Detecting Patients with Low Bone Mineral Density during Cone-Beam Computed Tomography

Population aging is a worldwide phenomenon that is often explained by improvements in living conditions. Common diseases in the older age group are investigated to improve their prevention and treatment. Osteoporosis, a silent disease characterized by the progressive decrease of bone mineral density, resulting in an increased risk of fractures, is one of the most common diseases that affect patients over 60 years of age. Dual-energy X-ray absorptiometry (DXA) is the gold standard test for the diagnosis of low bone mineral density. However, this test has a high cost and is not available to all populations. Previous studies have found that dental imaging can be used to identify low bone mineral density. Dental imaging examinations have lower costs and are more routine than DXA. Qualitative and quantitative radiomorphometric indices as well as mathematical methods are used to identify patients with low bone mineral density through dental imaging exams. In addition, the morphology of the mandibular bone cortex is the most studied panoramic radiography exam. Cone-beam computed tomography (CBCT) is a three-dimensional examination that produces high-quality images without distortion and magnification. This examination is widely used in dentistry and can be used for the evaluation of bone mineral density. However, CBCT is a low-cost examination, compared to DXA.

Giant Aggressive Aneurismal Bone Cyst of the Proximal Humerus Unresponsive to Denosumab

Aneurysmal Bone Cyst (ABC) is a destructive lesion. The main treatment is curettage, local adjuvant and grafting. However, it is difficult to apply the optimal surgical procedure in aggressive lesions. In these cases, the use of denosumab prior to surgery has been shown to reduce bone destruction and facilitate surgical treatment. A 22-year-old woman was referred for limited shoulder movement and pain complaints. Physical examination and radiological findings were interpreted in favor of ABC. The biopsy was also found to be consistent with the ABC. Since the lesion was aggressive, denosumab was applied prior to surgery. The mass quickly became calcified and patient’s pain complaint decreased. After stopping denosumab treatment, lesion progressed rapidly and destructive character became dominant at every part of lesion. The patient underwent proximal humeral resection and prosthesis. A painless limb with limited shoulder movement was achieved. Although denosumab application prior to surgery was initially good in this case, after termination of treatment, lesion progressed rapidly and the gains associated with denosumab use was lost.

Patient with Metastatic Process in the Skeleton of Unknown Etiology

Bearing bone involvement is a possible sign of generalization variety of cancers. In many cases the process of bearing skeletal diagnosed at the time when the primary tumor is not obvious. The task of the physician is quickly to determine whether it is a benign process or not, and diagnosis of the primary process by which then determine the further progress of therapy. The search for causative bearing shell process, alternatively the primary tumor, is often common practice in the hands of internist. Departments of Clinical Oncology do not have to have sufficient capacity for complex treatment all of newly discovered deposits skeleton whose nature does not have to be always initially clear. Therefore, in the opinion of the authors in these cases, the role of internist as a significant diagnosis very important In our article, we introduce six case reports of patients who were bearing the ambiguous process of investigation of the skeleton in our department in 2014. In accordance with the literature data were represented kidney tumor, multiple myeloma, chondrosarcoma, and in one case the origo malignant process was not found.

Treatment of Osteoporosis with Bisphosphonates: Is Vitamin D Necessary?

Bisphosphonates (BP) are the most commonly used medications for the treatment of osteoporosis. Of them, the most frequently prescribed worldwide is alendronate. Of the various compounds available, those that are ingested are usually indicated, but they are also available for intravenous use at different intervals, depending on their potency [1].

Bone Histomorphometric Findings in Ankylosing Spondylitis: A Case Report

There is minimal information on bone Histomorphometric characteristics in ankylosing spondylitis. We here report a case of a 36-year-old Japanese male that suffered from lumbago and could not gaze in the forward direction. Ultimately, a diagnosis of ankylosing spondylitis was made, and vertebroplasty was performed to correct the third lumbar spine. Histomorphometry of the iliac bone showed reduced bone volume parameters (bone volume, and trabecular thickness and width) than reference values. In addition, bone formation parameters (osteoid thickness and osteoblast surface per bone surface) and bone resorption parameters (eroded surface per bone surface and osteoclast number per bone surface) were also lower than reference values, indicating low bone turnover. By contrast, there was not a clear trend in bone resorption markers: bone- pecific alkaline phosphatase (17 U/l) was normal, TRACP-5b (136 mU/dl) was slightly lower, urinary N-terminal telopeptide (45.3 nmol BCE/mmol Cr) was normal, and deoxypyridinoline (9.1 nM/mM Cre) was higher than reference values. However, there was deficiency in 25-hydroxy vitamin D (25-OH-D; 14.4 ng/ml). This case highlights the rare possibility of performing bone histomorphometry, and indicates that a low bone volume and low bone turnover (in both bone formation and resorption) are characteristics of ankylosing spondylitis, although bone formation markers (bone-specific alkaline phosphatase) and bone mineral density are within the normal range. The possibility of a serum 25-OH-D deficient status in ankylosing spondylitis should be further considered.

In Vitro effect of Bone Morphogenetic Protein-2 (BMP-2) and Cigarette Smoke Extract (CSE) on Osteoblastic Mesenchymal Stem Cells: Beneficial Biological Effects of BMP-2 Negated By CSE

Introduction: Clinical and demographic studies have shown that tobacco smoking is a major contributor to non- and delayed-union in fracture healing. The cellular and molecular basis for this is poorly understood, and few studies in human fractures have been undertaken.Aims: To analyse the in vitro biological effects of tobacco smoking at the cellular level within the human fracture microenvironment, with specific regard to mesenchymal stem cell (MSC) proliferation and to ascertain whether the application of bone morphogenetic factor-2 (BMP-2) could be used therapeutically to improve fracture healing.Methods: Fracture haematomas (n=10) were collected from anaesthetised, non-smoking patients who had sustained a tibial fracture, and who were undergoing surgical operative fixation. The semi-solid material was dissected and explanted into tissue culture flasks. Complete culture media was introduced, and cultures were incubated at 37oC in a humidified 5% CO2 environment. Cigarette smoke extract (CSE) was produced and infused into the cell cultures to establish an in vitro smoking environment. A control group (n=10) was set-up and left ntreated by CSE. Harvested, spindle-shaped adherent cells were characterised by immunocytochemistry. Cell populations were counted via flow cytometry to assess and compare proliferation rates between CSE-treated and untreated cell cultures. BMP-2 concentrations (10 and 100 ng/mL (an additional dose of 500 ng/mL in CSE- reated cells)) were infused into cell cultures to enhance in vitro cellular viability, which was analysed by means of the MTT assay.Results: There was a significant reduction in the rate of proliferation of osteoblastic MSCs in CSE-treated cells after 5 days of culture (p < 0.05). At a dose of 100 ng/mL, BMP-2 augmented cellular growth and improved cellular viability in cultures not treated with CSE (p < 0.0001). No significant improvement was seen in CSE-treated cell cultures.Summary: The effect of smoking on bone fracture healing appears to contribute to the inhibition of osteoblast proliferation, which may not be reversible with the therapeutic use of exogenous BMP-2. Moreover, the improvement seen in non-smokers does strengthen the case for smokers to cease using tobacco in the perioperative setting in order that such treatments are rendered more effective.

Iguratimod, A Synthetic Disease Modifying Anti- Rheumatic Drug (Sdmard), and Various Dmards Suppress Joint Destruction. The Pathophysiological Mechanisms of the Inhibition of Bone/Cartilage Destruction

Objective: To elucidate the radiographic outcomes for rheumatoid arthritis (RA) patients using the synthetic disease-modifying antirheumatic drug (sDMARD) Iguratimod (IGU) and other DMARDs including injectable sodium aurothiomalate, bucillamine, salazosulphapyridine, infliximab, etanercept, tocilizumab and/or abatacept.Patients and Methods: 213 patients were enrolled in this study. Total Genant-modified Sharp scores (GSS) of hands/wrists and feet at baseline and at week 104 were calculated in 31 RA patients treated with a daily dose of 25 mg or 50 mg for 104 weeks.Results: Total GSS of 31 patients at week 104 showed no progression (total GSS <= 0.84: the smallest detectable change) in 16 (52%) patients with a mean score reduction (95% CI) of-4.3 (-8.1 ~ -0.5) (p < 0.05).Conclusion: Treatment with the sDMARD, IGU showed no radiographic progression in 16 (52%) RA patients at week 104. Concerning the suppression mechanism of joint destruction by IGU and other DMARDs, we speculate that DMARDs prevent bone/cartilage destruction by inhibiting the receptor activator of nuclear factor-kappa B (NF- kB) lig and (RANKL) and through other antirheumatic actions.

Treatment of Resistant and High-Risk Humeral Non-union Cases with rhBMP7

Introduction: Non-union of the humeral shaft is a rare condition. In these patients, more stable fixation with or without autograft results in nearly 95% union rate. The purpose of this study was to evaluate bone union following use of recombinant human bone morphogenetic protein-7 (rhBMP7) for treating humeral non-union.Material and methods: This was a prospective study of resistant non-union cases treated by repeated fixation and addition of rhBMP7. The case series consisted of 16 patients with an average age of 53.8 years (24-71). Patients presented with non-union of the humeral shaft and had experienced at least one failed attempt at surgical repair. Osigraft® (rhBMP7) was added to the non-union site after decortication, medullary canal reaming and fixation with one or two plates. The average time elapsed between the initial fracture and the second revision was 31 months (5-103). The patients had undergone an average of 2.3 procedures (1-6).Results: All patients were reviewed after at least 24 months of follow-up. No neurological complications were reported. One failure occurred in a non-compliant patient with septic non-union who had undergone four previous procedures. The other patients experienced bone union after an average of 12.4 months (6-14), with no further procedures required. The patients were able to return to their normal daily activities.Conclusion: Failure of the initial fracture treatment (unstable fixation, postoperative bone defect) is the primary cause of non-union. Although autograft is the gold standard treatment for non-union cases, the course of action to take if this primary strategy fails has not been defined. During secondary use (due to failed autograft procedure) and when there is no requirement for a structural graft (humerus can be shortened), providing stable fixation and adding a growth factor leads to bone union even in a septic environment.

Effect of Adipose Tissue-Derived Mesenchymal Stem Cells on Irradiated Bone Marrow-Derived Mesenchymal Stem Cells

Adipose-derived Mesenchymal stem cells have emerged as an attractive alternative source of cell therapy. While radiation therapy is an important application for head and neck cancer, the effect of adipose-derived mesenchymal stem cells on irradiated bone marrow-derived Mesenchymal stem cells is still unclear. Herein, we explored how clinical total radiation dose affect gene expression related with differentiation on murine bone marrow-derived mesenchymal stem cells and how murine adipose-derived mesenchymal stem cells affect irradiated murine bone marrow-derived mesenchymal stem cells. The clinical total radiation dose upregulates osterix mRNA expression. Moreover, adiposederived mesenchymal stem cells dramatically promoted the upregulation of osterix mRNA expression whereas inhibited NFATc1 mRNA expression. Taken as a whole, irradiated bone marrow-derived mesenchymal stem cells co-cultured with adipose-derived mesenchymal stem cells may exhibit osteogenic property.

Acid-Base Control and Osteoporosis: A Review

Bone functions as a store of alkali buffer, and is consumed over time if the organism is continually exposed to an acid-producing diet. This may result in osteoporosis. Alkali therapy may protect the bone, and may prevent the development of osteoporosis.