Long-Term Use of Glucocorticoid Exacerbates Bone Lesions in Postmenopausal Women With Rheumatoid Arthritis

Background Glucocorticoid-induced osteoporosis is osteoporosis arising due to long-term use of glucocorticoids. Current despite decades of intense research, the effects of long-term use of glucocorticoids in humans on bone cells and bone structural changes remain unclear. Methods We performed postmortem histomorphometric analysis of bone from two female patients with rheumatoid arthritis aged 64y and 85y. Our two patients had been treated with glucocorticoids for 19 years and 14 years, respectively. Results In case 1, all markers of cancellous bone volume were markedly decreased compared with the age-matched reference range. Connectivity of cancellous bone trabecula was absent. Only a few island bones were noted. There was prominent thinning of the cortical bone, and extension of the bone marrow cavity into the cortical bone with prominent cortical porosis. Cortical nodes between the endocortical surface and the trabecula disappeared due to endocortical resorption. Stoppage of lamellar structure was observed because the bone resorption by osteoclasts surpassed bone formation by osteoblasts. Empty lacunae characterized by disappearance of osteocytes were visible. In case 2, all volume markers of cancellous bone were decreased to the same extent as case 1. However, cortical porosis was more prominent than case 1. Conclusion These two cases suggest that use of glucocorticoid therapy > 10 y can induce severe osteoporosis in elderly RA women with higher disease activity, and that the disappearance of cancellous bone is the common characteristic. The 85 year-old woman was characterized by cortical porosis.

Morphological Analysis of Medullary Cavity for Designing Personalized Femoral Stem

To improve the quality and efficiency of femoral stem prosthesis design, a Monte Carlo method based on femoral bone marrow cavity analysis is proposed to measure morphological parameters using anatomical semantics. The region of interest is the femur, which includes the medullary cavity and cortical region. After this region is extracted, the size of the cavity and region is simulated using the Monte Carlo method. Finally, based on clinical needs, the morphological parameters are calculated and analyzed based on the size of the region of interest. From the perspective of the probability model, the non-random problem of solving the cross-section area of the femoral marrow cavity is transformed into one having a random nature so that a probability model can be used. The experimental results show that this method is simple, flexible, and efficient. It provides a new and reasonable scientific method for comprehensively understanding the anatomical morphological changes of the femoral marrow cavity. The measurement and analysis of the morphological parameters of the femoral bone marrow cavity in this paper provide the necessary scientific theoretical support for improved morphologic research, design, and clinical selection of femoral stem prostheses and has important significance and application value in clinical practice.

Epiphyseal enchondroma masking as osteoid osteoma: a case report

Background Enchondromas originating in the epiphyses of long bones are rare and epiphyseal osteoid osteomas are also uncommon. Diagnosis can become elusive when enchondromas or osteoid osteomas occur in atypical locations and present with nonspecific clinical and imaging characteristics. Case presentation We report a case of epiphyseal enchondroma of the left proximal femur in a 15-year-old girl with a 2-month history of left lower extremity pain. Preoperative CT displayed thickened cortex in the anterior surface of the left proximal femur with specks of calcification and inhomogeneity of the adjacent bone marrow cavity. She was diagnosed with osteoid osteoma. Postoperative pathological examination of surgically excised specimens revealed a diagnosis of enchondromas. Conclusions Our case highlights that enchondroma should be considered in lesions of the epiphysis.

Choice of a Method for Blocked Intramedullary Osteosynthesis in Tibial Fractures in the Context of Topographic-Anatomical Research

Blocked intramedullary osteosynthesis has become a "gold standard" for the treatment of patients with diaphyseal fractures of the tibia. However, there is still debate about the importance and necessity of reaming the bone marrow cavity when performing intramedullary osteosynthesis.The aim is to study the individual features of the structure of the medullary cavity of the tibia in relation to intramedullary osteosynthesis, as well as to evaluate the effect of blocked intramedullary osteosynthesis with preliminary reaming and without reaming of the bone marrow cavity on the vascular supply of the tibia.Material and methods. Using morphometric and radiological methods, an experimental topographical and anatomical study was carried out on 26 dry preparations and histotopograms-plates of tibial bone cuts, as well as on 10 lower limbs of corpses with X-ray contrast injection of arterial vessels. Statistical analysis was performed using the Student's parametric test and the nonparametric MannWhitney test.Results. Particular attention was paid to the detailed study of the main parameters of the tibial bone marrow cavity that are important for the technology of blocked intramedullary osteosynthesis (size, shape and curves of the bone marrow cavity, architectonics of its narrow part, density and distribution of spongy matter in it, topography of the a. nutricia tibialis channel and distribution of its branches). To assess the invasiveness of osteosynthesis on 10 anatomical objects with preliminary injection of vessels of the lower extremity with X-ray contrast mass, blocked intramedullary osteosynthesis of the tibia with and without reaming of the bone marrow cavity was modeled.Conclusion. It was concluded that any variant of intramedullary rod insertion is accompanied by damage to a. nutricia tibialis in a narrow part of the bone marrow cavity, and reaming of the bone marrow cavity has certain advantages in view of the pronounced individual differences in the structure of the tibia.

Radiographic and clinical assessment of unidirectional porous hydroxyapatite to treat benign bone tumors

Unidirectional porous hydroxyapatite (UDPHAp) was developed as an excellent scaffold with unidirectional pores oriented in the horizontal direction with interpore connections. The purpose of this study was to assess radiographic changes and clinical outcomes and complications following UDPHAp implantation to treat benign bone tumors. We retrospectively analyzed 44 patients treated with intralesional resection and UDPHAp implantation for benign bone tumors between 2010 and 2015. Clinical and radiographic findings were evaluated postoperatively at regular follow-up visits. The mean follow-up was 49 months. Radiographic changes were classified into five stages based on bone formation in the implanted UDPHAp according to Tamai’s classification. All patients showed excellent bone formation inside and around implanted UDPHAp. Absorption of UDPHAp and bone marrow cavity remodeling was identified in 20 patients at a mean of 17 months postoperatively, and was significantly more common in young patients. Preoperative cortical thinning was completely regenerated in 26 of 31 patients on average 10 months after surgery. There were no cases of delayed wound healing, postoperative infection, or allergic reaction related to implanted UDPHAp. UDPHAp is a useful bone-filling substitute for treating benign bone tumor, and the use of this material has a low complication rate.

Effects of zoledronic acid combined with metformin on bones of DB/DB mice

Background Diabetic patients are prone to osteoporosis. Both zoledronic acid and metformin have certain anti-osteoporotic effects.Here we explore the anti-osteoporotic effect of the combination of two drugs. Methods 12-week-old DB/DB mice were divided into DB/DB group, zoledronic acid group,metformin group and zoledronic acid combined with metformin group, WT mice were treated as WT group alone. The mice were killed after ten weeks. Then using Micro-ct to scan the tibia and stain the contralateral lower limbs with HE. Results First, we find that the body weight of DB/DB mice treated with metforminre stable and their blood glucose reduce.Second, after HE staining,it is observed under light microscope that there are a large number of adipocytes, few bone trabeculae, few osteoblasts and osteoclasts in the bone marrow cavity in the DB/DB group compared with the WT group, while the number of bone trabeculae in the combined treatment group is higher than that in the zoledronic acid group or metformin group, and a large number of blood cells, blood vessels and adipocytes are found in the bone marrow cavity of the combined drug group compared with the zoledronic acid group. Last, the results of Micro-ct present that, comparing with the DB/DB group and the metformin group,SMI is significantly different(P < 0.05);comparing with the DB/DB group and the zoledronic acid group,Tb.N,Tb.Sp,Conn.D and SMI are significantly different(P < 0.05);BV/TV, Conn.D, SMI, BMD, Tb.N and Tb.Sp in the combination treatment group are significantly difference than those in the DB/DB group(P < 0.05). Conclusion In term of the bone mass lose of DB/DB mice, the treatment of the zoledronic acid combined with metformin outperforms that using the zoledronic acid or metformin only.

Intramarrow injection needle: a new technique to treat patients with haematological and non-haematological malignancies by directly injecting therapeutic agents into the bone marrow cavity

AimsThe purpose of this report is to describe a new instrument designed for the injection of therapeutic agents directly into the bone marrow cavity as well as to aspirate bone marrow specimens for the diagnostic purposes.MethodsThe instrument consists of three parts: the needle, stilette and an adjustable guard. The overall length of the needle is 76 mm and has uniform external diameter except for the distal penetrating segment, which is sharp but short and safe to use on the sternum. The proximal end of the needle is fitted with a plastic T-bar handle, which is ergonomically designed for firm grip and easy manoeuvrability.ResultsThe instrument has been designed to obtain bone marrow aspirate specimens as well as to inject therapeutic agents into the posterior ilium.ConclusionsThe rationale for the intramedullary injection of therapeutic agents for the treatment of patients with leukaemia, lymphoma and other haematological and non-haematological malignant disorders is described. In an emergency when intravenous therapy becomes difficult due to collapsed veins, this instrument may be used for direct intramarrow infusion of blood and blood products.

Changes in the structural organization of bone after amputation

Introduction: Despite a considerable amount of work on limb amputations, questions of the mechanism and conditions for the occurrence of pathological rearrangement in the bone stump and ways to prevent it remain unexplored. Aim: To study the nature of changes in the structural organization of bone stump after amputation. Material and methods: Nine series of experiments were conducted on 129 rabbits with amputation of the thigh and closure of the filing with fascia, muscles with varying degrees of tension and a bone plate. Duration of observation is 1, 3, and 6 months. The research method is histological with a filling of blood vessels with a mascara-gelatin mixture. Results and discussion: Tight closure of the bone marrow cavity and uniform muscle tension during plastic surgery in the I–III series of experiments make it possible to obtain cylindrical stumps with the formation of a bone closure plate and the completion of the reparative process. In the majority of observations of the IV–IX series, significant violations of the structural organization of the bone occurred in the form of conical, club-shaped, swollen stumps, creeping fractures. Conclusions: The rapid completion of the reparative process and the normalization of intraosseous circulation with a locking bone plate, while maintaining normal bone marrow tissue, is possible only with a dense closure of the filing. The lack of tight closure of the bone marrow canal and uneven muscle tension cause a violation of regeneration with changes in the structural organization of the bone. These changes are manifested by a thickening of the bone diameter, axis curvature, creeping fractures.