The effect of bone morphogenetic protein-7 (OP-1) and demineralized bone matrix (DBM) in the rabbit tibial distraction model.

OP-1 (800 microg) or DBM (1900 mg) were implanted in a rabbit tibial distraction model, and healing was compared to a non treated control group. The limbs were harvested after ten weeks and examined using radiography, computerized axial tomography and histological analysis. Neither of the treatments showed a changed healing pattern. Densities as measured by CT scan were not increased and the only significant finding was an increased area of bone formation in the DBM treated group (65% increase as compared to the OP-1 group). These experimental results do not show an effect of these substances in this model of bone lengthening. They indicate that further studies are warranted to understand the process of bone formation and the working mechanisms of substances that potentially trigger bone healing.

Histomorphometry and micro-computed tomography of bone augmentation under a titanium membrane.

OBJECTIVES: Bone augmentation underneath an occlusive titanium membrane is evaluated in most cases by means of serial histological sections and histomorphometry. Micro-computed tomography (micro-CT) is a less invasive and dynamic technique to measure bone volume in animals of a size that fits into the gantry. The aim of the present study was to evaluate whether the latter approach could match histomorphometry to assess bone augmentation under a titanium membrane. MATERIAL AND METHODS: Pre-formed titanium cups were placed on the skull of 16 rabbits. Bone formation underneath the cups was allowed to occur for 12 weeks. The amount of bone volume assessed by micro-CT was expressed as a numerical unit. One unit volume corresponds to 0.043 mm3. The measurements reveal the volume of bone-like tissue under the membrane, with the same density as that of the original rabbit skull bone. Histological sections were cut along the same plane as the one used for the micro-CT images. The total bone surface was assessed by a digital image system in double-stained undecalcified histological sections and related to the maximum available surface of the titanium cups, which was on average 1366 mm2. RESULTS: The amount of total bone surface found under the titanium membrane varied between 40 and 163 mm2. Measured by micro-CT, the bone detected ranged from 3.7 to 396 numerical units. A highly significant (P<0.001) correlation was found between the total bone volume measured in conventional serial histological sections and by the micro-CT technique (r2=0.72). CONCLUSIONS: The total bone volume measured underneath a membrane using the micro-CT when compared with histological sections remained within a 16% error. This is because of the scattering effect of the metallic membrane and the impossibility to distinguish newly formed bone from the original skull bone on the micro-CT images.

Identifying postmenopausal women with osteoporosis by calcaneal ultrasound, metacarpal digital X-ray radiogrammetry and phalangeal radiographic absorptiometry: a comparative study.

Identifying women with osteoporosis remains a clinical challenge, as it may not be feasible or cost-effective to recommend dual-energy X-ray absorptiometry (DXA) for all postmenopausal women. In this regard, quantitative ultrasound (QUS) has emerged as an attractive screening tool because of the (relatively) low cost and because QUS and DXA-assessed BMD appear to be equally predictive of future (hip) fracture risk. The objective of this study was to compare the ability of calcaneal QUS to identify osteoporosis with two alternative potential screening methods: digital X-ray radiogrammetry (DXR) and radiographic absorptiometry (RA). We enrolled a total of 221 postmenopausal community-dwelling Caucasian women aged 50-75 years. Bone mineral density (BMD) was measured at the lumbar spine and the total hip regions using DXA. Calcaneal ultrasound attenuation and velocity were assessed using QUS and metacarpal and phalangeal bone density were estimated by the use of DXR and RA, respectively. Receiver operating characteristic (ROC) curves were constructed by calculating the specificity and sensitivity of QUS, DXR, and RA at different cut-point values in discriminating osteoporosis, as defined by a T-score below -2.5 at the spine or hip using DXA, and the areas under the curves (AUCs) were computed. The sensitivity for identifying women with osteoporosis was 67.6% [95% confidence interval (CI), 50.2-82.0%] using QUS and was 76.9% (95% CI, 60.7-88.8%) and 82.9% (95% CI, 67.9-92.8%), respectively, using DXR and RA. The negative predictive value (NPV, the proportion of patients with a negative test who have no osteoporosis) was 90% for QUS, compared with an NPV of 94% for both DXR and RA. These data suggest that metacarpal DXR and phalangeal RA may be as effective as calcaneal QUS for targeting DXA testing in high-risk postmenopausal women.

Factors determining the final outcome of treatment of idiopathic scoliosis with the Boston brace: a longitudinal study.

This study tries to determine factors influencing the final outcome of treatment of idiopathic scoliosis with the Boston brace and to compare the results with the natural history. One hundred and fifty-one patients, 130 girls and 21 boys, treated between 1982 and 1991, were reviewed. A series of continuous and categorical variables were measured, allowing for the construction of a multiple regression equation. Continuous variables were age at discovery of the curve, time of interval between discovery and treatment and age at the beginning of treatment. Furthermore age of menarche, duration of treatment, duration of weaning and age and time of follow-up were noted. Continuous numerical variables were the Cobb angle, the apical vertebral rotation, and the Risser stage. Categorical variables consisted of the results of a questionnaire and the King's classification of the curve. Good results are achieved in older children, with low Cobb angles and advanced maturity, who are, however, the very ones not expected to progress, as also indicated in studies on natural history. Brace treatment seems not to alter the natural history in general, and especially not in the older child; this is the case from age 12 years and Risser stage 2 onwards. In the younger child, a brace is probably still indicated, because it has been proved that a scoliosis is more prone to progress and that a possible positive result can still not be ruled out, as long as randomized control trials are not conducted.

The Impact of congenital, severe, untreated growth hormone (GH) deficiency on bone size and density in young adults: insights from genetic GH-releasing hormone receptor deficiency.

GH and IGF-I have well recognized effects on bone elongation during development, but their importance for bone mineralization and structure during the growth phase are less well understood. Because children with GH deficiency are generally treated with GH, little detailed information exists in humans about the effects of long-term GH deficiency on bone development. The recently described syndrome of genetic GHRH receptor deficiency in Pakistan (dwarfism of Sindh) affords a unique opportunity to examine the question of GH deficiency on bone development because the affected patients have congenital, severe, isolated GH deficiency, which had never been treated because of societal reasons. We performed dual energy x-ray absorptiometry scans in four adult males (age, 23-30 yr) to address the question of bone mineralization. Areal bone mineral density (BMD) was low (mean Z scores: -3.3, -2.1, -3.7, and -1.7) in the lumbar spine, femoral neck, forearm, and total skeleton, respectively. This low areal BMD is in part caused by the small bone size in these dwarfed patients. When corrected for size, volumetric BMD (bone mineral apparent density) was normal to near normal (mean Z scores: -1.2, +0.8, and +0.8 for lumbar spine, femoral neck and total skeleton, respectively). We conclude that GH/IGF-I deficiency has relatively little impact on bone mineralization during the bone accretion phase. This is in marked contrast to their effect on bone elongation and overall bone size.