a paired design. The animals were housed for 12 weeks after surgery. MRI scanning of both femora was performed before euthanasia after 12 weeks. Rotation was determined as the difference in the femoral version on MRI between the operated and non-operated femur after 12 weeks. Results External rotation in all operated femurs was observed. The mean difference in the femoral version on MRI between operated and non-operated femurs was 12.5° (range 9°-16°). No significant changes in axial growth were detected. Conclusions This study shows encouraging results regarding rotational guided growth, which may replace current invasive surgical treatment options for malrotation in children. However, further studies addressing potential secondary deformities are paramount and should be carried out.

Aortic Angiosarcoma Manifesting as Multiple Musculoskeletal Metastases: A Case Report.

Aortic angiosarcomas are rare. Due to its rarity and metastatic presentation, it is difficult to diagnose metastatic aortic angiosarcoma. We describe the clinicopathological and radiologic features of a metastatic aortic angiosarcoma presenting as musculoskeletal metastases. A 59-year-old male patient presented with left thigh pain. Plain radiographs revealed multifocal osteolytic lesions in the left femur shaft. Abdominopelvic computed tomography showed a lobulated osteolytic lesion in the left iliac bone. Magnetic resonance images revealed multifocal soft tissue lesions in the thigh musculature. A positron emission tomography/computed tomography (PET/CT) scan demonstrated multiple foci of increased uptake in the left femur bone, pelvis, left thigh, and calf musculature. Focal increased uptake in the lower abdominal aorta was newly detected. Pelvis biopsy showed tumor cell nests of epithelioid cells. The tumor cells showed vasoformative features. Immunohistochemically, the tumor cells showed positivity for vimentin, CD31, and ERG. The pathologic diagnosis of epithelioid angiosarcoma was established. The origin of the tumor was presumed to be the aorta. This case underscores the importance of PET scans in identifying primary lesions. In terms of the histopathologic diagnosis of biopsy samples with tumor cells exhibiting epithelioid neoplastic morphology, employing appropriate ancillary techniques such as immunocytochemistry with vascular markers may assist in accurately diagnosing metastatic angiosarcoma.

Surgically Treated Hind-Limb Fibromyxochondroma in a Cranwell’s Horned Frog (Ceratophrys cranwelli)

Ceratophrys cranwelli, commonly known as the Cranwell’s horned frog or Pacman frog, is an amphibian species native to South America. This species has gained interest both as a pet among hobbyists and as a subject of scientific inquiry in veterinary medicine. A two-year-old pet male albino Ceratophrys cranwelli was presented exhibiting lethargy, weight loss, and anorexia, persisting for two months. Clinical examination revealed a fracture localized to the proximal third of the left femur accompanied by an osteolytic process. The patient was discharged with a treatment regimen for suspected secondary nutritional hyperparathyroidism and an ulcerative skin lesion. Nevertheless, due to the progressive deterioration of the left thigh, amputation of the affected limb was proposed and performed at the coxofemoral joint. Histopathological analysis of the excised mass revealed an atypical mesenchymal mass consistent with a fibromyxochondroma. The surgical procedure was conducted under anesthesia induced by a combination of alfaxalone, ketamine, medetomidine, and butorphanol, with postoperative treatment consisting of enrofloxacin, meloxicam, and butorphanol. The patient showed good post-surgical recovery, exhibiting normal physiological and behavioral activities. This report highlights the management and the diagnostic challenges of a progressive limb lesion in a Ceratophrys cranwelli, offering insights into potential therapeutic approaches for similar cases in amphibians.

Evaluation of the Treatment Planning and Delivery for Hip Implant Cases on Tomotherapy.

The metal present in the implant creates artifacts during the treatment simulation, which impacts the treatment planning and delivery of the prescribed dose to the target and sparing normal tissues. This retrospective study evaluated the uncertainties in the planning and delivery of doses for prosthesis cases with dedicated phantom. In this retrospective study, 11 patients with a hip prosthesis having cervix carcinoma were selected. Two treatment plans were generated on treatment planning system (TPS) for each case. Plan_No_Res was without any beam restriction, and Plan_exit_only was the plan with restricted beam entry through the metallic implant. An indigenous phantom was utilized to verify the accuracy of the treatment. In the phantom, some groves were present, which could be filled by implants that mimic the patient's geometries, like left, right and bilateral femur implants. The delivered doses were recorded using optically stimulated luminescence dosimeters (OSLDs), which were placed at different positions in the phantom. The plans were further calculated using megavoltage computed tomography (MVCT) scans acquired during treatment. The patient data showed no significant dose changes between the two planning methods. The treatment time increases from 412.18 ± 86.65 to 427.36 ± 104.80 with P = 0.03 for Plan_No_Res and Plan_exit_only, respectively. The difference between planned and delivered doses of various points across phantom geometries was within ± 9.5% in each case as left, right, and bilateral implant. The variations between OSLDs and MVCT calculated doses were also within ± 10.8%. The study showed the competency of tomotherapy planning for hip prosthesis cases. The phantom measurements demonstrate the errors in dosimetry near the implant material, suggesting the need for precise methods to deal with artifact-related issues.

Emphysematous Osteomyelitis: Literature Review and a Case Report

Emphysematous osteomyelitis is a rare form of osteomyelitis characterized by the presence of intraosseous gas. It is caused by gas-forming organisms, most commonly being members of the Enterobacteriaceae family (particularly Escherichia coli) or anaerobes. Comorbidities such as diabetes mellitus, malignancy, alcohol abuse, Crohn’s disease, and other etiologies causing immune suppression, predispose to this condition. A prompt diagnosis of this potentially fatal condition is required to expedite early management. We present a patient diagnosed with multifocal emphysematous osteomyelitis involving the pelvic bones, left proximal femur, vertebral bodies, ribs, and clavicle caused by E. coli to highlight the unusual diffuse involvement by this rare disease. In addition, we reviewed 58 reported cases of emphysematous osteomyelitis including our case. Our purpose in revising all these cases was to observe any significant difference in outcome (if any exists in mortality) based on age, gender, causative organism, site of involvement, and treatment received. However, we could not observe any significant difference in outcome.

Ginsenoside Rc alleviates osteoporosis by the TGF-β/Smad signaling pathway.

Osteoporosis is a common chronic bone disorder in postmenopausal women. Ginsenosides are primary active components in ginseng and the effects of various ginsenoside variants in osteoporosis treatment have been widely revealed. We planned to explore the impact of ginsenoside Rc on bone resorption in an osteoporosis rat model. We used ovariectomized rats to assess the potential impact of ginsenoside Rc on osteoporosis. μ-CT was implemented for analyzing the microstructure of the distal left femur in rats. H&E staining together with Masson staining were applied for bone histomorphometry evaluation. ELISA kits were implemented to detect serum concentrations of TRACP-5b, OCN, CTX, as well as PINP. Ginsenoside Rc treatment lessened the serum levels of TRACP-5b as well as CTX, while increasing serum levels of OCN, and PINP of OVX rats. Moreover, we found that ginsenoside Rc contributed to the synthesis of type I collagen via increasing Col1a1 and Col1a2 levels in femur tissues of ovariectomized rats. Our findings also revealed that ginsenoside Rc activated the TGF-β/Smad pathway by increasing TGF-β as well as phosphorylated Smad2/3 protein levels. Ginsenoside Rc alleviates osteoporosis in rats through promoting the TGF-β/Smad pathway.

A reassessment of the historical fossil findings from Bahia State (Northeast Brazil) reveals a diversified dinosaur fauna in the Lower Cretaceous of South America

ABSTRACT Supposed dinosaur remains were collected between 1859 and 1906 in the Lower Cretaceous Recôncavo Basin (Northeast Brazil). Since these materials remained undescribed, and most were considered lost. Recently, some of these historical specimens were rediscovered in the Natural History Museum of London, providing an opportunity to revisit them after 160 years. The specimens come from five different sites, corresponding to the Massacará (Berriasian-Barremian) and Ilhas (Valanginian-Barremian) groups. Identified bones comprise mainly isolated vertebral centra from ornithopods, sauropods, and theropods. Appendicular remains include a theropod pedal phalanx, humerus, and distal half of a left femur with elasmarian affinities. Despite their fragmentary nature, these specimens represent the earliest dinosaur bones discovered in South America, enhancing our understanding of the Cretaceous dinosaur faunas in Northeast Brazil. The dinosaur assemblage in the Recôncavo Basin resembles coeval units in Northeast Brazil, such as the Rio do Peixe Basin, where ornithopods coexist with sauropods and theropods. This study confirms the presence of ornithischian dinosaurs in Brazil based on osteological evidence, expanding their biogeographic and temporal range before the continental rifting between South America and Africa. Additionally, these findings reinforce the fossiliferous potential of Cretaceous deposits in Bahia State, which have been underexplored since their initial discoveries.

Amorphous Calcium Carbonate from Plants Can Promote Bone Growth in Growing Rats.

This study aimed to investigate the effect of amorphous calcium carbonate (ACC) supplementation on bone growth in growing rats. We used 3-week-old male Wistar rats to simulate childhood and adolescent growth stages. Rats were divided into four groups as follows: a control group (C), a low-dose group (L, 20.65 mg/kg body weight (BW) ACC), a medium-dose group (M, 206.5 mg/kg BW ACC), and a high-dose group (H, 413 mg/kg BW ACC) administered by gavage. Body length (BL) and BW were measured weekly. The bone mineral density (BMD) of two lumbar vertebrae (L3 and L4) and the left femur were analyzed by micro-computed tomography (μCT) at 0, 4, 8, and 12 weeks. At the end of 12 weeks, the rats were sacrificed. After that, blood samples were collected from the abdominal aorta. Femurs and tibias were collected and weighed, and their lengths were measured. Then, bone samples were used to perform histopathological and histomorphometric analyses. It showed that ACC supplementation in growing rats increased the trabecular bone thickness and serum bone formation biomarkers. Furthermore, high-dose ACC decreased serum bone resorption biomarkers and increased BMD. ACC supplementation can enhance osteoblast metabolism and inhibit osteoclast metabolism, resulting in a higher bone formation rate compared to bone resorption. This led to increased trabecular bone thickness, a higher BMD, and supported bone growth.

Effects of Methotrexate, Moringa Leaf (Moringa oleifera) Extract, and Sambiloto Leaf (Andrographis paniculata) Extract on Blood Glucose Levels, Interleukin-6 Levels, and Trabecular Density in Streptozotocin-Nicotinamide-Induced Hyperglycemic Rodents

Introduction: Methotrexate (MTX), Moringa oleifera (MO), and Andrographis paniculata (AP) have been reported to have anti-hyperglycemic, antioxidative, and anti-inflammatory effects in diabetic rats. This study aims to investigate the single and combination effects of MTX, MO, and AP on random blood glucose levels, interleukin-6 (IL-6) levels, and trabecular density in diabetic rats. Methods: A total of 49 male rats were divided into seven groups, namely one control group and six diabetes mellitus (DM) groups. All rats in the DM groups were injected with streptozotocin-nicotinamide (STZ-NA) intraperitoneally. In addition, the DM groups were administered with a placebo daily (DG), a single dose of 500 mg/kg BW MO daily (DG+MO), a single dose of 500mg/kg BW AP daily (DG+AP), a single dose of 7 mg/kg BW MTX once a week (DG+MTX), a combination of MTX+MO, and a combination MTX+AP, respectively. The experiment lasted for 28 days. On day 29, the right and left femur of the rats were collected for IL-6 examination (ELISA) and histopathological analysis. Results: IL-6 expression levels were significantly lower in diabetic rats treated with single and combination of MTX, MO, and AP compared to untreated diabetic rats (p &lt; 0.05). However, the random blood glucose levels and trabecular density between treated and untreated diabetic rats were not significantly different (p &lt; 0.001, p = 0.152). In addition, IL-6 levels were not correlated with trabecular density in all groups (r = -0.057, p = 0.722). Conclusion: Single doses of MTX, MO leaf extract, and AP leaf extract could suppress IL-6 expression in the femur tissue in diabetic rats. However, the IL-6 expression was not correlated with trabecular density although it significantly affected blood glucose levels in this study.

Osteoporosis and low bone mass among schizophrenia and bipolar disorder: A cross-sectional study with newly diagnosed, drug-naïve subjects

BackgroundA growing body of data shows that schizophrenia (SCZ) and bipolar disorder (BD) have substantial metabolic risks; however, few studies have focused on bone metabolism. This study aimed to assess the prevalence and associated influencing factors of low bone mass and osteoporosis in SCZ and BD before pharmacological effects occur. Methods108 healthy controls (HCs) and drug-naïve individuals with SCZ (n = 56) and BD (n = 130) had their lumbar spine (L1–L4) and left femur (Neck/Trochanter/Ward's triangle) bone mineral density (BMD) determined using dual-energy X-ray absorptiometry. Besides, we measured bone turnover markers (BTMs) levels, including procollagen I N-terminal propeptide, osteocalcin, and C-terminal cross-linking telopeptide of type I collagen in different groups. ResultsIndividuals with SCZ and BD had significantly lower BMD and significantly higher prevalence of low bone mass and osteoporosis compared with HCs. In the main observation regions of the total lumbar (F = 18.368, p < 0.001) and left femur (F = 14.790, p < 0.001), BMD was lower in individuals with SCZ and BD than HCs, with SCZ showing lower BMD than BD. The osteocalcin (H = 11.421, p = 0.003) levels were significantly higher in SCZ and BD than HCs.Binary regression analysis showed that SCZ or BD was an independent risk factor for low bone mass and osteoporosis. In addition, sex, age, and BTMs also influenced the occurrence of low bone mass and osteoporosis. LimitationsCross-sectional study. ConclusionThe results findings of the study might contribute to our understanding of the increased risk of bone metabolism in SCZ and BD. Clinical trial registrationwww.chictr.org.cn, identifier ChiCTR1900021379.