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The aim of this study was to analyze regional differences in the stress distribution within the distal femur in advanced osteoarthritis (OA).
Distal femoral specimens with primary OA were obtained from 10 female donor cadavers (mean age, 65 years; range, 53–79). As controls, distal femurs without OA were obtained from 10 age- and sex-matched female cadavers (mean age, 67 years; range, 58–81). The articular surface of the distal femur was divided into anterior, middle, and posterior regions on each condyle. Mechanical properties and microstructure were assessed for each region with micro-computed tomography and finite element model analysis.
The control group showed differences in stress distribution among 6 regions on the distal femur (
Regional stress distribution in the distal femur was different between advanced OA and normal groups. There were no regional differences in stress distribution in the advanced OA group. Altered loading patterns, bone remodeling, and chemical composition will affect stress distribution.
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Type 2 diabetes mellitus is associated with an increased risk of osteoporotic fracture despite relatively preserved bone mineral density (BMD). Although this paradox might be attributed to the influence of insulin resistance (IR) on bone structure and material properties, the association of IR with femur bone geometry and strength indices remains unclear.
Using data from the Cardiovascular and Metabolic Disease Etiology Research Center cohort study, we conducted a cross-sectional analysis among nondiabetic postmenopausal women. IR was estimated using the homeostasis model assessment of IR (HOMA-IR). Compartment-specific volumetric BMD (vBMD) and bone volume of proximal femur were measured using quantitative computed tomography. The compressive strength index (CSI), section modulus (Z), and buckling ratio of the femoral neck were calculated as bone strength indices.
Among 1,008 subjects (mean age, 57.3 years; body mass index [BMI], 23.6 kg/m2), BMI, waist circumference, and vBMD of the femoral neck and total hip increased in a linear trend from the lowest (<1.37) to highest (≥2.27) HOMA-IR quartile (
Elevated HOMA-IR was associated with lower cortical bone volume and bone strength indices in nondiabetic postmenopausal women, independent of age and body size.
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In this report, we describe the case of a healthy 37-year-old male patient without a history of disease, who developed atraumatic bilateral fracture of the femoral neck. Radiological and blood investigations revealed osteopenia and severe vitamin D deficiency (7.42 ng/mL), respectively, but patient had no apparent risk factors for insufficiency fracture. Bilateral osteosynthesis was obtained using cannulated screws and laboratory findings improved after vitamin D supplementation. This case highlights the effect of vitamin D deficiency on demineralization in a young male patient.
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Wilson's disease (WD) is a rare inherited disorder of copper metabolism. It chiefly has hepatic, neurological and ophthalmic manifestations. Although osteoporosis, rickets and early arthritis are common features of WD, they are under-recognized. Musculoskeletal manifestations very rarely lead to diagnosis of the disease. Here we present a case of a 12-year-old girl who presented with a 3-month-old pathological fracture of neck of femur. WD was diagnosed on investigating the cause of the pathological fracture, which was managed by performing a conventional McMurray's intertrochanteric osteotomy. At 6 months follow up, fracture had united and patient was able to ambulate with support. WD can be a rare cause of pathological fracture. A high index of suspicion must be maintained in patients of pathological fracture presenting with associated neuropsychiatric or hepatic manifestations.
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To retrospectively assess whether the response of subtrochanteric lateral cortex (STLC) is different according to the bisphosphonate agents in terms of bone mineral density (BMD) change.
A total of 149 subjects, who had 2- to 4-year interval follow-up of BMD using dual energy X-ray absorptiometry (DXA), were included in this retrospective study divided into following 3 groups: control group (no consumption of any anti-osteoporotic drugs, n=38), alendronate group (naïve alendronate users, n=48), risedronate group (naïve risedronate users, n=63). BMD was measured at the STLC and subtrochanteric medial cortex (STMC) in each patient by drawing rectangular ROIs at the bone cortices. The percent change of BMD at the STLC were compared between the aforementioned 3 groups by using analysis of covariance model to control five independent variables of age, body mass index, percent change of STMC, hip axis length, time interval between DXA examinations.
The least square mean values±standard deviation of the percent change of BMD in the control, alendronate, and risedronate groups were 1.46±1.50, 2.23±1.26, and 6.96±1.11, respectively. The risedronate group showed significantly higher change of BMD percentage compared with the control (adjusted
The percent change of BMD at the STLC in the risedronate user group was greater than the alendronate and control groups. The implication of these changes needs to be further verified.
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The purpose of this study is to investigate differences of chemical composition between subchondral bone in advanced osteoarthritic (OA) and non-OA distal femur.
Twenty femurs were harvested, respectively. The subchondral trabeculae were obtained from the middle of medial articular surface of distal femurs. A 10 mm diameter cylindrical saw was used to harvest. Raman spectroscopy, a non-destructive technique, was employed to determine the chemical information of the trabecular bones in the human distal femurs.
The maximum intensity of the phosphate peak was 2,376.51±954.6 for the non-OA group and 1,936.3±831.75 for the OA group. The maximum intensity of the phosphate peak observed between the two groups was significantly different (
The result suggested that OA may affect the chemical compositions of trabecular bone, and such distinctive chemical information may be.
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Bone mineral density (BMD) is used as a sole parameter in the diagnosis of osteoporosis. Due to the ease of acquirement of BMD, clinical diagnosis still involves its usage although the limitations of BMD are quite well-established. Therefore, this preliminary study hoped to reduce the errors introduced by BMD alone by incorporating geometric and structural predictors simultaneously to observe if strength was implicitly dependent on the geometry and BMD. Hence, we illustrated the triadic relationship between BMD, buckling ratio (BR) and critical fracture load (Fcr).
The geometric predictor was the BR as it involves both the changes in the periosteum and the cortical thickness. Also, structural changes were monitored by finite element (FE) analysis-predicted Fcr. These BR and Fcr measurements were plotted with their respective femoral neck BMD values in elderly female patients (n=6) in a 3-year follow-up study, treated with ibandronate.
In all the three-dimensional plots (baseline, mid and final year), high Fcr values were found at regions containing high BMD and low BR values. Quantitatively, this was also proven where an averaged highest Fcr across the three years had a relatively higher BMD (46%) and lower BR (19%) than that of the averaged lowest Fcr. The dependence of FE predicted strength on both the geometry and bone density was illustrated.
We conclude that use of triadic relationships for the evaluation of osteoporosis and hip fractures with the combination of strength, radiology-derived BR and bone density will lay the foundation for more accurate predictions in the future.
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Bisphosphonate is notable for the treatment of osteoporosis in the world. But recently if Bisphosphonate is taken for a long time, it causes an insufficiency fracture by suppression of bone turn-over and it is reported rarely on femur neck. Here we report a case of insufficiency fracture on ipsilateral femur neck in woman treated with long term Bisphosphonate therapy.
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