Bone
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In some types of low-trauma fractures of older adults the number and incidence of fractures are stabilizing or even decreasing. However, very little population-based information is available concerning the nationwide numbers, incidences and especially secular trends of low-trauma fractures of the distal humerus. Therefore, we assessed the current trends in the number and incidence of low-trauma distal humeral fractures in Finnish women 60 years of age or older by taking into account all women who were admitted to Finnish hospitals for primary treatment of such fracture in 1970-2007. ⋯ Also, in all age groups (60-69, 70-79, and 80-) the trend of age-specific incidence was increasing from 1970 till the end of 1990s, and decreasing thereafter. In conclusion, the clear rise in the rate of low-trauma distal humeral fractures in Finnish women 60 years of age and older from 1970 till late 1990s has been followed by stabilized or even decreased fracture rates. The precise reasons for this secular change are unknown, but a cohort effect towards improved functionality among older women and actions and interventions in preventing falls and minimizing fall severity cannot be ruled out.
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Fracture healing is impaired in osteoporotic bone. Low-magnitude high-frequency vibration (LMHFV) has recently been proven to be osteogenic in osteoporotic intact bone. Our previous study found that LMHFV significantly enhanced fracture healing in adult rats. ⋯ Callus formation, mineralization and remodeling were enhanced by 25-30%, with a 70% increase in energy to failure than OVX-C. However, Sham-V was found to have lesser fracture healing enhancement, with significant increase in callus area only on week 2 and 3 than Sham-C, suggesting non-OVX aged bones were less sensitive to mechanical loading. The findings of this study provide a good basis to suggest that proceeding to clinical trials is the next step to evaluate the efficacy of LMHFV on osteoporotic fracture healing.
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Comparative Study
Is kyphoplasty better than vertebroplasty in restoring normal mechanical function to an injured spine?
Kyphoplasty is gaining in popularity as a treatment for painful osteoporotic vertebral body fracture. It has the potential to restore vertebral shape and reduce spinal deformity, but the actual clinical and mechanical benefits of kyphoplasty remain unclear. In a cadaveric study, we compare the ability of vertebroplasty and kyphoplasty to restore spine mechanical function, and vertebral body shape, following vertebral fracture. ⋯ Vertebroplasty and kyphoplasty were equally effective at restoring mechanical function to an injured spine. Only kyphoplasty was able to reverse minor vertebral wedging.
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Comparative Study
Comparison of effects of alfacalcidol and alendronate on mechanical properties and bone collagen cross-links of callus in the fracture repair rat model.
Both bone density and quality are important determinants of bone strength. Bone quality is prescribed by matrix characteristic including collagen cross-linking and bone structural characteristics and is important in reinforcement of bone strength. We investigated the effects of alfacalcidol (ALF), a prodrug of calcitriol, and alendronate (ALN), a bisphosphanate, on the mechanical properties and content of enzymatic cross-links in femoral bone using a fracture repair rat model. ⋯ Of particular interest, the Pyr-to-Dpyr ratio was significantly decreased by ALF administration, suggesting that ALF but not ALN normalized the enzymatic cross-link patterns in fractured bone to the control level. In conclusion, ALN and ALF treatment increased bone strength via the distinctive effect on bone mass and quality. ALN formed larger calluses and increased enzymatic cross-links despite delayed woven bone remodeling into lamellar bone, whereas ALF treatment induced lamellar bone formation coincided with increasing in the enzymatic cross-linking and normalizing the cross-link pattern in callus to native bone pattern.
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Randomized Controlled Trial
Effects of statins vs. non-statin lipid-lowering therapy on bone formation and bone mineral density biomarkers in patients with hyperlipidemia.
The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, named statins, are well-established cholesterol-lowering drugs able to reduce cardiovascular risk in hypercholesterolemic patients. The possible effect of statin on bone tissue, so-called pleiotropic effects has received particular attention. Studies reported a positive effect of statin on bone tissue in both of animal and human study by enhancing the expression of the bone morphogenetic proteins (BMPs), in particular of BMP2, which in turn leads to osteoblast differentiation and bone formation including interfering with osteoclastic activity. In a systematic review, the lipophilic statin as simvastatin had positive effect to bone mineral density (BMD) better than the more hydrophilic statin such as atorvastatin and fluvastatin. This study was aimed to compare efficacy of medical therapy between HMG-CoA reductase inhibitor and non-HMG-CoA reductase inhibitor group to changing of bone mineral density and bone markers in the patients with hyperlipidemia. ⋯ The lipophilic statin as moderate to high dose of simvastatin had beneficial positive effect to increasing BMD and could be additive use for prevention of bone loss in hyperlipidemia patients.