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Objective:Based on Web of Science database, this study aimed to explore the current status, research hotspots and development trends of countries regarding clinical management of osteoporotic fractures using bibliometrics and visualized analysis.Methods:We collected literatures in the field of clinical management of osteoporotic fractures included in Web of Science database, and applied bibliometrics to analyze the publication dates, countries, institutions, journals, authors, highly cited literatures and research hotspots. Visualization was drawn by VOSviewer software.Results:Analysis of the 2 508 articles revealed 3 types of data. (1) The analysis of basic information of the literature showed that: ①The country with the largest number of publications was the United States, which published 672 articles, followed by the United Kingdom and Canada, and China ranked fourth; ②The top three authors in the number of publications were Kanis JA, Cooper C and McCloskey EV respectively; ③The institution with the highest number of publications was the University of Sheffield, UK, followed by the University of Southampton, UK and the University of Toronto, Canada. (2) Network visualization of highly cited literatures showed that 118 highly cited literatures were mainly divided into 5 clusters, which were related to osteoporotic fracture diagnosis, treatment, medication adherence, management consensus and strategies of preventing refracture. (3) Temporal overlay visualization of research hotspots showed that early research mainly focused on traditional therapeutic drugs, and current research hotspots were mainly molecular targeted drugs, trabecular bone score and fracture liaison services.Conclusion:This study shows that the research activity of clinical management of osteoporotic fractures is increasing worldwide, and there is still a huge gap between China and Europe or the United States. Current research hotspots and development trends mainly focus on molecular targeted drugs, osteoporotic fracture treatment concepts, emerging fracture risk assessment tools, and fracture prevention and management models.
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Objective:To investigate the early clinical outcomes of a minimally invasive anterolateral approach (Orthopadische chirurgie munchen, OCM) versus a conventional (posterolateral approach, PLA) hemiarthroplasty in the treatment of senior femoral neck fractures.Methods:A retrospective analysis was performed on 90 elderly patients with femoral neck fractures who received anterolateral and posterolateral approaches for hemiarthroplasty in the Second Affiliated Hospital of Soochow University from December 2019 to June 2021 and were followed up. In the OCM group, there were 45 cases, including 18 males and 27 females, aged 83.33±5.29 years (range, 76-96 years); In the PLA group, there were 45 cases, including 13 males and 32 females, aged 81.87±5.00 years (range, 75-94 years). Postoperative, surgical indices, perioperative bleeding, and soft tissue injury were assessed; pain was assessed using the visual analogue scale (VAS), and hip function was evaluated using the Harris score and the University of California at Los Angeles (UCLA) score.Results:The incision length, postoperative hospital stay, hemoglobin reduction, and occult blood loss were lower in the OCM group than in the PLA group ( P<0.05), but there was no significant difference in intraoperative bleeding and postoperative transfusion rate ( P>0.05). Serum creatine kinase and C-reactive protein levels (232.98±83.70 IU/L and 81.67±48.85 mg/L) were lower in the OCM group than in the PLA group (296.93±124.58 IU/L and 104.79±36.75 mg/L) 1 day after surgery, and the differences were statistically significant ( t=2.86, P=0.005; t=2.54, P=0.013). Postoperative pain was significantly improved in all patients, and VAS scores were lower in the OCM group than in the PLA group at 12 h, 24 h, and 48 h postoperatively ( P<0.05). The time to get out of bed after surgery was 20.73±4.99 h in the OCM group compared with 41.69±13.58 h in the PLA group, with a statistically significant difference ( t=9.71, P<0.001). Harris scores (63.31±6.21 and 75.76±4.91) and UCLA scores (1.84±0.42 and 3.69±0.76) were higher in the OCM group on the day of discharge and at 1 month postoperatively than in the PLA group (52.69±10.01 and 71.33±3.66); (1.62±0.54 and 3.16±0.80) points, all with statistically significant differences ( P<0.05). However, the differences in Harris score and UCLA score between the two groups at 6 months postoperatively were not statistically significant ( P>0.05). There were two cases of intermuscular vein thrombosis in the OCM group, with a complication rate of 4% (2/45), and one case of dislocation in the PLA group, with a complication rate of 2% (1/45), there was no significant difference between the two groups ( P=1.000). Conclusion:The minimally invasive anterolateral approach is a more ideal procedure for elderly patients with femoral neck fractures undergoing hemiarthroplasty. It has the advantages of a short incision, small soft tissue damage, low occult blood loss, early removal from bed, a short postoperative hospital stay, an improvement in pain, and a good early recovery of hip function.
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Objective:To explore the risk factors for death within 1 year after hip fracture surgery in the elderly.Methods:A case control study was made on the clinical data of 551 elderly patients with hip fracture treated in Second Affiliated Hospital of Soochow University from January 2019 to December 2020, including 182 males and 369 females; aged 65-100 years [80(73,86)years]. Joint replacement, cannulated screw fixation or proximal femoral nail fixation were performed. The patients were divided into survival group ( n=494) and death group ( n=57) based on the death within 1 year after surgery recorded at postoperative telephone follow-up. The gender, age, hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, neurological diseases, chronic renal failure, anemia on admission, fracture types, American anesthesiologist Association (ASA) classification, operative methods, preoperative waiting time, duration of operation and perioperative blood transfusion were recorded in two groups. Univariate Cox regression was used to analyze the correlation between the above indexes and death within 1 year after surgery. All indexes with P<0.2 in the univariate analysis were included in multivariate Cox regression analysis to clarify the independent risk factors for death within 1 year after surgery. Results:Univariate Cox regression analysis showed that death within 1 year after surgery correlated with gender, age chronic respiratory diseases, chronic renal failure and anemia on admission (all P<0.01), but not with hypertension, diabetes, cardiovascular diseases, neurological diseases, fracture types, ASA classification, operative methods, preoperative waiting time, duration of operation or perioperative blood transfusion (all P>0.05). Multivariate Cox regression analysis showed that male ( HR=2.08, 95% CI 1.20, 3.61, P<0.01), age ≥ 80 years ( HR=2.22, 95% CI 1.15, 4.28, P<0.05), chronic respiratory diseases ( HR=2.54, 95% CI 1.19, 5.40, P<0.05), chronic renal failure ( HR=4.57, 95% CI 1.27, 16.44, P<0.05), anemia on admission ( HR=2.82, 95% CI 1.38, 5.76, P<0.01) were significantly associated with death within 1 year after surgery. Conclusion:Male age≥ 80 years, chronic respiratory disease, chronic renal failure and anemia on admission are independent risk factors for death within 1 year after hip fracture surgery in the elderly.
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With the aging of society, the incidence of osteoporosis is increasing. Osteoporotic fractures are directly related to osteoporosis. In the context of the gradual increase in osteoporosis, the number of osteoporotic fractures is increasing, and the incidence of refractures is also increasing annually. Refracture after an osteoporotic fracture refers to the occurrence of a new fracture after the initial fracture due to the lack of improvement in bone density and quality and the effect of low-energy external force on the bone. The occurrence of refracture has more harm to the patient's treatment plan, fracture healing, rehabilitation training, self-care ability, psychological expectation, compliance and other clinical indicators. Therefore, the prevention and management of refracture after osteoporotic fracture has gradually become a hot topic at home and abroad. At present, in this field of prevention and treatment, both clinicians and community doctors have problems with insufficient awareness and short-sighted clinical management, such as unclear management standards for refracture prevention, unclear division of labor between doctors at all levels and various types of doctors, and inadequate measures to improve patient's compliance. Focusing on the characteristics of osteoporotic fractures, refractures, and refracture prevention and management, the core points of refracture prevention and management are proposed and elaborated, and the corresponding contents, fixed teams, proprietary databases or proprietary books of refracture prevention and management should be clarified, so as to provide reference for further improving the clinical management of refracture prevention and treatment after osteoporotic fractures.
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Objective:To compare the numerical rating scales (NRS) and Oswestry disability index (ODI) of denosumab in Chinese postmenopausal osteoporosis patients after 3 months, and analyze the early adverse reactions to provide reference for clinical diagnosis and treatment.Methods:Using a prospective study method, 260 patients with postmenopausal osteoporosis who were outpatients and inpatients in the Second Affiliated Hospital of Soochow University from September 2020 to October 2021 were selected, and general information, including age, height, weight, bone mineral density, history of fragility fractures, and use of anti-osteoporosis drugs. All subjects received denosumab 60 mg subcutaneously, and were given calcium and vitamin D at the same time. Pain was scored by NRS before treatment and 3 months after treatment, and functional improvement was assessed by ODI.Results:After 3 months of denosumab treatment in postmenopausal women with osteoporosis, among patients with different age groups, different degrees of osteoporosis, history of fragility fractures, and history of use of anti-osteoporosis drugs, NRS score and ODI score were lower than those before treatment, and the difference was statistically significant ( P<0.05). In addition, in patients with a history of fragility fractures (mainly vertebral fractures), the NRS scores and the ODI score decreased more significantly, and the difference was statistically significant ( P<0.05); the NRS score and ODI score decreased more significantly in patients with severe osteoporosis than in patients with osteoporosis, and the difference was statistically significant ( P<0.05); the BMD value of lumbar spine was negatively correlated with the reduction of NRS score before and after treatment ( P=0.042). In this study, 260 patients had musculoskeletal pain in 6 (2.3%), fatigue in 5 (1.9%), rash in 4 (1.5%), urinary tract infection in 2 (0.7%), and dizziness in 2 (0.7%), 2 case of fever (0.7%), 1 case of hypocalcemia (0.4%), a total of 22 cases of adverse reactions were reported, and the overall adverse reaction rate was 8.5%. Conclusion:Denosumab can improve pain symptoms and functional disability early in the clinical application of Chinese postmenopausal women with osteoporosis, and the incidence of adverse reactions is low. Especially for postmenopausal female osteoporosis patients with severe osteoporosis, low lumbar spine bone density, and a history of fragility fractures (mainly vertebral fractures), the application effect is more significant.
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Bone modeling and bone remodeling are two different approaches to the physiological metabolism of the human skeleton; both involve bone formation and bone resorption, but they are very different. Bone modeling includes osteoblasts in formation drifts and osteoclasts in resorption drifts, where osteoblasts and osteoclasts are independent of each other but intrinsically coordinated, contributing to changes in bone morphology and structure ultimately. Bone remodeling is a process in which osteoblasts and osteoclasts are closely coupled, resulting in a dynamic balance or imbalance between bone formation and bone resorption, mostly in the form of normal maintenance or gradual reduction of bone mineral mass. Previous literature has suggested that the osteogenic and osteoclastic activities that cause bone modeling usually cease (or end) when the bone matures, but recent studies have shown that bone modeling can occur throughout life and is not only active during infancy and early childhood. Particularly in the context of osteoporosis, some bone-sparing medication can have a significant effect on the process of bone modeling, suggesting that promoting bone modeling may be another useful way to increase bone mass. Therefore, in the field of osteoporosis prevention and treatment, focuse on the role of bone modeling will be significant for patients with osteoporosis.
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The incidence of osteoporosis and its resulting osteoporotic fractures is increasing year by year. More and more scholars pay attention to the fact that the 2 years after osteoporotic fractures is a high-risk period for re-fractures and the key window period for secondary fracture prevention. Osteoporotic fractures are important risk factors for re-fractures, and many other factors, such as the time interval after fracture and fracture site, affect the occurrence of re-fractures. Therefore, traditional fracture risk assessment tools are not suitable for the re-fracture risk assessment, while preliminary reports of emerging re-fracture risk assessment tools have been available. In recent years, with the worldwide promotion of fracture liaison service (FLS), the comprehensive management strategies have effectively improved the diagnosis rate, treatment rate and drug compliance of patients with osteoporotic fractures, while reducing the risk of re-fractures. However, there are a variety of FLS projects with different models around the world, clinicians in some countries and regions have insufficient understanding and attention to the absence of management after osteoporotic fractures, and the risk of re-fractures is still imminent. Therefore, this article systematically elaborated the latest status of re-fractures after osteoporotic fractures, risk factors affecting re-fractures and new re-fracture risk assessment tools. The prevention and management strategies of re-fractures are summarized from three aspects: the standardized anti-osteoporosis drug therapy, the multidisciplinary FLS, as well as the early and personalized rehabilitation therapy, in order to provide references for clinical management of osteoporotic fractures in China.
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Objectives:To investigate the nursing effect of perioperative enhanced recovery after surgery（ERAS）management model in elderly patients with hip fracture.Methods:A retrospective case-control study was conducted to analyze the clinical data of 94 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from July 2017 to June 2018，including 24 males and 70 females aged 76-98 years［（83.7±5.4）years］. There were 54 patients with intertrochanteric fracture and 40 patients with femoral neck fracture. Surgical method was proximal femoral nail antirotation（PFNA）fixation or artificial hip arthroplasty. A total of 44 patients were managed by ERAS（enhanced recovery group）and 50 patients by traditional nursing（traditional rehabilitation group）. The off-bed time was compared between the two groups from aspects of different fracture sites，bone mineral density and causes of injury. The visual analogue scale（VAS）was tested preoperatively and at postoperative days 1，3 and 7. The complications were recorded at postoperative 1 month. The activity of daily living（ADL）score was assessed preoperatively and at postoperative 1 week，1 month and 3 months. The Harris hip score was assessed at postoperative 1 week，1 month，3 months and at the last follow-up. The length of hospital stay and death at postoperative 3 months and at the last follow-up were recorded.Results:All patients were followed up for 12-24 months［（17.7±6.2）months］. In enhanced recovery group，the off-bed time of patients with different fracture sites（femoral neck，femoral intertrochanter），bone mineral density（>-2.5 SD，≤-2.5 SD）and causes of injury（falls，traffic accidents and others）were markedly shortened as compared with traditional rehabilitation group（ P<0.01）. There was no significant difference in VAS between the two groups before operation（ P>0.05）. However，the VAS in enhanced recovery group was（3.4±0.9）points，（2.7±0.5）points，（1.7±0.6）points at postoperative days 1，3 and 7，significantly lower than that in traditional rehabilitation group［（4.3±1.1）points，（3.5±0.5）points，（2.7±0.9）points］（ P<0.01）. One month after operation，the incidence of pulmonary infection was 0% in enhanced recovery group and 28%（14/50）in traditional rehabilitation group（ P<0.01）. While there showed no significant differences in incidences of cardiovascular system，nervous system，urinary tract infection，lower limb deep vein thrombosis，impaired liver and kidney function，anemia，electrolyte disorder or hypoalbuminemia between the two groups（ P>0.05）. There was no significant difference in preoperative ADL score between the two groups（ P>0.05）. The ADL score in enhanced recovery group was（37.0±6.6）points，（70.1±8.4）points，（86.2±9.3）points at postoperative 1 week，1 month and 3 months，significantly higher than that in traditional rehabilitation group［（26.5±10.4）points，（50.1±11.4）points，（70.7±9.0）points］（ P<0.01）. The Harris hip score in enhanced recovery group was（80.9±8.6）points at postoperative 1 month，significantly higher than that in traditional rehabilitation group［（71.1±9.2）points］（ P<0.01）. There were no significant differences in Harris hip score between the two groups at postoperative 1 week，3 months and at the last follow-up（ P>0.05）. The length of hospital stay was（4.7±2.4）days in enhanced recovery group，significantly shorter than（7.8±3.9）days in traditional rehabilitation group（ P<0.01）. The enhanced recovery group showed no death within 3 months after operation and 2 deaths［5%（2/44）］at the last follow-up，while the traditional rehabilitation group revealed 4 deaths［8%（4/50）］within 3 months after operation. There was no significant difference in the mortality between the two groups until the last follow-up（ P>0.05）. Conclusion:For elderly patients with hip fracture，perioperative ERAS management model can effectively shorten periods in bed，relieve postoperative pain，reduce incidence of postoperative pulmonary infection，accelerate recovery of hip function，improve quality of life，shorten length of hospitalization and promote early recovery.
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Objective:Iron accumulation is related to the occurrence of postmenopausal osteoporosis. Meanwhile, autophagy abnormality of bone marrow hematopoietic cells is observed in hip osteoporotic fracture. This study is performed to investigate correlation between iron accumulation induced bone loss and hematopoietic autophagy dysfunction to explore the new risk factor of osteoporosis.Methods:Male iron accumulation mice model was established by intraperitoneally injecting ferric ammonium citrate. Serum ferritin and osteogenic indicator P1NP were tested by ELISA. Bone mineral density was measured by micro-CT. Femur and tibia bone marrows were collected for hematopoietic stem and progenitor cells proportion and cell apoptosis analysis. Autolysosome formation was measured by image flow cytometry. We used conditional mouse model Atg7 flox/flox; Vav-Cre(Atg7 -/-) in which Atg7 had been genetically deleted in the hematopoietic system. Bone marrow hematopoietic stem and progenitor cells were collected for RNA sequence. micro-CT scan was conducted for Atg7 -/- femur. Results:Ferritin level of iron accumulation mice was significantly higher than control group( P<0.05). Iron accumulation inhibited P1NP and induced decreased bone mineral density( P<0.05). Iron accumulation bone marrow displayed enhanced hematopoietic stem and progenitor cells proportion( P<0.05), with more cell apoptosis( P<0.05). Hematopoietic autophagy was deteriorated in iron accumulation bone marrow. Transcriptomic profiling showed up-regulation of iron activity in Atg7 -/- mice, with increased iron homeostasis and iron membrane transporter genes, including Lcn2, Tfr2, Slc40a1(Fpn1), Steap3, and Cpox. micro-CT revealed severe bone loss and decreased bone mineral density in Atg7 -/- mice( P<0.05). Conclusion:Iron accumulation induced bone loss is related to inhibition of hematopoietic cells. Hematopoietic autophagy dysfunction is associated with bone loss.
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Objective:To evaluate the effect of zoledronic acid administration for osteoporotic vertebral compression fracture (OVCF) after treatment with percutaneous kyphoplasty (PKP).Methods:A retrospective case-control study was performed on 430 elderly patients with OVCF admitted to the Second Affiliated Hospital of Soochow University from January 2012 to December 2016. There were 31 males and 399 females, with age of 52-92 years[(72.8±8.3)years]. Fracture segments were at T 5-T 10 (82 vertebrae), T 11-L 2 (389 vertebrae) and L 3-L 5 (173 vertebrae). In zoledronic acid group ( n=178), patients were given zoledronic acid 3 days after PKP surgery. In basic treatment group ( n=252), patients were only given basic treatment after PKP surgery. Bone mineral density was measured before operation and one year after operation. Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed before operation, 3 days and one year after operation. Incidence rate of refracture, mortality and complication rate were recorded after operation. Results:All patients were followed up for 12-60 months (mean, 27 months). Before operation and at postoperative 1 year, the vertebral bone mineral density in zoledronic acid group was (-2.3±1.5)SD and (-1.2±2.3)SD ( P<0.05), and that in basic treatment group was (-2.2±1.2)SD and (-2.1±1.1)SD ( P>0.05). At postoperative 1 year, the bone mineral density in zoledronic acid group was significantly better than that in basic treatment group ( P<0.05). At preoperative 3 days, postoperative 3 days and postoperative 1 year, the VAS was (8.6±0.8)points, (2.8±0.8)points, (2.1±0.8)points in zoledronic acid group, and was (8.5±1.1)points, (2.9±0.9)points, (3.0±2.3)points in basal treatment group; ODI was 48.7±5.3, 24.0±2.9, 22.3±3.3 in zoledronic acid group, and was 48.3±6.1, 24.5±3.8, 27.6±4.0 respectively in basal treatment group. The VAS and ODI were significantly reduced in two groups at postoperative 3 days and 1 year compared to those before operation ( P<0.05). Moreover, the VAS and ODI in zoledronic acid group were significantly lower than those in basal treatment group at postoperative 1 year ( P<0.05). At postoperative 2 years, the incidence rate of refracture in zoledronic acid group was 10.1%(18/178), significantly lower than 16.7%(43/252) in basic treatment group ( P<0.05). Mortality rate in zoledronic acid group was 5.1%(9/178), and that in basic treatment group was 6.3%(16/252) ( P>0.05). No serious complications were observed in both groups such as nerve injury or pulmonary embolism. Conclusion:For OVCF patients, zoledronic acid given after PKP can improve the bone mineral density, reduce pain, fasten function recovery, and effectively decrease the refracture rate.
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Objective To investigate the guiding significance of Daping orthopedics operative risk scoring system for senile patient (DORSSSP) for stratified treatment of elderly patients with severe hip fractures.Methods A retrospectively case-control study was performed for data of 440 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from January 2014 to January 2018,including 130 male and 310 female patients aged 60-98 years [(79.3 ± 6.3) years].According to the DORSSSP scoring system,the patients were divided into low risk group (Group A,n =208),medium risk group (Group B,n =157) and high risk group without SICU transfer after operation (Group C,n =23) and high risk group with SICU transfer after operation (Group D,n =52).The risk prediction results of each group were recorded and compared with the actual complications and mortality.Results (1)According to the prediction of DORSSSP,the number of postoperative complications in Groups A,B,C and D were 52,60,14 and 31,respectively,while the number of actual complications after operation was 45,55,13 and 16.There was significant difference between the predicted value and the actual value of postoperative complications in Group D (P ＜ 0.01),which was not found in other three groups (P ＞ 0.05).The incidence of postoperative complications in Group D was lower than that in Group C (P ＜0.05).(2) According to the prediction of DORSSSP,the number of postoperative death in Groups A,B,C and D were 0,three,two and four,respectively,while the number of actual death after operation was 0,one,two and one,respectively.The predicted value and the actual value of death were significantly different in Group D (P ＜ 0.05),but were not in other three groups (P ＞ 0.05).The incidence of postoperative death in Group D was lower than that in Group C (P ＞ 0.05).Conclusions There is a good correlation between DORSSSP score and postoperative complications and mortality.Based on DORSSSP score for stratified treatment,the interventional treatment of elderly patients with severe hip fracture after operation into SICU can better reduce the incidence of complications.
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Objective@#To investigate the guiding significance of Daping orthopedics operative risk scoring system for senile patient (DORSSSP) for stratified treatment of elderly patients with severe hip fractures.@*Methods@#A retrospectively case-control study was performed for data of 440 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from January 2014 to January 2018, including 130 male and 310 female patients aged 60-98 years [(79.3±6.3)years]. According to the DORSSSP scoring system, the patients were divided into low risk group (Group A, n=208), medium risk group (Group B, n=157) and high risk group without SICU transfer after operation (Group C, n=23) and high risk group with SICU transfer after operation (Group D, n=52). The risk prediction results of each group were recorded and compared with the actual complications and mortality.@*Results@#(1)According to the prediction of DORSSSP, the number of postoperative complications in Groups A, B, C and D were 52, 60, 14 and 31, respectively, while the number of actual complications after operation was 45, 55, 13 and 16. There was significant difference between the predicted value and the actual value of postoperative complications in Group D (P<0.01), which was not found in other three groups (P>0.05). The incidence of postoperative complications in Group D was lower than that in Group C (P<0.05). (2) According to the prediction of DORSSSP, the number of postoperative death in Groups A, B, C and D were 0, three, two and four, respectively, while the number of actual death after operation was 0, one, two and one, respectively. The predicted value and the actual value of death were significantly different in Group D (P<0.05), but were not in other three groups (P>0.05). The incidence of postoperative death in Group D was lower than that in Group C (P>0.05).@*Conclusions@#There is a good correlation between DORSSSP score and postoperative complications and mortality. Based on DORSSSP score for stratified treatment, the interventional treatment of elderly patients with severe hip fracture after operation into SICU can better reduce the incidence of complications.
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Ferroptosis is a new concept of cell death. With the deepening of ferroptosis research, there have been many new understandings of the correlation of ferroptosis with clinical outcomes, diagnosis, and treatment of diseases. Ferroptosis is different from programmed cell death such as apoptosis and autophagy. Ferroptosis is an iron-dependent adjustable cell death that is regulated by glutathione peroxidase 4(GPX4), which requires iron to participate. Moreover, ferroptosis is involved in in many disease processes such as tumors and neurodegeneration. In 2019, journals such as Nature and Cell successively published studies on the mechanism of ferroptosis and clinical diseases, and " ferroptosis" has been increasingly recognized by clinical researchers. Therefore, understanding the main characteristics and regulation mechanism of ferroptosis as well as the influence pathway and mode of iron metabolism process on the occurrence of ferroptosis in vivo is very beneficial to understand the correlation between clinical diseases and ferroptosis, and to enlighten and expand the thinking of clinical diagnosis and treatment. This article reviewed the literature on ferroptosis as well as the relationship between ferroptosis and clinical diseases, in order to gain a deeper understanding of the new concept of ferroptosis.
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Objective:To explore the changes of bone mineral density (BMD) and type H vessel, which was recently identified as strongly positive for CD31 and Endomucin (CD31 hiEmcn hi) in long bone from ovariectomized (OVX) mice compared withSham group. Methods:C57BL/6Jwild-type mice were used for experiments and bone tissuewas collected. Eight-week-old female mice were randomly divided into bilateral ovariectomy (OVX) and a sham operation (Sham). The bilateral ovaries were exposed and removed in the OVX group. In the sham group, the ovaries were only exposed but left intact. After 4weeks, these mice were killed for experiment and the femurs were collected for Micro CT scanning in order to observe the changes of bone mineral density (BMD) and trabecular indexes, including bone volume (BV), total volume of interest (TV), bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N). The fresh tibia of each mouse was fixed, decalcified, dehydrated and embedded for immunostaining. All experimental data were analyzed with t-test. Results:Mouse femora from two groups were dissected at 4 week time points, and the attached soft tissue was completely removed for Micro CT scanning. BMD in OVX is 0.11±0.01 g/cm 3 and 0.21±0.01 g/cm 3 in Sham, which indicated the BMD in OVX significantly decreased. The results showed significant difference between the groups ( P=0.001). The microarchitecture in trabecular bone changed. BV/TV in OVX is 11.52%±1.77% and 25.87%±1.31% in Sham, which indicated the BV/TV in OVX significantly decreased. The results showed significant difference between the groups ( P<0.05). Tb.N in OVX is 1.67±0.33/mm and 2.95±0.82/mm in Sham, which indicated the Tb.N in OVX slightly decreased. The results showed no significant difference between the groups ( P=0.066). Tb.Th in OVX is 0.06±0.01 mm and 0.07±0.01 mm in Sham, which indicated the Tb.Th in OVX significantly thinned. The results showed significant difference between the groups ( P=0.021). Tb.Sp in OVX is 0.29±0.15 mm and 0.19±0.01 mm in Sham, which indicated the Tb.Sp in OVX significantly increased. The results showed significant difference between the groups ( P<0.05). In the groups BMD decreased and trabecular microstructure was broken. Both BMD and trabecular indexes (BV/TV, Tb. Th, Tb. Sp) showed significant changes in OVX group compared with Sham ( P<0.05) except Tb.N. We next examined the expression of CD31 and EMCN via immunostaining in order to observe the changes of type H vessel.By immunostaining, the percentage of HV/TV in OVX group was 9.14%±0.99% and 29.33%±1.22% in the sham-operated mice. Dramatically decreased type H vessels in the metaphysis of OVX mice were observed compared with that of Sham control mice. The results showed significant difference between the groups ( P<0.05). Conclusion:In this study, ovariectomized mice, a widely used model for postmenopausal osteoporosis, exhibited significantly reduced type H vessels accompanied by reduced BMD, which indicatedtype H vessel involved in the occurrence of postmenopausal osteoporosis.
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Most osteoporotic hip fracture occurs in the elderly, with the aging of society, the incidence of such fracture is increasing. The majority of patients are now treated with surgery due to high mortality rate by non-surgical treatment. In the choice of time interval about "fracture-operation", several studies found that elderly with osteoporotic hip fracture had various co-morbidities and their physiological reserve function of the body were obviously reduced, which should be corrected before surgery. However, others believed that the co-morbidities are not aggravated within 2-3 days, using the "window period" to perform surgery could help patients to stand as early as possible after operation, which was beneficial not only to the control of co-morbidities, but also to the prevention of complications such as pneumonia, bedsore and muscular atrophy caused by lying on bed after fracture. Therefore, there are some different opinions on the operation time after fracture in the guidelines and consensus of various countries, including 36 hours, 48 hours, 120 hours and early operation. Among these time points, the idea of "surgery within 48 hours after fracture" has been incorporated into the National Medical Insurance Payment Conditions by the Israeli Ministry of Health, and has been included in the guidelines by the American Association of Orthopaedics, and has been reported in most clinical studies. This article reviewed the studies on different operation time after hip osteoporotic fracture, especially for the reasons, advantages and clinical management process of hip fracture surgery within 48 hours. In addition, these views were analyzed in order to provide reference and inspiration for clinical treatment and hospital management of hip osteoporotic fracture.
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Objective@#To investigate the effect of endogenous iron accumulation onbone mass, intraosseous vessels and the effect of exogenous iron on endothelial cell activity.@*Methods@#The mice were divided into control group (C57/BL6 mice without hepcidin knockout) and hepcidin-knockout group (10 mice in each group, 8 weeks old and weighing about 22 g). The mice in both groups were killed at the age of 16 weeks. Serum ferritin levels were measured by Enzyme-linked immunosorbent assay (ELISA), and iron accumulation in liver tissue was measured by Prussian blue staining, while femoral micro-structure was measured by micro-CT, and H-type vessel immunofluorescence staining was used to detect the number of H-vessels in bone. Cell experiments were divided into normal culture group (normal cell group) and intervention group (Fe group) with 200 μmol/L ammonium ferric citrate. Scratch test was used to detect the migration ability of vascular endothelial cells, and tube formation test was used to detect the function of vascular endothelial cells. The endothelial activity of vascular endothelial cells was detected by immunofluorescence.@*Results@#The level of serum ferritin (318.30±12.53 ng/ml) in the hepcidin-knockout group was significantly higher than that in control group (109.60±4.66 ng/ml). The percentage of blue area of Prussian liver iron staining in the hepcidin-knockout group (80.80%±3.156%) was significantly higher than that in control group (20.94%±2.813%). Bone mineral density in the hepcidin-knockout group (0.044±0.002 mg/m3) was significantly higher than that in control group (0.131±0.008 mg/m3). The number of intraosseous blood vessels in the hepcidin-depleted mice (17.06%±1.060%) was significantly lower than that in control group (38.76%±4.576%). There were significant differences between the two groups in each index (t=-49.367,-13.788, 35.293, 6.165; all P < 0.05). The scratches of vascular endothelial cells in Fe group were reduced by 24.300%±1.849% after 24 hours of culture, which was significantly lower than that in normal group (39.060%±3.211%). The area of vascular endothelial cells in Fe group (0.035±0.003 mm2) was significantly lower than that in normal group (0.330±0.018 mm2). The EMCN positive cells of vascular endothelial cells in Fe group were significantly lower than those in normal group. The percentage of cell number (12.000%±3.462%) was significantly lower than that of normal cell group (0.035%±0.003%). There were significant differences in cell indices between the two groups (t=9.790, 18.929, 13.922; all P< 0.05).@*Conclusion@#Endogenous iron accumulation aggravated bone loss in mice, and the number of intraosseous blood vessels decreased significantly. Vascular endothelial cells were inhibited by iron intervention in migration, tube-formation and endothelial ability.
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Objective@#To compare the clinical effects of surgery within and over 48 hours for hip fractures in elderly patients.@*Methods@#From May 2017 to April 2018, 47 patients over 75 years old with hip fracture were operated in our hospital and met with inclusion criteria. The patients were divided into two groups: within 48-hour group and over 48-hour group according to study design. In the within 48-hour group, there were 22 patients including 5 males and 17 females, aged from 76 to 97 years, with an average age of 83.6±5.0 years, and there were 10 femoral neck fractures (3 total hip arthroplasty, 7 hemiarthroplasty) and 12 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). There were 25 patients (7 males and 18 females) in the over 48-hour group, aged from 76 to 98 years, with an average age of 83.8±5.8 years, and there were 10 femoral neck fractures (2 total hip arthroplasty, 8 hemiarthroplasty) and 15 femoral intertrochanteric fractures (proximal femoral intramedullary nail fixation). At the end of the follow-up period, the clinical data of the two groups were compared. The differences in the length of stay, cost of stay (excluding implants), postoperative complications within 1 month, hip function score (Harris score) within 1 month and 3 months, and mortality within 3 months and at the end of follow-up were analyzed.@*Results@#Both groups were followed up for 12 to 24 months, with an average of 17.7 months. The hospitalization time (7.9±3.0 d), hospitalization expenses (16 627.5±6 428.8 yuan), the incidence of early complications after operation (59.1%) and Harris score (80.9±8.6) in the within 48-hour group were significantly better than those in the over 48-hour group (12.3±4.1 d, 23 799.0±9 785.3 yuan, 88.0%, 71.1±9.2, respectively). At 3 months after operation, there was no significant difference in Harris score between the two groups (83.9±7.3 in within 48-hour group and 82.3±8.9 in over 48-hour group; t=0.668, P=0.507). Within 3 months, there was no death inwithin 48-hour group, but 2 in over 48-hour group; and 1 in within 48-hour group at the last follow-up.@*Conclusion@#Elderly patients with hip fracture benefit significantly from surgery within 48 hours after admission.
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The specimens of femur from wild-type mice(WT) of 6 months and Hepcidin-knockout(KO) mice of 6 months(iron accumulation model) were obtained for Micro-CT examination. Western blot and co-immunoprecipitation were used to detect the changes of related parameters in Wnt signaling pathway. Compared with wild-type mice, the bone mass in Hepcidin-KO mice was significantly decreased, the binding of β-catenin to FOXO3a increased, and binding of β-catenin to TCF4/TCF7L2 decreased in bone tissue, without significant changes in the expression of β-catenin, TCF4/TCF7L2, and FOXO3a. These results suggest that iron accumulation may affect bone formation through interfering with canonical Wnt/β-catenin signaling pathway, finally leading to osteoporosis.
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Objective@#To study the impact on bone mineral density, serum bone metabolism markers, and the expression of osteoprotegerin (OPG) and receptor activator of NF-κB ligand (RANKL) in the adult offspring exposed to maternal high sucrose diet during gestation.@*Methods@#The pregnant Sprague-Dawley (SD) rats were randomly divided into two groups: high sucrose diet group (HS group) rats were given 20% sucrose solution and standard rat food, normal diet group (ND group) rats were provided with fresh tap water and standard rat food. The serum concentrations of alkaline phosphatase (ALP), osteocalcin, tartrate resistant acid phosphatase-5b (TRACP-5b), OPG, and RANKL were measured by the enzyme linked immunosorbent assay (ELISA). The lumbar vertebrae were attained and prepared for micro-computed tomography (Micro-CT) scanning. Compared the expression of OPG and RANKL mRNA in the adult lumbar vertebrae were determined by realtime quantitative PCR.@*Results@#The maternal blood glucose levels and insulin levels were higher in the HS group(P<0.05). The body weight gain during pregnancy and fetal body weight were heavier in the HS group(P<0.05). In HS group that compared to ND group, the serum concentrations of ALP and OPG were decreased, while TRACP-5b and RANKL were increased, and the ratio of OPG/RANKL were significantly increased(P<0.05). Compared to ND group, the bone mineral density, the bone volume per tissue volume, trabecular thickness, the trabecular number were decreased in HS group(P<0.05). The trabecular separation was increased in HS group compared to ND group(P<0.05). The expression of OPG mRNA in the offspring lumbar vertebrae was significantly down-regulated. Conversely, the expression of RANKL mRNA was significantly up-regulated.@*Conclusion@#Maternal high sucrose diet during gestational periods may affect the bone mineral density, serum bone metabolism markers, and the expression of OPG and RANKL in adult offspring.
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The specimens of femur from wild-type mice(WT) of 6 months and Hepcidin-knockout(KO) mice of 6 months ( iron accumulation model ) were obtained for Micro-CT examination. Western blot and co-immunoprecipitation were used to detect the changes of related parameters in Wnt signaling pathway. Compared with wild-type mice, the bone mass in Hepcidin-KO mice was significantly decreased, the binding ofβ-catenin to FOXO3a increased, and binding of β-catenin to TCF4/TCF7L2 decreased in bone tissue, without significant changes in the expression ofβ-catenin, TCF4/TCF7L2, and FOXO3a. These results suggest that iron accumulation may affect bone formation through interfering with canonical Wnt/β-catenin signaling pathway, finally leading to osteoporosis.[Summary] The specimens of femur from wild-type mice(WT) of 6 months and Hepcidin-knockout(KO) mice of 6 months ( iron accumulation model ) were obtained for Micro-CT examination. Western blot and co-immunoprecipitation were used to detect the changes of related parameters in Wnt signaling pathway. Compared with wild-type mice, the bone mass in Hepcidin-KO mice was significantly decreased, the binding ofβ-catenin to FOXO3a increased, and binding of β-catenin to TCF4/TCF7L2 decreased in bone tissue, without significant changes in the expression ofβ-catenin, TCF4/TCF7L2, and FOXO3a. These results suggest that iron accumulation may affect bone formation through interfering with canonical Wnt/β-catenin signaling pathway, finally leading to osteoporosis.