Senile Osteoporotic Fractures Research Articles

Biodegradable Zn-2Cu-0.5Zr alloy promotes the bone repair of senile osteoporotic fractures via the immune-modulation of macrophages

Delayed bone-healing of senile osteoporotic fractures remains a clinical challenge due to the alterations caused by aging in bone and immune systems. The novel biomaterials that address the deficiencies in both skeletal cells and immune systems are required to effectively treat the bone injuries of older patients. Zinc (Zn) has shown promise as a biodegradable material for use in orthopedic implants. To address the bone-healing deficiencies in elderly patients with bone injuries, we developed a biodegradable Zn-based alloy (Zn–2Cu-0.5Zr) with enhanced mechanical properties, including a yield strength of 198.7 MPa and ultimate tensile strength of 217.6 MPa, surpassing those of pure Zn and Zn–2Cu alloys. Cytotoxicity tests conducted on bone marrow mesenchymal stem cells (BMSCs) and MC3T3-E1 cells demonstrated that the extracts from Zn–2Cu-0.5Zr alloy exhibited no observable cytotoxic effects. Furthermore, the extracts of Zn–2Cu-0.5Zr alloy exhibited significant anti-inflammatory effects through regulation of inflammation-related cytokine production and modulation of macrophage polarization. The improved immune-osteo microenvironment subsequently contributed to osteogenic differentiation of BMSCs. The potential therapeutic application of Zn–2Cu-0.5Zr in senile osteoporotic fracture was tested using a rat model of age-related osteoporosis. The Zn–2Cu-0.5Zr alloy met the requirements for load-bearing applications and accelerated the healing process in a tibial fracture in aged rats. The imaging and histological analyses showed that it could accelerate the bone-repair process and promote the fracture healing in senile osteoporotic rats. These findings suggest that the novel Zn–2Cu-0.5Zr alloy holds potential for influencing the immunomodulatory function of macrophages and facilitating bone repair in elderly individuals with osteoporosis.

Tetrahedral Framework Nucleic Acids Promote Senile Osteoporotic Fracture Repair by Enhancing Osteogenesis and Angiogenesis of Callus.

Senile osteoporotic fracture has aroused increasing attention due to high morbidity and mortality. However, to date, there is no effective therapeutic approach available. Senile osteoporosis is characterized by impaired osteogenesis and angiogenesis, osteoporotic fracture repair could also be promoted by enhancing osteogenesis and angiogenesis. Tetrahedral framework nucleic acids (tFNAs) are a multifunctional nanomaterial that have recently been extensively used in biomedical fields, which could enhance osteogenesis and angiogenesis in vitro. Therefore, we applied tFNAs to intact and femoral fractural senile osteoporotic mice, respectively, to evaluate the effects of tFNAs on senile osteoporosis and osteoporotic fracture repair regarding the osteogenesis and angiogenesis of the callus at the early healing stages and to initially explore the potential mechanism. The outcomes showed that tFNAs had no significant effects on the osteogenesis and angiogenesis of the femur and mandible in intact senile osteoporotic mice within 3 weeks after tFNA treatment, while tFNAs could promote osteogenesis and angiogenesis of callus in osteoporotic fracture repair, which may be regulated by a FoxO1-related SIRT1 pathway. In conclusion, tFNAs could promote senile osteoporotic fracture repair by enhancing osteogenesis and angiogenesis, offering a new strategy for the treatment of senile osteoporotic fracture.

Is Vitamin D deficiency an endangerment for Fracture?

Introduction: The incidence of fragility hip fracture is on a step increase. Vitamin D is essential for the growth and development of the bone. The decrease in the exposure to sun’s radiation leads to this deficiency causing a global threat. There were many studies pointing towards Vitamin D deficiency as a risk factor for fracture. However, the relationship between serum Vitamin D and bone mineral density (BMD) in the senile osteoporotic fracture is still unclear. The aim of this study is to find out whether Vitamin D deficiency is a risk factor for fragility fracture. Method: It is a prospective study done at Sri Ramachandra Medical College Chennai and Velammal Medical college Madurai between Jan 2017 to Dec 2019. The inclusion criteria were male patients age more than seventy and female patients more than sixty presented with fragility hip fractures. The group I was the cases, patients with hip fractures. The group II was the age and gender-matched control. All the patients included in the study underwent both Vitamin D 25 OH and Dexa scan. The current study had 56 patients in group I as cases and 54 patients in group II as control. Results: The mean value of vitamin D 25OH in fracture patient group I was 19.85 and the age and gender-matched control group was 26.09. The current study had totally seventy-nine patients in the study who were either Vitamin D deficient or insufficient. The present study had 16 cases patient and 15 controls who were having sufficient level vitamin D. Conclusion: Vitamin D has no role in fracture prevention and certainly Vitamin D deficiency is not an endangerment for fractures.

Association of Bone Morphogenetic Protein (BMP)/Smad Signaling Pathway with Fracture Healing and Osteogenic Ability in Senile Osteoporotic Fracture in Humans and Rats.

BackgroundTo investigate the effect of the BMP/Smad signaling pathway on fracture healing and osteogenic ability in senile osteoporotic fracture on humans and rats.Material/MethodsSixty-two patients and well-matched normal controls were enrolled for clinical observation. A rat model of senile osteoporotic fracture was established. Serum BMP2 and Smad4 levels, as well as alkaline phosphatase (ALP) activity, were detected by ELISA. Fracture healing was observed by X-ray radiography and bone formation was analyzed by micro-CT.ResultsSerum BMP2 and Smad4 levels in patients with senile osteoporotic fracture were significantly lower than those in normal controls (all P<0.01). BMP2 was highly positively correlated with Smad4 in patients with senile osteoporotic fracture (r=0.738). Compared with patients with low serum BMP2 and Smad4 levels, visual analog scale scores decreased, bone mineral density (BMD) increased, and duration of fracture healing was shortened in patients with high levels (all P<0.05). Compared with the Model group, serum BMP2 and Smad4 levels increased, fracture healing was improved, BMD, trabecular bone volume (TBV), tissue volume (TV), bone volume fraction (BV/TV), mean trabecular thickness (Tb. Th), and mean number of trabecular bone (Tb. N) were increased, and ALP activity increased in the BMP2 overexpression group (all P<0.05), while each index in the NC group showed no statistical difference relative to rats in the Model group (all P>0.05).ConclusionsBMP2 overexpression can promote fracture healing and osteogenic ability in senile osteoporotic fractures through activating the BMP/Smad signaling pathway.

Locking system strengthened by biomimetic mineralized collagen putty for the treatment of osteoporotic proximal humeral fractures.

The current study is to observe the effect of the locking system strengthened by biomimetic mineralized collagen putty for the treatment of senile proximal humeral osteoporotic fractures. From January 2012 to December 2015, 80 cases of senile patients with osteoporotic proximal humeral fractures were randomly divided into an observation group and a control group, each group with a total of 40 cases. The control group was simply treated with locking plate. The observation group was treated with locking plate in combination with biomimetic mineralized collagen putty. The therapeutic effect thereby was observed. The excellent and satisfactory rate was 90% in observation group and was 72.5% in control group. The difference between the two groups was statistically significant (χ2 = 5.3312, P < 0.05). The fracture healing time was 11.82 ± 3.62 weeks in observation group and 19.78 ± 5.46 weeks in control group. The shoulder joint function score was 89.63 ± 8.12 in observation group and 76.92 ± 8.18 in control group. There was significant difference between the two groups (t = 7.1272; 12.7834, P < 0.05). The complication rate was 10% in the observation group and 32.5% in the control group (χ2 = 7.3786, P < 0.05). Locking system strengthened by biomimetic mineralized collagen putty has advantages such as accelerating healing of senile proximal humeral fracture, improving the therapeutic effect, reducing the complications. As one of the optimal internal fixation method, it provides a new option for better treatment of senile osteoporotic fracture.

Clinical analysis of locking proximal humerus plate combined with MIPO in the treatment of senile osteoporotic fractures of the proximal humerus

Objective To investigate the clinical efficacy of locking proximal humerus plate (LPHP)combined with MIPO in the treatment of senile osteoporotic fractures of the proximal humerus.Methods 40 cases of senile osteoporotic fractures of the proximal humerus were randomly divided into control group and observation group.Control group was given conventional LPHP,while observation group was given LPHP combined with MIPO.Neer percentile score and postoperative complications were used to assess curative effect.Results The excellent rate in control group was 80.0％,while that in observation group was 95.5％,with statistical significant difference (P ＜ 0.05).The complication rate in control group was 35.0％,while that in observation group was 10.0％,with statistical significant difference (P ＜ 0.05).Conclusions LPHP combined with MIPO is effective in senile osteoporotic fractures of the proximal humerus and can effectively reduce the incidence of complications,worthy of clinical promotion. Key words: LPHP; MIPO; Osteoporotic fractures of the proximal humerus

Experience of percutaneous vertebroplasty

Objective To explore the strategic points of percutaneous vertebroplasty and search for the best therapeutic scheme.Methods 25 patients with senile osteoporotic fractures and vertebral osteolytic destruction caused by tumors were treated with percutaneous vertebroplasty (PVP,PKP).The treatment effect was evaluated by the changes of evaluation scores.Results After a six-month-to-2-years' follow-up,the good-and-excellent rate was 94％ according to the changes of VAS score,vertebral front,middle and posterior height and Cobb angle.Conclusion Vertebroplasty (PVP,PKP) for patients with senile osteoporotic fractures and vertebral osteolytic destruction caused by tumors has good curative effect and can relieve patients' pain and restore their life quality. Key words: Vertebroplasty; Operation process; Operation complications

Influence of defective bone marrow osteogenesis on fracture repair in an experimental model of senile osteoporosis

Bone marrow osteogenesis in senile osteoporotic bone is impaired and, as such, may have significant implications on the successful outcome of fracture repair. Here we utilize a well-established murine model of senile osteoporosis, the P6 strain of senescence-accelerated mice (SAMP6), to investigate fracture healing in aged osteoporotic bone. A femoral osteotomy was created in SAMP6 and in non-osteoporotic age-matched control R1 senescence-resistant mice (SAMR1). The course of fracture healing was evaluated over a period of 42 days using quantitative microCT and histological analysis. The differentiation capabilities of bone mesenchymal progenitor cells derived from SAMP6 and SAMR1 mice was examined, and their osteogenic potential determined. Although preliminary in vitro analysis confirmed that bone marrow-derived stem cells (BMSC) isolated from SAMP6 mice had a reduced osteogenic capacity, no significant deficit in fracture repair as determined by quantitative microCT could be detected. This was supported by histology assessment, where complete bridging of the fracture gap was evident by day 28 and was fully healed day 42 in both SAMP6 and SAMR1 mice. Further in vitro studies revealed that periosteal-derived progenitor cells (PDPC) isolated from SAMP6 mice had an osteogenic potential comparable to that observed in SAMR1 mice. In conclusion, fracture healing in SAMP6 mice is not detrimentally affected by impairment of BMSC osteogenesis, suggesting that bone marrow-mediated repair processes are dispensable for normal bone healing in this senile osteoporotic fracture model. Furthermore, the influence of PDPC in the repair process may partly explain the absence of any detectable deficits in fracture repair in SAMP6 mice.

Multi-center clinical study of the prevalence rate of senile osteoporotic fracture in China

Multi-center clinical study of the prevalence rate of senile osteoporotic fracture in China

The associations between mineral crystallinity and the mechanical properties of human cortical bone

It is well known that the amount of mineralization renders bone its stiffness. However, besides the mere amount of the mineral phase, size and shape of carbonated apatite crystals are postulated to affect the mechanical properties of bone tissue as predicted by composite mechanics models. Despite this predictive evidence, there is little experimental insight on the relation between the characteristics of mineral crystals and hard tissue mechanics. In this study, Raman spectroscopy was used to provide information on the crystallinity of bone's mineral phase, a parameter which is an overall indicator of mineral crystal size and stoichiometric perfection. Raman scans and mechanical tests (monotonic and fatigue; n = 64 each) were performed on the anterior, medial, lateral and posterior quadrant sections of 16 human cadaveric femurs (52 y.o.–85 y.o.). The reported coefficient of determination values ( R 2) were adjusted for the effects of age to bring out the unbiased contribution of crystallinity. Crystallinity was able to explain 6.7% to 48.3% of the variation in monotonic mechanical properties. Results indicated that the tissue-level strength and stiffness increased with increasing crystallinity while the ductility reduced. Crystallinity explained 11.3% to 63.5% of the variation in fatigue properties. Moduli of specimens with greater crystallinity degraded at a slower rate and, also, they had longer fatigue lives. However, not every anatomical quadrant displayed these relationships. In conclusion, these results acknowledge crystal properties as an important bone quality factor and raise the possibility that aberrations in these properties may contribute to senile osteoporotic fractures.