Protective effect of Rhizoma drynariae extract on osteoporosis in ovariectomized rat model

Purpose: To investigate the therapeutic effect of Rhizoma drynariae extract (RDE) on ovariectomyinduced osteoporosis in rats. Methods: Female Sprague-Dawley rats were randomly assigned to a sham-operated group (control) and five ovariectomy (OVX) subgroups: OVX with vehicle (OVX), OVX with 17ß-estradiol (E2, 25 μg/kg/day), and OVX with RDE doses (40, 80, and 160 mg/kg/day). Daily oral administration of E2 or RDE started 4 weeks after OVX and lasted for 16 weeks. The bone mineral density (BMD) of the L4 vertebrae and right femurs was estimated. The length of each femur was measured with a micrometer gauge, and the center of the diaphysis determined. Three representatives L4 vertebrae were selected to evaluate the trabecular microarchitecture. Serum alkaline phosphatase (ALP), urinary calcium (U-Ca), urinary phosphorus (U-P), urinary creatinine (Cr) and osteocalcin (OC) levels were measured. Results: The study showed that high-dose of RDE significantly inhibited the bone mineral density (BMD) reduction of L4 vertebrae (0.20 ± 0.02 g/cm3, p < 0.05) and femurs (0.18 ± 0.02 g/cm3, p < 0.05) caused by OVX and prevented the deterioration of trabecular microarchitecture (p < 0.05), which were accompanied by a significant decrease in skeletal remodeling (p < 0.05) as evidenced by the lower levels of bone turnover markers. High-dose of RDE improved morphometric parameters, namely, Tb-N (3.8 ± 0.2 mm, p < 0.05), Tb-Th (0.083 ± 0.011 mm, p < 0.05) and Tb-Sp (0.19 ± 0.01 mm, p < 0.05) in L4 vertebrae significantly. The present study indicates that the administration of RDE at higher doses over a 16-week period can prevent OVX-induced osteoporosis in rats without hyperplastic effects on the uterus. Conclusion: Thus, RDE is a potential natural alternative for postmenopausal osteoporosis treatment in elderly women.

Anti-osteoporosis activity of Astragalus membranaceus Bunge extract in experimental rats

Purpose: To investigate the anti-osteoporosis effect of Astragalus membranaceus (Fisch.) Bunge. extract (AMBE) in experimental rats. Method: Female Sprague-Dawley rats were randomly divided into six groups: control group, ovariectomy (OVX) with vehicle group, OVX with 17β-estradiol (E2, 25 μg/kg/day) group, and OVX with AMBE doses (60, 120 and 240 mg/kg/day) groups. Daily oral administration of AMBE or E2 was started 4 weeks after OVX and lasted for 16 weeks. The bone mineral density (BMD) of L4 vertebrae and right femurs was evaluated. The length of each femur was measured with a micrometer, and the center of diaphysis was determined. Three representative L4 vertebrae were selected to evaluate trabecular microarchitecture. Serum alkaline phosphatase (ALP), urinary calcium (U-Ca), urinary phosphorus (UP), urinary creatinine (Cr) and osteocalcin (OC) levels were measured. Results: AMBE dose-dependently inhibited the bone mineral density (BMD) reduction of L4 vertebrae (0.27 ± 0.03 g/cm2, p < 0.05) and femurs (0.23 ± 0.03 g/cm2, p < 0.05) caused by OVX and prevented the deterioration of trabecular microarchitecture (p < 0.05), which were accompanied by a significant decrease in skeletal remodeling (p < 0.05) as evidenced by the lower levels of bone turnover markers. A higher dosage of AMBE treatment (240 mg/kg/day) increased U-Ca/Cr (0.27 ± 0.03 mmol/mmol), ALP (137.23 ± 16.72 U/L), U-P/Cr (4.18 ± 0.27 mmol/mmol) and OC (8.47 ± 0.26 mmol/L) levels (both p < 0.05). Conclusion: The findings of this study indicate that AMBE prevents OVX-induced osteoporosis in rats.

Anti-osteoporosis effect of Cistanche deserticola Ma extract in ovariectomized rats

Purpose: To investigate the therapeutic effects of Cistanche deserticola Ma. extract (CDME) on ovariectomy-induced osteoporosis in rats. Methods: Female Sprague-Dawley rats were randomly assigned to a control group and five ovariectomy (OVX) subgroups, that is, OVX with vehicle (OVX), OVX with 17ß-estradiol (E2, 25 μg/kg/day), and OVX with CDME doses (40, 80, or 160 mg/kg/day). Daily oral administration of E2 or CDME started 4 weeks after OVX and lasted for 16 weeks. Bone mineral density (BMD) of L4 vertebrae and right femur of rats was estimated, The length of each femur was measured, and biochemical analysis of serum and urine specimens were performed. Results: CDME dose-dependently inhibited the reduction in BMD of L4 vertebrae (0.23 ± 0.02 g/cm3, p < 0.05) and femurs (0.20 ± 0.03 g/cm3, p < 0.05) caused by OVX and prevented the deterioration of trabecular microarchitecture (p < 0.05), which were accompanied by a significant decrease in skeletal remodeling (p < 0.05) as evidenced by the lower levels of bone turnover markers. Conclusion: This study indicates that CDME prevents OVX-induced osteoporosis in rats, and could be used for treating osteoporosis in elderly women.

Impact on hip fracture mortality after the establishment of an orthogeriatric care program in a colombian hospital

El objetivo del estudio es evaluar la mortalidad a un año en pacientes con fractura de cadera, mayores de 65 años tratados en un programa establecido de orto-geriatría. 298 se trataron de acuerdo al protocolo de orto-geriatría, se calculo la mortalidad a un año, se establecieron los predictores de mortalidad orto-geriátrico. La sobrevida anual se incremento de 80% a 89% (p = .039) durante los cuatro años de seguimiento del programa y disminuyo el riesgo de mortalidad anual postoperatorio (Hazard Ratio = 0.54, p = .049). La enfermedad cardiaca y la edad maor a 85 años fueron predictores positivos para mortalidad.

Prevalencia del síndrome de cementación ósea en pacientes de artroplastia de cadera, Hospital Universitario Mayor Méderi 2014

Resumen Introducción: Con el fin de estimar la prevalencia del síndrome de cementación ósea (SICO) en pacientes llevados a artroplastia de cadera cementada en el Hospital Universitario Mayor Méderi 2014. Materiales y métodos: Se realizó un estudio observacional, descriptivo, de corte transversal, se evaluaron los registros de historia clínica de los pacientes llevados a artroplastia cementada de cadera desde enero a diciembre de 2014. Se estimó la prevalencia del número total de casos de SICO sobre el total de intervenidos y la mortalidad del número de muertes intraoperatorias sobre el total de pacientes que desarrollaron el SICO. Resultados: Se encontraron 102 pacientes llevados a artroplastia cementada de cadera; 73,5% de género femenino, la mediana de edad fue 82 años, la prevalencia de SICO fue de 0,96 x 100 procedimientos y la mortalidad de 7,14 x 100 eventos (1 caso), el evento más frecuentemente relacionado fue las Perdida sanguínea < 300ml (p.valor: 0,006), el resto de diferencias entre los factores de riesgo reconocidos no fueron estadísticamente significativas. Discusión Se encontró una baja frecuencia del evento, con una muerte relacionada, se requieren estudios prospectivos para explorar desenlaces en el tiempo para la presentación de SICO y factores de riesgo adicionales. Palabras clave: "Hipotensión/Diagnóstico", "Prevalencia", "Artroplastia de Reemplazo de Cadera/Efectos Adversos", "Cementos Óseos/Efectos Adversos", "Complicaciones Postoperatorias/Etiología" y "Complicaciones Postoperatorias/Inducido Químicamente"

Assessing model credibility of CT-Based finite element model to predict bone strength

Osteoporosis is one of the major causes of mortality among the elderly. Nowadays, areal bone mineral density (aBMD) is used as diagnostic criteria for osteoporosis; however, this is a moderate predictor of the femur fracture risk and does not capture the effect of some anatomical and physiological properties on the bone strength estimation. Data from past research suggest that most fragility femur fractures occur in patients with aBMD values outside the pathological range. Subject-specific finite element models derived from computed tomography data are considered better tools to non-invasively assess hip fracture risk. In particular, the Bologna Biomechanical Computed Tomography (BBCT) is an In Silico methodology that uses a subject specific FE model to predict bone strength. Different studies demonstrated that the modeling pipeline can increase predictive accuracy of osteoporosis detection and assess the efficacy of new antiresorptive drugs. However, one critical aspect that must be properly addressed before using the technology in the clinical practice, is the assessment of the model credibility. The aim of this study was to define and perform verification and uncertainty quantification analyses on the BBCT methodology following the risk-based credibility assessment framework recently proposed in the VV-40 standard. The analyses focused on the main verification tests used in computational solid mechanics: force and moment equilibrium check, mesh convergence analyses, mesh quality metrics study, evaluation of the uncertainties associated to the definition of the boundary conditions and material properties mapping. Results of these analyses showed that the FE model is correctly implemented and solved. The operation that mostly affect the model results is the material properties mapping step. This work represents an important step that, together with the ongoing clinical validation activities, will contribute to demonstrate the credibility of the BBCT methodology.

Dosimetric optimization of CT protocols for the preoperative planning of hip arthroplasty

Radiation dose in x-ray computed tomography (CT) has become a topic of great interest due to the increasing number of CT examinations performed worldwide. In fact, CT scans are responsible of significant doses delivered to the patients, much larger than the doses due to the most common radiographic procedures. This thesis work, carried out at the Laboratory of Medical Technology (LTM) of the Rizzoli Orthopaedic Institute (IOR, Bologna), focuses on two primary objectives: the dosimetric characterization of the tomograph present at the IOR and the optimization of the clinical protocol for hip arthroplasty. In particular, after having verified the reliability of the dose estimates provided by the system, we compared the estimates of the doses delivered to 10 patients undergoing CT examination for the pre-operative planning of hip replacement with the Diagnostic Reference Level (DRL) for an osseous pelvis examination. Out of 10 patients considered, only for 3 of them the doses were lower than the DRL. Therefore, the necessity to optimize the clinical protocol emerged. This optimization was investigated using a human femur from a cadaver. Quantitative analysis and comparison of 3D reconstructions were made, after having performed manual segmentation of the femur from different CT acquisitions. Dosimetric simulations of the CT acquisitions on the femur were also made and associated to the accuracy of the 3D reconstructions, to analyse the optimal combination of CT acquisition parameters. The study showed that protocol optimization both in terms of Hausdorff distance and in terms of effective dose (ED) to the patient may be realized simply by modifying the value of the pitch in the protocol, by choosing between 0.98 and 1.37.