Lower osteocalcin and osteopontin contents of the femoral head in hip fracture patients than osteoarthritis patients.

UNLABELLED: In patients with femoral neck fracture, clinical factors, bone metabolism markers (in serum, urine, and bone), bone mineral density, radiographic parameters, and bone histomorphometric parameters were investigated to detect determinants of fragility fracture. The osteocalcin/deoxypyridinoline ratio and osteopontin/calcium ratio of cortical bone were selected as significant predictors. INTRODUCTION: Measurement of bone mineral density is widely used to assess bone strength, but this also depends on other bone components and on bone structure. The objective of this study was to investigate risk factors for fracture related to bone quality, the patient's history, and the patient's lifestyle. METHODS: Twenty-one patients with femoral neck fracture and 18 patients with osteoarthritis were enrolled. Blood and urine samples were collected on admission to hospital, and bone samples were obtained from femoral necks resected during surgery. Multivariate logistic regression analysis was performed using osteoarthritis and femoral neck fracture as combined variables to assess the influence of alcohol or coffee intake, eating natto (fermented soybeans), osteocalcin and calcium concentrations, the osteocalcin/deoxypyridinoline ratio and osteopontin/calcium ratios of cortical bone and cancellous bone, various bone histomorphometric parameters, the bone mineral density of the lumbar spine and the intact contralateral femoral neck, and various radiographic parameters of the spine RESULTS: By forward stepwise multivariate analysis, the osteocalcin/deoxypyridinoline and osteopontin/calcium ratios of cortical bone were selected as significant factors for fracture (the odds ratios were 0.493 and <0.001, respectively; both P<0.001). CONCLUSIONS: A decrease of osteopontin and osteocalcin in bone is important for promoting vulnerability to hip fracture.

Calcifying tendonitis of the gastrocnemius. A report of three cases.

We describe the clinical features of calcifying tendonitis in the medial head of gastrocnemius in three elderly female patients. The presenting symptom was chronic pain in the posteromedial area of the knee in two patients and acute pain in the back of the knee in one. All had limitation of movement of the knee and marked tenderness in the region of the tendinous origin of the medial head of gastrocnemius with posterior knee pain induced by stretching the tendon. An injection of 1% lidocaine and steroid into the tendon resulted in temporary relief from pain and improved movement.

Risk factors for long-term treatment of whiplash injury in Japan: analysis of 400 cases.

We studied the risk factors for long-term treatment of 400 patients with whiplash injury in Japan. Most of the patients were injured in rear-end car collisions, but none had cervical bone lesions or spinal cord or root lesions. We evaluated the following risk factors: sex, age, degree of vehicle damage, and admission or non-admission to the hospital. The group of patients younger than 20 years old healed more quickly than patients 30 years or older. Damage to more than half of the car was associated with a longer treatment. Patients who were admitted to the hospital need treatment longer than the non-admission group. Thus, age over 30 years, a large amount of damage to the vehicle, and admission to the hospital are predictors of long-term treatment for whiplash injury in Japan.

Electron and immunoelectron microscopy on healing process of the rat anterior cruciate ligament after partial transection: the roles of multipotent fibroblasts in the synovial tissue.

The healing process of the rat anterior cruciate ligament (ACL) after partial transection was examined. In sham operated samples, the synovial tissue near the infrapatellar fat pad includes an abundance of young fibroblasts which can be classified into two types: A type cells often exist along the surface of the synovial tissue and contain numerous lysosomes, while B type cells are often associated with small vessels and are actively involved in the production of fibronectin and laminin. At 1 week after transection of the ACL, B type cells frequently undergo mitotic proliferations and are eventually incorporated into the endothelium of the growing capillaries extending from the proximal remnants of the synovial tissue to the transected lesion. The transformation of B to A type cells is indicated by our electron micrographs. After 2 weeks, the replacement of the transected lesion by regenerated soft tissue becomes pronounced. After 4 weeks, B type cells in the deeper layer of the regenerated tissue are first involved in the production of type III and then in that of type I collagens as revealed by the immunocytochemistry. The present study indicates that B type cells are a kind of stem cell: they possess the ability to transform to vasoformative cells involved in a manner suggestive of vasculogenesis, to phagocytic A type cells and to the synthetic fibroblasts in the regeneration of the ACL.

Local bone turnover in the metaphysis of the proximal tibia and the lumbar vertebra during the early periods after ovariectomy in rats.

To clarify the local changes in bone formation and resorption during the early period after ovariectomy (OVX), 200 SD rats, 4 months of age, underwent OVX or sham surgeries and seven to nine rats from each group were terminated at 1, 3, 7, 11, 15, 19, 23, 28, 35, 63, and 91 days postsurgery after tetracycline labeling. Serum intact osteocalcin levels were measured. Undecalcified sections of the 5th lumbar body (L5) and the right proximal tibia were measured for trabecular bone area, the labeled perimeters and the interlabeling distances after Villanueva's staining. On the 4th lumbar body (L4) and the left proximal tibia, undecalcified sections were measured for the trabecular osteoclast by tartrate-resistant acid phosphatase staining. The uterine horns were atrophied on the 3rd postovariectomy day (day 3). Serum osteocalcin levels increased on day 7 and reached the highest value on day 23. In either L5 or the metaphysis of the proximal tibia, trabecular bone volume (BV/TV) significantly decreased on day 15. The trabecular bone loss on day 28 was approximately 50% in the tibia and 15% in the L5. In either the lumbar or the tibia, osteoclast numbers significantly increased at day 3, and peaked between days 15 and 23. In the tibia, however, the bone formation rates (BFR/BS) were significantly reduced on the 3rd and 7th post-surgical days compared with the start value for both the OVX and sham groups. The BFR/BS values in L5 did not decrease during the first 7 days in either group. The BFR/BS values were then increased for both L5 and the tibia after day 7. These data clearly demonstrated that the local bone turnover 7 days post-OVX was identical in the proximal tibia and the lumbar vertebra. In the proximal tibia, however, it may be suggested that the increased bone resorption and reduced formation within 7 days after OVX due to the combined effects of both an estrogen deficiency and the surgical intervention would possibly play a critical role in the greater magnitude of the trabecular bone loss.

Light and electron microscopy of hydroxyapatite depositions in the ligamentum flavum.

STUDY DESIGN: Ligamenta flava obtained from 24 patients who had undergone surgery for degenerative spinal diseases were investigated regarding the histopathology of hydroxyapatite crystal depositions. OBJECTIVES: Light and electron microscopy and energy dispersive x-ray microanalysis were done to clarify the cause and process of hydroxyapatite crystal depositions in the ligament. SUMMARY OF BACKGROUND DATA: No reports have been made regarding the cause of calcification in the ligamenta flava induced by hydroxyapatite crystal depositions. METHODS: Samples were fixed in 10% formalin and 2.5% glutaraldehyde for light and electron microscopy. Energy dispersive x-ray microanalysis was done to detect calcium and phosphate hydroxyapatite crystal deposition areas. RESULTS: Hydroxyapatite crystals, which occasionally formed clusters, existed in the connective tissue of the dural side around abundant profiles of growing capillaries. Hydroxyapatite crystals showed needle shaped figures, and the x-ray microanalysis revealed that the ratio of calcium to phosphate was about 1.66:1. A decrease or loss of collagenous and elastic fibers was prominent in these hydroxyapatite deposition areas. CONCLUSIONS: Hydroxyapatite crystal depositions occur around the growing capillaries in the dural side of the ligamenta flava.

Degenerative change and rotator cuff tears. An anatomical study in 160 shoulders of 80 cadavers.

In order to determine the effects of friction and rubbing in the development of rotator cuff tear, we studied 160 shoulders of 80 cadavers (age at death 43-93 years, mean 69.3 years). Seventy-two cadavers were fixed with formalin and eight were fresh cadavers. The surface of the cuff and the undersurface of the acromion were observed macroscopically. Eight shoulders of fresh cadavers were examined by scanning electron microscopy. Ninety-eight specimens (61%) showed degenerative changes of the supraspinatus tendon. The number of tendons with degeneration and tear increased from the fifth to sixth decade of life, and the size of the tear increased with age. However, there was no sustained increase in the incidence with aging from the age of 60 to 90 years, and the percentage with degenerative changes of the cuff remained at approximately 60% in each decade. Ninety-six specimens (60%) showed degeneration of the subacromial surface. The percentage with degeneration of the undersurface of the acromion remained at approximately 60% from the sixth to ninth decade. There was a significant correlation between the severity of the changes in the rotator cuff and the subacromial surface. Scanning electron microscopy showed changes suggesting effects of friction and rubbing on the rotator cuff, such as regularly arranged wool-like spherical structures on the surface of the tendon and rounded ruptured ends of the tendon fibers. These results indicate that degenerative change of the rotator cuff is aggravated by a friction and rubbing mechanism with the undersurface of the acromion and leads to development of a complete tear.

Microangiographic study of spinal cord injury and myelopathy.

Post-mortem microangiography has been performed in 12 patients with traumatic cervical cord injury, 2 patients with myelopathy, and one patient with post-traumatic syringomyelia. Microangiography defined 4 zones in the injured spinal cord. In traumatic injury, the size and extent of the non-filling area (Zone 1) was directly related to the injury force. Subsequently these areas became cavitated. Surrounding the non-filling area, widely extending areas demonstrated filling of capillaries but showed damaged neurons and axons (Zone 2). In the chronic stage, Zone 2 replaced by gliomesenchymal tissue. The capillaries in the gliomesenchymal scars revealed a distorted abnormal arrangement (Zone 3). In a case with myelopathy, the hypervascular areas (Zone 4) were observed just around the chronically compressed area. The vascular increases were considered to be a reaction against chronic compression. In a patient with post-traumatic syringomyelia, the vascular network of the posterior grey matter disappeared and the central arteries were distorted by the distending forces of the syrinx. The microangiographs suggested that vascular factors might play a significant role in original cavity formation; but in cavity extension, these factors were not primary.