Bone Response Research Articles

The Influence of Nanostructured Hydroxyapatite Surface in the Early Stages of Osseointegration: A Multiparameter Animal Study in Low-Density Bone.

Background and ObjectiveThe success rates of dental implants in low-density bone have been reported as a challenge, especially for early or immediate loading in the maxilla posterior area. Nanoscale architecture affects the roughness, surface area, surface energy of the implant and can enhance osseointegration. This study aimed to evaluate the implant-surface topography and biomechanical, histomorphometric, and histological bone responses to a new nanostructured hydroxyapatite surface placed in the iliac crest of sheep.MethodsTen female sheep (2–4 years) received 30 implants (n=10/group): HAnano® coated (Epikut Plus®, S.I.N. Implant System, Sao Paulo, SP, Brazil), SLActive (BLX®, Straumann, Basel, Switzerland), and TiUnite (NobelActive®, Nobel Biocare, Göteborg, Sweden) surfaces. Scanning electron microscopy with energy-dispersive spectroscopy evaluated the implant surface topography, the insertion torque value, and resonance frequency analysis evaluated the primary stability, bone-implant contact, and bone-area fraction occupancy were evaluated after 14 and 28 days after implant placement.ResultsThe surface morphology was considerably comparable between the implant groups’; however, the TiUnite® group presented a remarkable different surface. The SLActive® and TiUnite® groups presented an insertion torque average of 74 (±8.9) N/cm that was similar to that of HAnano® 72 (±8.3) N/cm (p >0.05). The resonance frequency evaluated with Osstell®/SmartPeg® or Penguin®/MulTipeg® showed similar results when assessing implants from the same group. BIC and BAFO significantly increased (p<0.05) throughout the experimental periods to all groups, but BIC and BAFO values were similar among the implants at the same time point. After 4 weeks, bone-implant contact was higher than 80% of the total length analyzed. New bone occupies around 60% of analyzed area around the implants.ConclusionHAnano® coated surface promoted comparable osseointegration as SLActive and TiUnite in the sheep model. The three tested surfaces showed comparable osseointegration at the early stages of low-density bone repair in the sheep model.

Differential responses of bone to angiotensin II and angiotensin(1-7): beneficial effects of ANG(1-7) on bone with exposure to high glucose.

Osteoporosis, diabetes, and hypertension are common concurrent chronic disorders. This study aimed to explore the respective effects of angiotensin II (ANG II) and angiotensin(1-7) [ANG(1-7)], active peptides in the renin-angiotensin system, on osteoblasts and osteoclasts under high-glucose level, as well as to investigate the osteo-preservative effects of ANG II type 1 receptor (AT1R) blocker and ANG(1-7) in diabetic spontaneously hypertensive rats (SHR). ANG II and ANG(1-7), respectively, decreased and increased the formation of calcified nodules and alkaline phosphatase activity in MC3T3-E1 cells under high-glucose level, and respectively stimulated and inhibited the number of matured osteoclasts and pit resorptive area in RANKL-induced bone marrow macrophages. Olmesartan and Mas receptor antagonist A779 could abolish those effects. ANG II and ANG(1-7), respectively, downregulated and upregulated the expressions of osteogenesis factors in MC3T3-E1 cells. ANG II promoted the expressions of cathepsin K and MMP9 in RAW 264.7 cells, whereas ANG(1-7) repressed these osteoclastogenesis factors. ANG II rapidly increased the phosphorylation of Akt and p38 in RAW 264.7 cells, whereas ANG(1-7) markedly reduced the phosphorylation of p38 and ERK under high-glucose condition. After treatments of diabetic SHR with valsartan and ANG(1-7), a significant increase in trabecular bone area, bone mineral density, and mechanical strength was only found in the ANG(1-7)-treated group. Treatment with ANG(1-7) significantly suppressed the increase in renin expression and ANG II content in the bone of SHR. Taken together, ANG II/AT1R and ANG(1-7)/Mas distinctly regulated the differentiation and functions of osteoblasts and osteoclasts upon exposure to high-glucose condition. ANG(1-7) could protect SHR from diabetes-induced osteoporosis.

Bone response to eccentric versus concentric cycling in adolescents with obesity

ObjectivesBecause adolescents with obesity are susceptible to bone fragility during weight loss (WL), we evaluated the impact of eccentric (ECC) versus classical concentric (CON) training at the same oxygen consumption (V˙O2) on bone density, geometry and strength. MethodsThirty five adolescents were included into 2 training (CON and ECC cycling) and a control (CTR, without training) groups. Anthropometry, dual-energy X-ray absorptiometry, hip structural analysis and quantitative bone ultrasound were assessed before and after the 12-week intervention. ResultsThe trainings promoted significant improvements in body mass index, total fat (FM) and lean mass (LM), with better improvements for FM and LM in the ECC group (p < 0.05). Leg LM percentage increased only in the ECC group (p < 0.05). Total body bone mineral content and density increased in both training groups (p < 0.001) with significant time x group interactions only between ECC and CTR (p < 0.05). Buckling ratio at the intertrochanteric region and femoral shaft increased only in CTR and CON groups (p < 0.05). Speeds of sounds at the calcaneum increased only in ECC group (p < 0.01). ConclusionsBone fragility, from a compromised relationship between density, geometry and strength, might be prevented with the ECC modality.

Exercise and Diet: Uncovering Prospective Mediators of Skeletal Fragility in Bone and Marrow Adipose Tissue.

To highlight recent basic, translational, and clinical works demonstrating exercise and diet regulation of marrow adipose tissue (MAT) and bone and how this informs current understanding of the relationship between marrow adiposity and musculoskeletal health. Marrow adipocytes accumulate in the bone in the setting of not only hypercaloric intake (calorie excess; e.g., diet-induced obesity) but also with hypocaloric intake (calorie restriction; e.g., anorexia), despite the fact that these states affect bone differently. With hypercaloric intake, bone quantity is largely unaffected, whereas with hypocaloric intake, bone quantity and quality are greatly diminished. Voluntary running exercise in rodents was found to lower MAT and promote bone in eucaloric and hypercaloric states, while degrading bone in hypocaloric states, suggesting differential modulation of MAT and bone, dependent upon whole-body energy status. Energy status alters bone metabolism and bioenergetics via substrate availability or excess, which plays a key role in the response of bone and MAT to mechanical stimuli. Marrow adipose tissue (MAT) is a fat depot with a potential role in-as well as responsivity to-whole-body energy metabolism. Understanding the localized function of this depot in bone cell bioenergetics and substrate storage, principally in the exercised state, will aid to uncover putative therapeutic targets for skeletal fragility.

Bone regeneration in a mouse model of type 1 diabetes: Influence of sex, vitamin D3, and insulin

AimThis study set forth a question: are there any differences in bone responses to insulin and/or vitamin D3 treatment in female and male type 1 diabetic (T1D) mice? Main methodsTo address this issue, a non-critical sized femur defect was created in streptozotocin (STZ)-T1D mice. Control non-diabetic and T1D female and male mice received: saline; vitamin D3; insulin; or vitamin D3 plus insulin, for 21 days. Key findingsFemale and male T1D mice showed impaired bone healing, as indicated by histological and micro-computed tomography (micro-CT) analysis. Vitamin D3 or insulin improved the bone regeneration in T1D mice, irrespective of sex. Vitamin D3 plus insulin did not exhibit any additional effects. There were no differences regarding the numbers of TRAP-stained osteoclasts in either evaluated groups. The osteoblast-related gene osterix was upregulated in vitamin D3-treated male T1D mice, as revealed by RT-qPCR. Female T1D mice treated with vitamin D3, insulin, or vitamin D3 plus insulin presented an increased expression of insulin growth factor-1 (IGF-1) mRNA. Conversely, IGF-1 mRNA levels were reduced by the same treatments in male TD1 mice. SignificanceAltogether, the results suggested that T1D similarly delayed the osseous healing in female and male mice, with beneficial effects for either vitamin D3 or insulin in T1D mice of both sexes. However, data indicated marked sex differences regarding the expression of genes implicated in bone formation, in T1D mice treated with vitamin D3 and/or insulin.

Finite Element Method and Von Mises Investigation on Bone Response to Dynamic Stress with a Novel Conical Dental Implant Connection.

The bioengineering and medical and biomedical fields are ever closer, and they manage to obtain surprising results for the development of new devices. The field of simulations and studies in silica has undergone considerable development in recent years, favoring the advancement of medicine. In this manuscript, a study was carried out to evaluate the force distribution on the implant components (In-Kone® Universal) and on the peri-implant tissues subjected to loading. With the finite element analysis and the Von Mises method, it was possible to evaluate this distribution of forces both at 0 degrees (occlusal force) and at 30 degrees; the applied force was 800 N. The obtained results on this new type of connection and on all the implant components are satisfactory; the distribution of forces appears optimal even on the peri-implant tissues. Surely, studies like this help to obtain ever more performing devices, improving both the clinic and the predictability of rehabilitations.

Does Lag Screw Retightening Improve Compression in Hindfoot Arthrodesis?

Category:Hindfoot; Ankle; Ankle ArthritisIntroduction/Purpose:Non-union and delayed union are common complications following hindfoot arthrodesis. The failure to obtain and maintain compression at the arthrodesis site may be a causative factor. Partially threaded cannulated ‘lag’ screws are commonly used for fixation in hindfoot arthrodesis; however, the ability of these screws to maintain compression in the hindfoot bones has not been well-characterized. The goals of this work were to: 1) quantify the stress relaxation response of hindfoot bones when compressed with a lag screw, particularly compression change upon screw retightening, and 2) compare the results to prior studies on stress relaxation in direct bone compression.Methods:12 pairs of calcaneus, talus and tibia bone cylinders, 25mm in diameter, were cut with a keyhole saw from fresh thawed cadaveric feet. The bone cylinders were prepared for simulated arthrodesis by removing the cartilage and flattening the subchondral surface with an oscillating saw. A Futek LTH 300 donut load cell and two metal washers were sandwiched between the two bone cylinders. An 8.0mm partially threaded cannulated lag screw (Smith and Nephew) was placed from the posterior- inferior aspect of the calcaneus cylinder to the anterior-superior aspect of the talus cylinder to simulate subtalar arthrodesis, or from the superior aspect of the tibia cylinder to the inferior aspect of the talus cylinder. Compression was recorded continuously as the screws were tightened by three-quarters of a turn and left untouched for 3 minutes. Recording continued as the screws were retightened one quarter-turn and then left untouched for 30 additional minutes.Results:Both initial and subsequent compression with a lag screw demonstrated a stress relaxation pattern, with increased maximum compression and slowed decay upon retightening. Maximum compression after three quarter-turns and retightening averaged 284 N and 351 N, respectively (n=12; t=-2.55; p=0.0136). Time to decay to 80% of maximum compression after three quarter-turns and retightening averaged 34 and 528 (n=9; t=-2.59; p=0.0159) seconds, respectively, compared to 21 seconds for direct compression. Compression loss 30 minutes after retightening averaged 25.5% (SD=8.8%), compared to 34.3% for direct compression.Conclusion:The maximum compression attained following retightening was significantly greater than the maximum compression attained after initial tightening. The time required to reach 80% of maximum compression was significantly longer after subsequent compared to initial maximum compression. These findings suggest that screw retightening before surgical wound closure may slow compression loss, which could increase the likelihood of successful arthrodesis. Lag screw compression resulted in a lower percent compression loss and loss rate compared to direct compression, which was previously used to describe bone viscoelasticity.

In vivo degradation behaviour and bone response of a new Mg-rare earth alloy immobilized in a rat femoral model

A new type of Mg-rare earth (Ce, La) and the AZ31 alloy sheets were prepared by vertical twin-roll casting (TRC) technology under identical casting conditions, and their microstructural features, degradation behaviours and bone responses were investigated. The microstructural characterization showed that the Mg-RE (rare earth) exhibited a higher amorphous forming ability than the AZ31. Moreover, the results of electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization indicated that the Mg-RE sheets displayed a higher corrosion resistance compared with the AZ31 sheets. Additionally, the Ti, Mg-RE and AZ31 sheet implants were immobilized and implanted in a rat femur model to observe degradation behavior during 16 weeks. in vivo tests showed that no significant change in the femur surrounding the Ti group, which excluded the external factor that the new bone formation resulting from bone remodeling. Furthermore, the Mg-RE group induced more newly formed bones, which met the necessary conditions for the prevention of pathological fractures. Therefore, the novel Mg-RE alloy appear to hold a healing candidate as the biodegradable implant material.

Anatomical variations in cortical bone surface permeability: Tibia versus femur

Cortical bone surfaces (periosteal and endosteal) exhibit differential (re)modelling response to mechanical loading. This poses a serious challenge in establishing an in silico model to predict site-specific new bone formation as a function of mechanical stimulus. In this regard, mechanical loading-induced fluid motion in lacunar-canalicular system (LCS) is assumed osteogenic. Micro-architectural properties, especially permeability regulate canalicular fluid motion within the bone. The knowledge of these properties is required to compute flow distribution. Along the same line, it is possible that cortical surfaces may experience differential fluid distribution due to anatomical variations in microarchitectural properties which may induce distinct new bone response at cortical surfaces. Nevertheless, these properties are not well reported for cortical surfaces in the literature. Accordingly, the present study aims to measure microarchitectural properties especially permeability at different anatomical locations (medial, lateral, anterior, and posterior) of periosteal and endosteal surfaces using nanoindentation. A standard poroelastic optimization technique was used to estimate permeability, shear modulus, and Poisson's ratio. The properties are also compared for two weight-bearing bones i.e. tibia and femur. Endosteal surface was found more permeable as compared to the periosteal surface. Tibial endosteal surface had shown greater permeability values at most of the anatomical locations as compared to femoral endosteal surface. The outcomes may be used to precisely predict site-specific osteogenesis in cortical bone as a function of canalicular flow distribution. This work may ultimately be beneficial in designing the loading parameters to stimulate desired new bone response for the prevention and the cure of bone loss.

Mapping Regional Cortical Bone Responses to Local Changes in Loading and Systemic Stimuli.

Quantification of cortical bone mass and architecture using μCT is commonplace in osteoporosis and osteoarthritis research. Different groups often report substantially divergent mouse cortical bone responses to nominally comparable interventions. In the case of studies assessing bones' responses to externally applied loading, these differences are commonly associated with methodological differences in the loading regime. This chapter describes a widely published, standardized method of in vivo mouse tibia axial loading to produce lamellar bone formation. Despite uniform application of axial loading, changes in bone mass are highly site-specific within individual bones. For example, the mouse proximal tibia rapidly accrues new bone following axial loading, but this osteogenic response tapers to produce undetectable differences distally. Consequently, the bone sites selected for comparisons substantially influence the magnitude of differences observed. Application of the freely available Site Specificity software allows site-specific responses to be identified by rapidly quantifying cortical bone mass at each 1% site along the bone's length. This high-content screening tool has been informatively applied to study the local effects of changes in loading as well as systemic interventions including hormonal treatment and aging. Automated multisite analyses of cortical mass is increasingly identifying site-specific effects of "systemic" interventions such as global gene deletions. Biological mechanisms underlying this apparent regionalization of cortical responses are largely unknown but may start to be elucidated by increasingly widespread application of Site Specificity methods.

Connexin 43 in osteogenesis

Skeleton formation and its proper functioning is possible thanks to specialized bone tissue cells: bone forming osteoblasts, bone resorbing osteoclasts and osteocytes located in bone cavities. Gap junctions are transmembrane channels connecting neighboring cell. Thanks to gap junctions it is possible for signals to be directly transmitted by cells. Gap junction type channels, and more specifically the connexin proteins that build them, have a key impacton the bone turnover process, and thus on both bone building and remodeling. A particularly important connexin in bone tissue is connexin43 (Cx43), which is necessary in the proper course of the bone formation process and in maintaining bone homeostasis. The importance of the presence of Cx43 in bones is showed by skeletal defects in diseases such as ODD syndrome and craniometaphyseal dysplasia caused by mutations in GJA1, the gene encoding Cx43. The role of Cx43 in the differentiation of stem cells into bone cells, anti-apoptotic action of bisphosphonates and bone responses to hormonal and mechanical stimuli have also been demonstrated. In addition to connexin43, the presence of other connexins such as connexin45, 46 and 37 was also noted in bone tissue.

Response to: Comment on "The Use of Pulsed Electromagnetic Fields to Promote Bone Responses to Biomaterials In Vitro and In Vivo".

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Does Physical Exercise Always Improve Bone Quality in Rats?

For decades, the osteogenic effect from different physical activities on bone in rodents remained uncertain. This literature review presents for the first time the effects on five exercise models (treadmill running, wheel running, swimming, resistance training and vibration modes) in three different experimental rat groups (males, females, osteopenic) on bone quality. The bone parameters presented are bone mineral density, micro-architectural and mechanical properties, and osteoblast/osteocyte and osteoclast parameters. This review shows that physical activities have a positive effect (65% of the results) on bone status, but we clearly observed a difference amongst the different protocols. Even if treadmill running is the most used protocol, the resistance training constitutes the first exercise model in term of osteogenic effects (87% of the whole results obtained on this model). The less osteogenic model is the vibration mode procedure (31%). It clearly appears that the gender plays a role on the bone response to swimming and wheel running exercises. Besides, we did not observe negative results in the osteopenic population with impact training, wheel running and vibration activities. Moreover, about osteoblast/osteocyte parameters, we conclude that high impact and resistance exercise (such jumps and tower climbing) seems to increase bone formation more than running or aerobic exercise. Among the different protocols, literature has shown that the treadmill running procedure mainly induces osteogenic effects on the viability of the osteocyte lineage in both males and females or ovariectomized rats; running in voluntary wheels contributes to a negative effect on bone metabolism in older male models; whole-body vertical vibration is not an osteogenic exercise in female and ovariectomized rats; whereas swimming provides controversial results in female models. For osteoclast parameters only, running in a voluntary wheel for old males, the treadmill running program at high intensity in ovariectomized rats, and the swimming program in a specific ovariectomy condition have detrimental consequences.

Comparing the Responses of Osseous Versus Soft-Tissue Metastases of Renal Cell Carcinoma to Receptor Tyrosine Kinase Inhibitors and Immunotherapy

BACKGROUND: Checkpoint inhibitors and receptor tyrosine kinase inhibitors (RTKIs) have changed the standard of care for metastatic renal cell carcinoma (mRCC). Anecdotal evidence suggests these therapies may be less effective for treating bone than soft-tissue metastases. PURPOSE: We performed a retrospective review evaluating the relative clinical responses in soft-tissue and bone metastases in patients undergoing therapy using RTKIs and anti-programmed death-1 (PD-1) agents for mRCC. METHODS: Of the 2,212 patients in our institutional cancer registry with renal cell carcinoma (1997–2017), 68 (82 disease courses) were identified with measurable bone and soft-tissue metastases treated with RTKIs and/or PD-1s. Extent of metastasis was quantified at the time of therapy initiation (baseline) and at 3 months, 6 months, and 1 year. Changes in disease status were categorized as complete response, partial response, stable, mixed, or progression of disease according to RECIST v1.1 and MD Anderson criteria. These categories were further organized into “response to treatment” or “evidence of progression” to generate a generalized linear effects model with soft-tissue response as the independent variable and bone response as the dependent variable. Alpha = 0.05. RESULTS: Soft-tissue response correlated with bone response at 3 months (76 disease courses, p = 0.005) and 6 months (48 disease courses, p = 0.017). Of the patients with controlled soft-tissue disease, only 14 (19%) and 15 (32%) had progression in bone at 3 and 6 months, respectively. CONCLUSION: Contrary to anecdotal reports, osseous metastases do not appear to respond worse than soft-tissue metastases to treatment with these agents.

Mechano-adaptive Responses of Alveolar Bone to Implant Hyper-loading in a pre-clinical in vivo model.

Oral implants transmit biting forces to peri-implant bone. In turn, those forces subject peri-implant bone to mechanical stresses and strains. Here, our objective was to understand how peri-implant bone responded to conditions of normal versus hyper-loading in a mouse model. Sixty-six mice were randomly assigned to 2 groups; both groups underwent bilateral maxillary first molar extraction followed by complete healing. Titanium alloy implants were placed in healed sites and positioned below the occlusal plane. After osseointegration, a composite crown was affixed to the implant so masticatory loading would ensue. In controls, the remaining dentition was left intact but in the hyper-loaded (test) group, the remaining molars were extracted. 3D finite element analysis (FEA) calculated peri-implant strains resulting from normal and hyper-loading. Peri-implant tissues were analyzed at multiple time points using micro-computed tomography (µCT) imaging, histology, enzymatic assays of bone remodeling, and vital dye labeling to evaluate bone accrual. Compared to controls, hyper-loaded implants experienced a 3.6-fold increase in occlusal force, producing higher peri-implant strains. Bone formation and resorption were both significantly elevated around hyper-loaded implants, eventually culminating in a significant increase in peri-implant bone volume/total volume (BV/TV). In our mouse model, masticatory hyper-loading of an osseointegrated implant was associated with increased peri-implant strain, increased peri-implant bone remodeling, and a net gain in bone deposition. Hyper-loading results in bone strain with catabolic and anabolic bone responses, leading to a net gain in bone deposition.

A three-dimensional multiscale finite element model of bone coupling mineralized collagen fibril networks and lamellae

Despite evidence of contribution of mineralized collagen fibrils (MCF) to both the microscale elastic and fracture response of bone, the extent of influence of MCF orientation and material property variation on the lamellar scale mechanical properties is still not well quantified. To this end, in this study, we developed a three-dimensional multiscale finite element model that linked submicroscale models of MCF networks to microscale models of several lamellae. The developed models evaluated the individual and relative influence of MCF orientation as well as material property variation due to MCF mineral distribution and interaction on the lamellar scale mechanical response of bone. The simulation results showed that the elastic modulus, ultimate strength, and fracture energy at the lamellar scale decreased as the angle between the main axis of MCFs and loading direction increased. The heterogeneity in mineral distribution along MCFs did not lead to a significant difference in the mechanical behavior at the lamellar scale compared to the material property heterogeneity introduced in the models due to MCF orientation variation. Variation in the interaction between MCFs at the submicroscale had a substantial influence on the lamellar scale mechanical properties. In summary, this study established a multiscale model that linked MCFs to lamellae providing the capability of quantifying the relative influence of modifications in material and organizational properties of MCFs due to age, diseases, and treatments on the fracture processes at the lamellar length scale.

Alveolar bone response to maxillary incisor retraction using stable skeletal structures as a reference.

To evaluate alveolar bone change in relation to root position change after maxillary incisor retraction via cone-beam computed tomography (CBCT) using stable skeletal structures as a reference. A total of 17 subjects (age 24.7 ± 4.4 years) who required retraction of the maxillary incisors were included. Labial and palatal alveolar bone changes and root change were assessed from preretraction and 3 months postretraction CBCT images. The reference planes were based on stable skeletal structures. The Kruskal-Wallis test and Wilcoxon signed-rank test were used to compare changes within and between groups, as appropriate. Spearman rank correlations were used to identify the parameters that correlated with alveolar bone change. The significance level was set at .05. The labial alveolar bone change after maxillary incisor retraction was statistically significant (P < .05), and the bone remodeling/tooth movement (B/T) ratio was 1:1. However, the palatal bone remained unchanged (P > .05). The change in inclination was significantly related to labial alveolar bone change. Using stable skeletal structures as a reference, the change in labial alveolar bone followed tooth movement in an almost 1:1 B/T ratio. Palatal alveolar bone did not remodel following maxillary incisor retraction. The change in inclination was associated with alveolar bone change.

Functional electrical stimulation (FES)-assisted rowing combined with zoledronic acid, but not alone, preserves distal femur strength and stiffness in people with chronic spinal cord injury.

People with spinal cord injury (SCI) have high fracture risk at the knee after the injury. Therapies that prevent bone loss or stimulate an anabolic response in bone have been proposed to reduce fractures. Zoledronic acid (ZA) is a potent bisphosphonate that inhibits osteoclastic resorption. Functional electrical stimulation (FES)-assisted rowing is a potentially osteogenic exercise involving mechanical stimulation to the lower extremities. Here, we investigated the effect of FES-assisted rowing with and without ZA on bone strength and stiffness in individuals with SCI. Twenty individuals from a cohort of adults with SCI who participated in a clinical trial were included in the study. CT scans of their knees before and after the intervention were converted to finite element models. Bone failure strength (Tult) and stiffness were calculated at the proximal tibia and distal femur. Tult at the distal femur increased 4.6% among people who received rowing + ZA and decreased 13.9% among those with rowing only (p < 0.05 for group). Torsional and compressive stiffness at the femur metaphysis increased in people with rowing + ZA (+ 3 to +4%) and decreased in people with rowing only (- 7 to -8%; p < 0.05). Tult in the proximal tibia decreased in everyone, but the loss was attenuated in the rowing + ZA group. People with initially stronger bone tended to lose more strength. Overall, we observed increases in bone strength at the distal femur but not the proximal tibia, with FES-assisted rowing combined with ZA treatment. Rowing alone did not significantly prevent bone loss at either site, which might be attributed to insufficient mechanical loading.

Osteocytic FGF23 and Its Kidney Function.

Osteocytes, which represent up to 95% of adult skeletal cells, are deeply embedded in bone. These cells exhibit important interactive abilities with other bone cells such as osteoblasts and osteoclasts to control skeletal formation and resorption. Beyond this local role, osteocytes can also influence the function of distant organs due to the presence of their sophisticated lacunocanalicular system, which connects osteocyte dendrites directly to the vasculature. Through these networks, osteocytes sense changes in circulating metabolites and respond by producing endocrine factors to control homeostasis. One critical function of osteocytes is to respond to increased blood phosphate and 1,25(OH)2 vitamin D (1,25D) by producing fibroblast growth factor-23 (FGF23). FGF23 acts on the kidneys through partner fibroblast growth factor receptors (FGFRs) and the co-receptor Klotho to promote phosphaturia via a downregulation of phosphate transporters, as well as the control of vitamin D metabolizing enzymes to reduce blood 1,25D. In the first part of this review, we will explore the signals involved in the positive and negative regulation of FGF23 in osteocytes. In the second portion, we will bridge bone responses with the review of current knowledge on FGF23 endocrine functions in the kidneys.

Are teeth superior to implants? A mapping review

Statement of problemThere is a long-held assumption that teeth are superior to implants because the periodontal ligament (PDL) confers a preeminent defense against biologic and mechanical challenges. However, adequate analysis of the literature is lacking. As a result, differential treatment planning of tooth- and implant-supported restorations has been compromised. PurposeGiven an abundance and diversity of research, the purpose of this mapping review was to identify basic scientific gaps in the knowledge of how teeth and implants respond to biologic and mechanical loads. The findings will offer enhanced evidence-based clinical decision-making when considering replacement of periodontally compromised teeth and the design of implant prostheses. Material and methodsThe online databases PubMed, Science Direct, and Web of Science were searched. Published work from 1965 to 2020 was collected and independently analyzed by both authors for inclusion in this review. ResultsA total of 108 articles met the inclusion criteria of clinical, in vivo, and in vitro studies in the English language on the periradicular and peri-implant bone response to biologic and mechanical loads. The qualitative analysis found that the PDL's enhanced vascularity, stem cell ability, and resident cells that respond to inflammation allow for a more robust defense against biologic threats compared with implants. While the suspensory PDL acts to mediate moderate loads to the bone, higher compressive stress and strain within the PDL itself can initiate a biologic sequence of osteoclastic activity that can affect changes in the adjacent bone. Conversely, the peri-implant bone is more resistant to similar loads and the threshold for overload is higher because of the absence of a stress or strain sensitivity inherent in the PDL. ConclusionsBased on this mapping review, teeth are superior to implants in their ability to resist biologic challenges, but implants are superior to teeth in managing higher compressive loads without prompting bone resorption.