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The impact of obesity upon bone metabolism is controversial since both beneficial or harmful effects have been reported. Bone remodeling is modulated by the central nervous system through cytokines, hormones and neuromodulators. The present study aimed to evaluate the effects evoked by bilateral retroperitoneal white adipose tissue (rWAT) denervation (Dnx) upon bone mineral metabolism and remodeling in an experimental model of obesity in rats. Male Wistar rats were fed during 18 weeks with high-fat diet (HFD) or standard diet (SD) as controls, and rWAT Dnx or Sham surgery was performed at the 14th week. Biochemical and hormonal parameters, bone histomorphometry, rWAT and hypothalamus protein and gene expression were analyzed. The HFD group presented decreased bone formation parameters, increased serum and bone leptin and FGF23, increased serum and hypothalamic neuropeptide Y (NPY) and decreased serum 1,25-dihydroxyvitamin D3 and PTH. After rWAT Dnx, bone markers and histomorphometry showed restoration of bone formation, and serum and hypothalamic NPY decreased, without alteration in leptin levels. The present study shows that the denervation of rWAT improved bone formation in obese rats mediated by a preferential reduction in neurohormonal actions of NPY, emphasizing the relevance of the adipose tissue-brain-bone axis in the control of bone metabolism in obesity.
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Leptina , Osteogênese , Masculino , Ratos , Animais , Ratos Wistar , Tecido Adiposo , Obesidade , Neuropeptídeo Y , DenervaçãoRESUMO
Bone biopsy is still the gold standard tool to evaluate either trabecular or cortical bone, though the quantitative computed tomography of the vertebrae (QCT), a non-invasive technique, could be useful to evaluate bone structure in patients with chronic kidney disease (CKD). Cortical bone microstructure derangements have been associated with poor outcomes in the general population. An association between trabecular bone density, assessed by QCT, and bone volume and microarchitecture by histomorphometry, has been previously documented. This relationship has not yet been fully evaluated in cortical bone in the CKD scenario. The aim of this study was to evaluate the relationship among vertebrae density measured by QCT, structural histomorphometric parameters of cortical bone and biochemical and hormonal data in 50 CKD stage 2-5ND patients. This was a post hoc analysis of a cross-sectional study where cortical porosity and cortical thickness were analyzed in undecalcified bone samples from the iliac crest. The cortical bone density was obtained by QCT from the thoracic vertebrae. The patients were 52 ± 10 years, 68% men, 30% diabetes and the estimated glomerular filtration rate 34 ± 16 mL/min/1.73 m2. Cortical porosity was 4.6% (3.6; 6.6) and cortical thickness was 578.4 ± 151.8 µm, while cortical bone density was 149.2 ± 58.3 HU. Cortical density correlated with cortical thickness (p = 0.001) but not with cortical porosity (p = 0.30). Higher porosity was associated with older age (p = 0.02), higher levels of PTH (p = 0.04) and lower renal function (p = 0.03), while smaller thickness was associated with higher levels of PTH (p = 0.02). Lower density was associated with older age (p = 0.02) and higher levels of PTH (p = 0.01). In conclusion, cortical bone density measured by QCT was able to mirror the cortical thickness of bone biopsy in pre-dialysis CKD patients. In addition, PTH action on cortical bone can be already seen in this population.
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SUMMARY: The aim of the present study was to evaluate the changes of alveolar bone in aged rats. The mandibles of the 4- month and 22-month aged rats were scanned by micro-CT. After the reconstruction of the alveolar bone,the distance between the cemento enamel junction (CEJ) and the alveolar bone crest (ABC) was measured. The micro architectures of the inter-radicular alveolar bone were analyzed. The 22-month rats experienced the reduction in alveolar crest height in the buccal side and the lingual side, and significant increase in alveolar bone loss compared with the 4-month rats. The 22-month rats had a porous microarchitecture, the trabecular arrangement was obviously dissociated with the expanded inter-bone spaces of marrow, and the bone histomorphometry analysis showed the decreased bone volume/tissue volume and trabecular thickness in the 22-month rats. These results suggest that alveolar bone loss and alveolar trabecular bone deterioration might contribute to the weakening of molar support in the elderly.
RESUMEN: El objetivo del presente estudio fue evaluar los cambios del hueso alveolar en ratas envejecidas. Las mandíbulas de las ratas de 4 y 22 meses se escanearon mediante micro-TC. Después de la reconstrucción del hueso alveolar, se midió la distancia entre la unión cementoesmalte (CEJ) y la cresta ósea alveolar (ABC). Se analizaron las microarquitecturas del hueso alveolar interradicular. Las ratas de 22 meses experimentaron la reducción de la altura de la cresta alveolar. en el lado bucal y lingual, y un aumento significativo en la pérdida de hueso alveolar en comparación con las ratas de 4 meses. Las ratas de 22 meses tenían una microarquitectura porosa, la disposición trabecular estaba obviamente disociada con los espacios interóseos expandidos de la médula y el análisis de histomorfometría ósea mostró una disminución del volumen óseo / volumen tisular y del grosor trabecular en las ratas de 22 meses. Estos resultados sugieren que la pérdida ósea alveolar y el deterioro del hueso trabecular alveolar podrían contribuir al debilitamiento del soporte molar en los ancianos.
Assuntos
Animais , Masculino , Ratos , Perda do Osso Alveolar/patologia , Perda do Osso Alveolar/diagnóstico por imagem , Envelhecimento , Ratos Wistar , Microtomografia por Raio-XRESUMO
CONTEXT: No study has yet evaluated the relationships among bone marrow adiposity (BMA), bone histomorphometry (BH), and glycemic control in premenopausal women with type 2 diabetes (T2DM). OBJECTIVE: We aimed to assess the effect of glycemic control on BMA, correlate the parameters of BH with BMA, and correlate BMA with the use of hypoglycemic agents and with bone mineral density (BMD). METHODS: This was a cross-sectional study that evaluated 26 premenopausal women with T2DM who were divided into groups with HbA1c < 7% (good control [GC], n = 10) and HbA1c > 7% (poor control [PC], n = 16). BMA parameters (adipocyte number [Ad.N], total adipocyte perimeter [Ad.Pm], total adipocyte area [Ad.Ar], percentage adipocyte volume per marrow volume [Ad.V/Ma.V]) and peri-trabecular adipocyte number divided by bone surface (Ad.N/BS) were evaluated. BH static (bone volume fraction [BV/TV], osteoid thickness [O.Th], osteoid surface/bone surface [OS/BS]) and dynamic parameters and serum insulin-like growth factor-1 were measured. BMA data were compared between the GC and PC groups. Correlations were performed. RESULTS: Ad.N, Ad.Pm, and Ad.Ar were higher in PC (all, P = 0.04). HbA1c correlated positively with Ad.N/BS (P < 0.01) and Ad.N/BS correlated negatively with O.Th (P < 0.01) and OS/BS (P = 0.02). Positive and negative correlations were observed between insulin and metformin use, respectively, with all adipocyte parameters except Ad.N/BS (P < 0.05). Structural parameters were negatively correlated with the BMA. BMD of the femoral neck (r = -549, P < 0.01) and total femur (r = -0.502, P < 0.01) were negatively correlated with Ad.V/Ma.V. CONCLUSION: Poor glycemic control is associated with hyperplasia and hypertrophy of BMAs and with lower BV/TV. Ad.N/BS, a new BMA parameter, is correlated with HbA1c and negatively with O.Th. The use of insulin seems to stimulate the expansion of BMA while that of metformin has the opposite effect. These findings suggest that the increase in BMA may play a role in the T2DM bone disease; on the other hand, good glycemic control might help prevent it.
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Adipócitos/patologia , Adiposidade , Medula Óssea/metabolismo , Medula Óssea/patologia , Diabetes Mellitus Tipo 2/metabolismo , Pré-Menopausa/metabolismo , Malha Trabecular/metabolismo , Malha Trabecular/patologia , Absorciometria de Fóton , Adulto , Densidade Óssea/efeitos dos fármacos , Estudos Transversais , Diabetes Mellitus Tipo 2/patologia , Feminino , Hemoglobinas Glicadas/análise , Controle Glicêmico , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Fator de Crescimento Insulin-Like I/análise , Metformina/uso terapêutico , Pessoa de Meia-IdadeRESUMO
The treatment of polytrauma patients represents a great challenge in the maxillofacial and orthopedic surgery fields. Therefore, this study tested the hypothesis that the use of a bioactive coating (by plasma electrolytic oxidation, PEO) on titanium microplates could improve the fracture healing of low bone mineral density (BMD) rats. Thirty female rats underwent bilateral ovariectomy surgery (OVX), and 35 rats underwent fake surgery (SHAM). Three months later, animals were subjected to femoral fracture simulation and were fixed with either non-coated (CONV) or coated (PEO) titanium miniplates. Eight weeks postoperatively, microplate/bone complexes were analyzed through computed microtomography, histometric, confocal microscopy, molecular, and biomechanical analysis. Bioactive elements (Ca and P) were incorporated on the PEO microplate and the surface was modified in a volcano-like structure. In the microCT analysis the OVX/PEO group had greater values for Tb.Th (bone trabecular thickness), Tb.Sp (separation of bone trabeculae) and Tb.N (number of trabeculae) parameters compared to the OVX/CONV group. According to histometric analysis, the OVX/PEO group showed significantly higher new bone formation than the OVX/CONV group (P < 0.05). For the fluorochrome area, the OVX groups (PEO and CONV) showed greater values for calcein precipitation (old bone) than alizarin red (new bone). Molecular results showed greater values for proteins related to the final phase of bone formation (P < 0.05) in the OVX/PEO group. The OVX/PEO group showed higher bone/miniplate system resilience compared to the others (P < 0.05). It was concluded that PEO coating optimizes bone healing on simulated femoral fractures in low bone mineral density rats. This sheds new light in the treatment of osteoporotic patients with bone fractures.
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Doenças Ósseas Metabólicas , Fraturas do Fêmur , Osteoporose , Animais , Densidade Óssea , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/terapia , Humanos , Ovariectomia , RatosRESUMO
Aim: To analyze the effects of body weight loss on bone mineral density (BMD) on hip (Hip BMD) and lumbar spine (Lumbar BMD) after six months of bariatric surgery. Bariatric surgery is an effective treatment for morbid obesity. Nonetheless, there are scant data on the effect of weight bearing on bone structure.Material and methods: Seventeen obese women aged 41.2 ± 11.3 yrs. who underwent Roux-en-Y gastric bypass (RYGB) were included. Body composition assessments were performed through dual-energy X-ray absorptiometry immediately before and after 6-months RYGB. Data collected pre- and post-RYGB included total body weight, body mass index (BMI), lean body mass (LM), fat mass (FM) and bone mineral content. The pre- (PRE) and post-operative (POST) results were compared.Results: Lumbar BMD POST presented a non-significant loss of 1.8% whereas Hip BMD POST showed a significant loss of 17.8%. The analysis demonstrated that BMI and LM PRE explained 26% and 49%, respectively, of Hip BMD PRE variability. In addition, LM POST explained 30% of hip BMD POST variability and was not significant for Lumbar BMD POST.Conclusions: Obesity and rapid weight loss showed direct influence in Hip BMD after six months of bariatric surgery. However, its effect on the lumbar spine area was smaller due to the higher capacity of the spine to dissipate loads through its curvature.
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Cirurgia Bariátrica/efeitos adversos , Composição Corporal/fisiologia , Densidade Óssea/fisiologia , Obesidade Mórbida/cirurgia , Absorciometria de Fóton , Adulto , Cirurgia Bariátrica/estatística & dados numéricos , Índice de Massa Corporal , Brasil/epidemiologia , Feminino , Seguimentos , Derivação Gástrica/efeitos adversos , Derivação Gástrica/estatística & dados numéricos , Quadril , Humanos , Estudos Longitudinais , Vértebras Lombares , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/metabolismo , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do TratamentoRESUMO
This study evaluated the peri-implant bone repair in orchiectomized rats receiving intermittently PTH 1-34. The treatment returned the bone quality and quantity of the animals to normal in the computerized microtomography, laser confocal microscopy, and histological analysis. The PTH 1-34 promoted marked bone formation with increased volume, improved quality, and greater bone turnover. INTRODUCTION: Osteoporosis can be a problem in implant osseointegration. So this study aimed to evaluate the quantity and quality of peri-implant bone repair in orchiectomized Wistar rats receiving intermittently administered PTH 1-34. METHODS: Animals (n = 24) were divided into 3 groups: healthy control (SHAM), orchiectomized (ORQ), and orchiectomized and treated with 0.5 µg/kg/day PTH 1-34 (TERI), and each received an implant in the right and left tibial metaphysis, which was allowed to repair for 60 days. The resultant bone formation was evaluated through computerized microtomography (micro-CT) to compare the percent bone volume (BV/TV), trabecular thickness (Tb.Th), trabecular number and separation (Tb.N, Tb.Sp), and bone implant contact (BIC) through the intersection surface (i.S) between groups. Laser confocal microscopy was used to evaluate fluorochrome areas for mineral apposition rate (MAR) and neoformed bone area (NBA). In addition, histological evaluation of calcified tissues with Stevenel blue and alizarin red staining was performed. RESULTS: Treatment with PTH 1-34 returned the bone quality and quantity of the osteoporotic animal to normal, as the TERI group presented statistically significant higher values for BV/TV, Tb.Th, and BIC parameters compared with ORQ (p < 0.05), but when compared with SHAM (p > 0.05), no statistical difference was noted. In addition, in the bone turnover analysis (MAR, NBA) for TERI, the highest results are presented, followed by SHAM, and then ORQ (TERI × ORQ: p < 0.05). CONCLUSIONS: Intermittent treatment with PTH 1-34 on orchiectomized animals promoted marked bone formation with increased volume, improved quality, and greater bone turnover in the peri-implant space, returning the bone quality and quantity to the present standard in healthy animals.
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Osteoporose , Teriparatida , Animais , Densidade Óssea , Osso e Ossos , Feminino , Humanos , Osseointegração , Osteoporose/tratamento farmacológico , Ovariectomia , Ratos , Ratos Wistar , Microtomografia por Raio-XRESUMO
INTRODUCTION: Intermittent 1-34 parathyroid hormone (iPTH) administration, a bone-forming treatment, is widely used as a therapy for severe osteoporosis. It can only be used for a maximum of 24 mo and must be followed by an antiresorptive drug to retain the new formed tissue. Mechanical load, in the form of low-intensity and high-frequency vibration, has received considerable attention due to its ability to prevent bone loss. AIM: To investigate the ability of whole body mechanical vibration (MV) to potentiate the anabolic effects of iPTH and to inhibit bone resorption following discontinuation of iPTH treatment in estrogen-deficient rats. METHODOLOGY: Fifty-four 6-month-old female Wistar rats were ovariectomized (OVX) or sham-operated. After 5 mo, they were divided into 7 groups: Sham - non-OVX; Control - OVX, vehicle for 60 d; MV - OVX, submitted to MV for 60 d; PTH60d - OVX, injected with iPTH for 60 d; PTH+MV - OVX, injected with iPTH combined with MV for 60 d; PTH30d - OVX, injected with iPTH for 30 d, and untreated for 30 d; PTH30d/MV30d - OVX, injected with iPTH for 30 d, followed by MV for 30 d. Bone mineral density (BMD) and body composition (lean mass and fat) were evaluated at OVX (T0), the beginning (T1), and at the end (T2) of treatments by dual X-ray absorptiometry (DXA). Femurs were processed for histomorphometry (bone volume - BV/TV and cortical thickness - Ct.Th) and tibias for biomechanical test. RESULTS: Body composition and BMD were similar among the groups at T0. In T2, MV presented higher fat than other groups (except PTH60d) and PTH30d/MV30d showed greater lean mass than Control. At T1, Sham presented the highest BMD, but between T1 vs T2 there was an increase in all iPTH-treated groups. At T2, BMD was higher in PTH60d and PTH+MV than in the Control and MV groups. The highest BV/TV was observed in the PTH+MV group, followed by PTH60d. Cortical thickness was increased in PTH60d and PTH+MV compared to Sham. Vibration applied post-iPTH (PTH30d/MV30d) improved the force at failure in tibias when compared to Sham and Control groups. CONCLUSION: MV potentiated iPTH anabolic effects in cancellous bone; however, MV was unable to maintain bone mass after stopping iPTH in ovariectomized rats.
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Conservadores da Densidade Óssea/farmacologia , Densidade Óssea/efeitos dos fármacos , Osso Esponjoso/efeitos dos fármacos , Fêmur/efeitos dos fármacos , Teriparatida/farmacologia , Vibração , Absorciometria de Fóton , Animais , Fenômenos Biomecânicos , Composição Corporal/efeitos dos fármacos , Osso Esponjoso/patologia , Feminino , Fêmur/patologia , Ovariectomia , Ratos , Suporte de CargaRESUMO
El objetivo fue evaluar el volumen óseo BV/TV (%) del hueso interradicular en ratas Wistar: A) en relación a la edad; B) en relación a la zona de estudio en animales de la misma edad. Se utilizó Grupo A) 15 ratas Wistar hembras de 6 (I), 10 (II) y 14 (III) semanas, Grupo B) 9 ratas Wistar macho de 8 semanas. Tras la eutanasia, se extrajeron los maxilares inferiores y se procesaron histológicamente para obtener cortes mesio-distales del primer molar inferior coloreados con H.E. Sobre microfotografías digitales se evaluó el BV/TV (%). El análisis estadístico se realizó en A) mediante ANOVA y Bonferroni test y en B) se calculó el rango (R). Los resultados en A) el BV/TV (%) aumenta significativamente con la edad de los animales; en B) se encontró que el BV/TV (%) varía hasta un 20% si se considera el volumen total y este rango disminuye a 8.3% al estudiar su mitad coronal. En conclusión, el BV/TV (%) del hueso interradicular del primer molar inferior de ratas Wistar varía considerablemente con la edad de los animales y en animales de una misma edad -según se considere evaluar todo el hueso interradicular del espacio alveolar o la mitad superior del mismo-. Los resultados de este trabajo recomiendan emplear animales de la misma edad y realizar mediciones histomorfométricas empleando la mitad coronal de dicho hueso, especialmente en los diseños de periodontitis experimental (AU)
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Animais , Ratos , Técnicas Histológicas , Mandíbula/anatomia & histologia , Dente Molar/anatomia & histologia , Fotomicrografia , Interpretação Estatística de Dados , Análise de Variância , Ratos Wistar , Arcada OsseodentáriaRESUMO
Bone mineral density (BMD) loss is a known complication of human immunodeficiency virus (HIV) infection and its treatment, particularly with tenofovir disoproxil fumarate (TDF)-containing antiretroviral regimens. Although renal proximal tubular dysfunction and phosphaturia is common with TDF, it is unknown whether BMD loss results from inadequate mineralization. We evaluated change in BMD by dual-energy X-ray absorptiometry (DXA) and bone histomorphometry by tetracycline double-labeled transiliac crest biopsies in young men living with HIV before (n = 20) and 12 months after (n = 16) initiating TDF/lamivudine/efavirenz. We examined relationships between calciotropic hormones, urinary phosphate excretion, pro-inflammatory and pro-resorptive cytokines, and bone remodeling-related proteins with changes in BMD and histomorphometry. Mean age was 29.6 ± 5.5 years, with mean CD4 + T cell count of 473 ± 196 cells/mm3 . At baseline, decreased bone formation rate and increased mineralization lag time were identified in 16 (80%) and 12 (60%) patients, respectively. After 12 months, we detected a 2% to 3% decrease in lumbar spine and hip BMD by DXA. By histomorphometry, we observed no change in bone volume/total volume (BV/TV) and trabecular parameters, but rather, increases in cortical thickness, osteoid volume, and osteoblast and osteoclast surfaces. We did not observe significant worsening of renal phosphate excretion or mineralization parameters. Increases in PTH correlated with decreased BMD but not histomorphometric parameters. Overall, these data suggest abnormalities in bone formation and mineralization occur with HIV infection and are evident at early stages. With TDF-containing antiretroviral therapy (ART), there is an increase in bone remodeling, reflected by increased osteoblast and osteoclast surfaces, but a persistence in mineralization defect, resulting in increased osteoid volume
Assuntos
HIV , Antirretrovirais , Tenofovir/uso terapêuticoRESUMO
Bone mineral density (BMD) loss is a known complication of human immunodeficiency virus (HIV) infection and its treatment, particularly with tenofovir disoproxil fumarate (TDF)-containing antiretroviral regimens. Although renal proximal tubular dysfunction and phosphaturia is common with TDF, it is unknown whether BMD loss results from inadequate mineralization. We evaluated change in BMD by dual-energy X-ray absorptiometry (DXA) and bone histomorphometry by tetracycline double-labeled transiliac crest biopsies in young men living with HIV before (n = 20) and 12 months after (n = 16) initiating TDF/lamivudine/efavirenz. We examined relationships between calciotropic hormones, urinary phosphate excretion, pro-inflammatory and pro-resorptive cytokines, and bone remodeling-related proteins with changes in BMD and histomorphometry. Mean age was 29.6 ± 5.5 years, with mean CD4 + T cell count of 473 ± 196 cells/mm3 . At baseline, decreased bone formation rate and increased mineralization lag time were identified in 16 (80%) and 12 (60%) patients, respectively. After 12 months, we detected a 2% to 3% decrease in lumbar spine and hip BMD by DXA. By histomorphometry, we observed no change in bone volume/total volume (BV/TV) and trabecular parameters, but rather, increases in cortical thickness, osteoid volume, and osteoblast and osteoclast surfaces. We did not observe significant worsening of renal phosphate excretion or mineralization parameters. Increases in PTH correlated with decreased BMD but not histomorphometric parameters. Overall, these data suggest abnormalities in bone formation and mineralization occur with HIV infection and are evident at early stages. With TDF-containing antiretroviral therapy (ART), there is an increase in bone remodeling, reflected by increased osteoblast and osteoclast surfaces, but a persistence in mineralization defect, resulting in increased osteoid volume. © 2019 American Society for Bone and Mineral Research.
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Antirretrovirais/uso terapêutico , Osso e Ossos/patologia , Infecções por HIV/tratamento farmacológico , Osteogênese , Tenofovir/uso terapêutico , Adulto , Antirretrovirais/farmacologia , Biomarcadores/sangue , Densidade Óssea/efeitos dos fármacos , Remodelação Óssea/efeitos dos fármacos , Osso e Ossos/efeitos dos fármacos , Citocinas/metabolismo , Infecções por HIV/sangue , Infecções por HIV/fisiopatologia , Humanos , Masculino , Osteogênese/efeitos dos fármacos , Tenofovir/farmacologiaRESUMO
Secondary hyperparathyroidism is a complication of chronic kidney disease that compromises skeletal integrity. In patients with secondary hyperparathyroidism undergoing parathyroidectomy, parathyroid hormone levels dramatically decrease. The effects of parathyroidectomy on bone tissue are poorly understood, especially regarding the proteins expressed by osteocytes, such as fibroblast growth factor 23, dentin matrix protein 1, matrix extracellular phosphoglycoprotein, sclerostin, receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin, which regulate bone turnover. The objective of this study was to characterize the bone expression of these proteins by immunohistochemistry and correlate these results with those of bone histomorphometry before and after parathyroidectomy. We studied bone biopsies that were obtained from 23 patients before and 12â¯months after parathyroidectomy. We observed an improvement in bone microarchitecture, but impaired mineralization after parathyroidectomy. We found significant increases in sclerostin and osteoprotegerin expression and a decrease in the RANKL/osteoprotegerin ratio after parathyroidectomy, suggesting that their expression is regulated by parathormone. These proteins correlated with structural and bone formation parameters. We conclude that after parathyroidectomy, significant changes occur in the bone expression of osteocyte proteins and that these proteins potentially regulate bone remodeling.
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Osso e Ossos/metabolismo , Hiperparatireoidismo Secundário/metabolismo , Paratireoidectomia , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/cirurgia , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Humanos , Osteócitos/fisiologia , Osteoprotegerina/metabolismoRESUMO
Abstract Renal osteodystrophy (ROD), a group of metabolic bone diseases secondary to chronic kidney disease (CKD), still represents a great challenge to nephrologists. Its management is tailored by the type of bone lesion - of high or low turnover - that cannot be accurately predicted by serum biomarkers of bone remodeling available in daily clinical practice, mainly parathyroid hormone (PTH) and alkaline phosphatase (AP). In view of this limitation, bone biopsy followed by bone quantitative histomorphometry, the gold-standard method for the diagnosis of ROD, is still considered of paramount importance. Bone biopsy has also been recommended for evaluation of osteoporosis in the CKD setting to help physicians choose the best anti-osteoporotic drug. Importantly, bone biopsy is the sole diagnostic method capable of providing dynamic information on bone metabolism. Trabecular and cortical bones may be analyzed separately by evaluating their structural and dynamic parameters, thickness and porosity, respectively. Deposition of metals, such as aluminum and iron, on bone may also be detected. Despite of these unique characteristics, the interest on bone biopsy has declined over the last years and there are currently few centers around the world specialized on bone histomorphometry. In this review, we will discuss the bone biopsy technique, its indications, and the main information it can provide. The interest on bone biopsy should be renewed and nephrologists should be capacitated to perform it as part of their training during medical residency.
Resumo A osteodistrofia renal (OR), um grupo de doenças ósseas metabólicas secundárias à doença renal crônica (DRC), ainda representa um grande desafio para os nefrologistas. Seu manejo é individualizado de acordo com o tipo de lesão óssea - de alto ou baixo remodelamento - cujo diagnóstico não pode ser prevista com precisão pelos biomarcadores séricos de remodelação óssea disponíveis na prática clínica diária, principalmente o paratormônio (PTH) e a fosfatase alcalina (FA). Em vista dessa limitação, biópsia óssea seguida de histomorfometria óssea quantitativa, método padrão-ouro para o diagnóstico de OR, ainda é considerado um procedimento de grande importância. A biópsia óssea também é recomendada na avaliação da osteoporose em indivíduos com DRC, a fim de auxiliar na escolha do melhor medicamento anti-osteoporótico. É importante observar que a biópsia óssea é o único método diagnóstico capaz de proporcionar informações dinâmicas sobre o metabolismo ósseo. Os ossos trabecular e cortical podem ser analisados separadamente por meio da avaliação de seus parâmetros estruturais e dinâmicos, espessura e porosidade, respectivamente. A deposição óssea de metais como alumínio e ferro também pode ser detectada. Apesar de suas características singulares, o interesse pela biópsia óssea diminuiu nos últimos anos. Poucos centros em todo o mundo são especializados em histomorfometria óssea. A presente revisão discute a técnica de biópsia óssea, suas indicações e as principais informações que ela pode oferecer. O interesse pela biópsia óssea deve ser renovado e os nefrologistas devem ser capacitados a realizá-la durante o período de residência médica.
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Humanos , Distúrbio Mineral e Ósseo na Doença Renal Crônica/patologia , Osso e Ossos/patologia , Biópsia/instrumentação , Padrões de Prática Médica , Desenho de Equipamento , NefrologiaRESUMO
We investigated the effects of estrogen therapy (ET) associated with low-intensity and high-frequency mechanical vibration (MV) on bone tissue in osteopenic female mice. Fifty 3-month-old female Swiss mice were ovariectomized (OVX) or sham-operated, and distributed after 4â months into the following groups, with 10 animals per group: Sham; Control, OVXâ +â vehicle solution; MV, OVXâ +â MV; ET, OVXâ +â 17ß-estradiol; and MVâ +â ET, OVXâ +â MV and 17ß-estradiol. Both vehicle solution and 17ß-estradiol (10â µgâ kg-1â day-1 ) were injected subcutaneously 7â days per week, and vibration (0.6â g, 60â Hz) was delivered 30â min per day, 5â days per week. Bone mineral density (BMD) and body composition were evaluated by densitometry at baseline and after 60â days of treatment when the animals were euthanized, and their femurs underwent histomorphometric and histochemical analyses. The Control group showed increased weight and fat percentage, while the ET and MVâ +â ET groups showed increased lean mass but decreased fat percentage. At the end of the treatment period, the BMD decreased in Control, remained constant in Sham and MV, and increased in ET and MVâ +â ET. The MVâ +â ET group showed the greatest bone volume compared with Sham (129%), Control (350%), MV (304%) and ET (14%). No differences occurred in cortical thickness. The Control group showed the highest content of mature collagen fibers, while the MVâ +â ET group showed the highest content of immature collagen fibers. In conclusion, ET plus MV was effective in improving bone quality in osteopenic female mice, and this improvement is associated with specific changes in trabecular but not cortical bone.
Assuntos
Doenças Ósseas Metabólicas , Estradiol/farmacologia , Vibração , Animais , Densidade Óssea/efeitos dos fármacos , Osso e Ossos/efeitos dos fármacos , Feminino , Camundongos , Estimulação Física/métodosRESUMO
ABSTRACT Objective: To assess the effects of atorvastatin calcium in the treatment of dexamethasone-induced osteoporosis. Methods: Osteoporosis induction consisted of the administration of an intramuscular dose of 7.5 mg/kg of body weight of dexamethasone, once a week for four weeks, except for the control animals (G1). The animals were divided into the following groups: G1 (control group without osteoporosis), G2 (control group with untreated osteoporosis), G3 (control group with osteoporosis treated with sodium alendronate 0.2 mg/kg) and G4 (group with osteoporosis treated with atorvastatin calcium 1.2 mg/kg). Serum alkaline phosphatase, bone alkaline phosphatase, and biometric and bone histomorphometric assessments were performed after 30 and 60 days of treatment onset. Results: In relation to the biometric and histomorphometric analyses, at 60 days of treatment, G4 presented bone density (Seedor index), bone trabecular density, and cortical thickness of 0.222 ± 0.004 g/cm, 59.167 ± 2.401%, and 387,501 ± 8573 µm, respectively, with a positive and statistically significant difference (p < 0.05), in relation to G2. At 30 and 60 days of treatment, G4 presented statistically significant serum levels of alkaline phosphatase alkaline phosphatase (p < 0.05) that were higher than all groups (7.451 ± 0.173 µg/L and 7.473 ± 0.529 µg/L, respectively). Conclusion: Treatment with atorvastatin calcium demonstrated the ability of this drug to increase osteoblastic activity and bone tissue repair activity, acting differently from alendronate sodium, which demonstrated predominantly antirebsorptive activity.
RESUMO Objetivo: Avaliar os efeitos da atorvastatina cálcica no tratamento da osteoporose induzida com dexametasona. Métodos: A indução da osteoporose consistiu na administração de dexametasona na dose de 7,5 mg/kg de peso corporal, por via intramuscular, uma vez por semana durante quatro semanas, à exceção dos animais do grupo controle (G1). Os animais foram distribuídos nos seguintes grupos: G1 (grupo controle sem osteoporose), G2 (grupo controle com osteoporose sem tratamento), G3 (grupo controle com osteoporose tratado com alendronato de sódio 0,2 mg/kg) e G4 (grupo com osteoporose tratado com atorvastatina cálcica 1,2 mg/kg). Após 30 e 60 dias do início do tratamento dos animais, foram feitas as dosagens dos níveis séricos de fosfatase alcalina, fosfatase alcalina óssea, avaliação biométrica e histomorfométrica óssea. Resultados: Em relação às análises biométricas e histomorfométricas, aos 60 dias de tratamento o G4 apresentou densidade óssea (índice Seedor), densidade trabecular óssea e espessura da cortical de 0,222 ± 0,004 g/cm, 59,167 ± 2,401% e 387,501 ± 8,573 µm, respectivamente, com diferença positiva, estatisticamente significativa (p < 0,05), em relação ao grupo G2. Aos 30 e 60 dias de tratamento, o G4 apresentou níveis séricos de fosfatase alcalina óssea estatisticamente significativos (p < 0,05) e superiores a todos os grupos (7,451 ± 0,173 µg/L e 7,473 ± 0,529 µg/L, respectivamente). Conclusão: O tratamento com atorvastatina cálcica demonstrou a capacidade desse fármaco de aumentar a atividade osteoblástica e a atividade reparadora tecidual óssea, atuar de forma diferente do alendronato de sódio, que demonstrou atividade preponderantemente antirreabsortiva.
Assuntos
Animais , Ratos , Osso e Ossos , Alendronato , Difosfonatos , Fosfatase Alcalina , GlucocorticoidesRESUMO
OBJECTIVE: To assess the effects of atorvastatin calcium in the treatment of dexamethasone-induced osteoporosis. METHODS: Osteoporosis induction consisted of the administration of an intramuscular dose of 7.5 mg/kg of body weight of dexamethasone, once a week for four weeks, except for the control animals (G1). The animals were divided into the following groups: G1 (control group without osteoporosis), G2 (control group with untreated osteoporosis), G3 (control group with osteoporosis treated with sodium alendronate 0.2 mg/kg) and G4 (group with osteoporosis treated with atorvastatin calcium 1.2 mg/kg). Serum alkaline phosphatase, bone alkaline phosphatase, and biometric and bone histomorphometric assessments were performed after 30 and 60 days of treatment onset. RESULTS: In relation to the biometric and histomorphometric analyses, at 60 days of treatment, G4 presented bone density (Seedor index), bone trabecular density, and cortical thickness of 0.222 ± 0.004 g/cm, 59.167 ± 2.401%, and 387,501 ± 8573 µm, respectively, with a positive and statistically significant difference (p < 0.05), in relation to G2. At 30 and 60 days of treatment, G4 presented statistically significant serum levels of alkaline phosphatase alkaline phosphatase (p < 0.05) that were higher than all groups (7.451 ± 0.173 µg/L and 7.473 ± 0.529 µg/L, respectively). CONCLUSION: Treatment with atorvastatin calcium demonstrated the ability of this drug to increase osteoblastic activity and bone tissue repair activity, acting differently from alendronate sodium, which demonstrated predominantly antirebsorptive activity.
OBJETIVO: Avaliar os efeitos da atorvastatina cálcica no tratamento da osteoporose induzida com dexametasona. MÉTODOS: A indução da osteoporose consistiu na administração de dexametasona na dose de 7,5 mg/kg de peso corporal, por via intramuscular, uma vez por semana durante quatro semanas, à exceção dos animais do grupo controle (G1). Os animais foram distribuídos nos seguintes grupos: G1 (grupo controle sem osteoporose), G2 (grupo controle com osteoporose sem tratamento), G3 (grupo controle com osteoporose tratado com alendronato de sódio 0,2 mg/kg) e G4 (grupo com osteoporose tratado com atorvastatina cálcica 1,2 mg/kg). Após 30 e 60 dias do início do tratamento dos animais, foram feitas as dosagens dos níveis séricos de fosfatase alcalina, fosfatase alcalina óssea, avaliação biométrica e histomorfométrica óssea. RESULTADOS: Em relação às análises biométricas e histomorfométricas, aos 60 dias de tratamento o G4 apresentou densidade óssea (índice Seedor), densidade trabecular óssea e espessura da cortical de 0,222 ± 0,004 g/cm, 59,167 ± 2,401% e 387,501 ± 8,573 µm, respectivamente, com diferença positiva, estatisticamente significativa (p < 0,05), em relação ao grupo G2. Aos 30 e 60 dias de tratamento, o G4 apresentou níveis séricos de fosfatase alcalina óssea estatisticamente significativos (p < 0,05) e superiores a todos os grupos (7,451 ± 0,173 µg/L e 7,473 ± 0,529 µg/L, respectivamente). CONCLUSÃO: O tratamento com atorvastatina cálcica demonstrou a capacidade desse fármaco de aumentar a atividade osteoblástica e a atividade reparadora tecidual óssea, atuar de forma diferente do alendronato de sódio, que demonstrou atividade preponderantemente antirreabsortiva.
RESUMO
The trabecular bone score (TBS) is a novel tool using grayscale variograms of the lumbar spine bone mineral density (BMD) to assess trabecular bone microarchitecture. Studies in patients with chronic kidney disease (CKD) suggest it may be helpful in assessing fracture risk. However, TBS has not been validated as a measure of trabecular architecture against transiliac bone biopsy with histomorphometry in CKD patients. We hypothesized that TBS would reflect trabecular architecture at the iliac crest in CKD patients. We obtained tetracycline double labeled transiliac crest bone biopsy, areal BMD of the spine, total hip, femoral neck (FN) and spine TBS by dual energy X-ray absorptiometry (DXA), and cortical and trabecular volumetric density and microarchitecture by high resolution peripheral quantitative computed tomography (HR-pQCT) in CKD patients from two centers: twenty-two patients from Columbia University Medical Center, USA and thirty patients from Hospital das Clinicas - Universidade de São Paulo, Brazil. Two patients were excluded for outlier status. Univariate and multivariate relationships between TBS and measures from DXA, HR-pQCT and histomorphometry were determined. Patients were 50.2⯱â¯15.8â¯years old, 23 (46%) were men, and 33 (66%) were on dialysis. TBS was <1.31 in 21 (42%) patients and 22%, 14% and 10% had T-scoresâ¯≤â¯-2.5 at spine, FN and total hip respectively. In univariate regression, TBS was significantly associated with trabecular bone volume (BV/TV), trabecular width (Tb.Wi), trabecular spacing, cortical width but not with trabecular number or cortical porosity. FN Z-score and height were also associated with cancellous BV/TV and Tb.Wi, In multivariate analysis, TBS remained an independent predictor of BV/TV and Tb.Wi. There were no relationships between TBS and dynamic parameters from histomorphometry. These data suggest that TBS reflected trabecular microarchitecture and cortical width measured by bone biopsy in CKD patients. Future studies should address its utility in the identification of CKD patients who may benefit from fracture prevention strategies.
Assuntos
Absorciometria de Fóton , Osso Esponjoso/diagnóstico por imagem , Osso Esponjoso/patologia , Osso Cortical/diagnóstico por imagem , Osso Cortical/patologia , Insuficiência Renal Crônica/diagnóstico por imagem , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Insuficiência Renal Crônica/patologia , Estatísticas não ParamétricasRESUMO
Bone healing depends of a transient inflammatory response, involving selective migration of leukocytes under the control of chemokine system. CCR2 has been regarded as an essential receptor for macrophage recruitment to inflammation and healing sites, but its role in the intramembranous bone healing on craniofacial region remains unknown. Therefore, we investigated the role of CCR2 on F4/80+ cells migration and its consequences to the intramembranous healing outcome. C57BL/6 wild-type (WT) and CCR2KO mice were subjected to upper right incisor extraction, followed by micro-computed tomography, histological, immunological, and molecular analysis along experimental periods. CCR2 was associated with F4/80+ cells influx to the intramembranous bone healing in WT mice, and CCR2+ cells presented a kinetics similar to F4/80+ and CCR5+ cells. By contrast, F4/80+ and CCR5+ cells were significantly reduced in CCR2KO mice. The absence of CCR2 did not cause major microscopic changes in healing parameters, while molecular analysis demonstrated differential genes expression of several molecules between CCR2KO and WT mice. The mRNA expression of TGFB1, RUNX2, and mesenchymal stem cells markers (CXCL12, CD106, OCT4, NANOG, and CD146) was decreased in CCR2KO mice, while IL6, CXCR1, RANKL, and ECM markers (MMP1, 2, 9, and Col1a2) were significantly increased in different periods. Finally, immunofluorescence and FACS revealed that F4/80+ cells are positive for both CCR2 and CCR5, suggesting that CCR5 may account for the remaining migration of the F4/80+ cells in CCR2KO mice. In summary, these results indicate that CCR2+ cells play a primary role in F4/80+ cells migration along healing in intramembranous bones, but its deficiency does not critically impact healing outcome.
Assuntos
Maxila/metabolismo , Receptores CCR2/genética , Cicatrização , Animais , Biomarcadores , Movimento Celular , Modelos Animais de Doenças , Imuno-Histoquímica , Macrófagos/imunologia , Macrófagos/metabolismo , Macrófagos/patologia , Masculino , Maxila/diagnóstico por imagem , Maxila/patologia , Camundongos , Camundongos Knockout , Monócitos/imunologia , Monócitos/metabolismo , Monócitos/patologia , Receptores CCR2/metabolismo , Cicatrização/genética , Microtomografia por Raio-XRESUMO
Abstract: Background: Histomorphometric analysis of bone samples is a key tool for studying bone metabolism; however, only a few pediatric reference data exist. The aim of the present study is to report more reference data and to investigate if histomorphometric differences exist between age and gender. Methods: We obtained 19 transiliac bone samples previously marked with tetracycline, from children between 8 and 17 years (13 were male), with normal blood test results and urine biochemical bone markers. We evaluated bone histomorphometric parameters using a digitalizing table with osteomeasure to obtain normative data of means and standard deviations, as well as median and range. Due to the small sample, a Monte Carlo simulation was applied. Structural, static, dynamic, and resorptic histomorphometric parameters were evaluated by age and gender following the American Society for Bone and Mineral Research recommendations. Results: Bone volume (in the older children) and mineral apposition rate (in the younger children), the eroded surface (in boys), and the new bone wall thickness (in girls) were significantly increased. On the trabecular area of mineralization front, the modeling and the remodeling bone formation were similar (16 and 18%). The rest of the histomorphometric bone parameters by age and gender showed no significant difference. Conclusion: In healthy children, these bone histomorphometric findings, with these techniques and for this ages could be used as reference values.
Resumen: Introducción: El análisis histomorfométrico del tejido óseo para el estudio de las enfermedades metabólicas óseas, cuando se correlacionan los hallazgos clínicos, sigue siendo la herramienta con mayor sensibilidad y especificidad para la mayoría de los diagnósticos. En los niños existen pocos reportes histomorfométricos del tejido óseo metabólico normal, por lo que nuestro propósito es reportar más datos de referencia e investigar si hay diferencias histomorfométricas entre edades y sexos. Métodos: Estudio realizado en 19 niños de 8 a 17 años (13 masculinos) sin anomalías clínicas ni bioquímicas evidentes. Se tomaron muestras de tejido óseo transilíaco marcadas con tetraciclina. Se obtuvieron medias, desviaciones y rangos histomorfométricos totales, y correlación por edad y sexo, siguiendo las recomendaciones para la histomorfometría de la American Society for Bone and Mineral Research. Se realizó una simulación Montecarlo. Resultados: El volumen óseo (en niños mayores), la velocidad de agregación del mineral (en niños menores), la erosión trabecular periférica (en niños) y el grosor de la pared ósea nueva (en niñas) exhibieron aumentos significativos. En el área trabecular del frente de mineralización, el modelado y el remodelado de la formación ósea fueron similares (16 y 18%). El resto de los parámetros histomorfométricos óseos no mostraron diferencias significativas. Conclusiones: Estos hallazgos histomorfométricos del tejido óseo de niños normales con estas técnicas y para estas edades pueden ser utilizados como valores de referencia.
Assuntos
Adolescente , Criança , Feminino , Humanos , Masculino , Osso e Ossos/metabolismo , Densidade Óssea/fisiologia , Remodelação Óssea/fisiologia , Valores de Referência , Biópsia , Fatores Sexuais , Fatores Etários , ÍlioRESUMO
Background: Histomorphometric analysis of bone samples is a key tool for studying bone metabolism; however, only a few pediatric reference data exist. The aim of the present study is to report more reference data and to investigate if histomorphometric differences exist between age and gender. Methods: We obtained 19 transiliac bone samples previously marked with tetracycline, from children between 8 and 17 years (13 were male), with normal blood test results and urine biochemical bone markers. We evaluated bone histomorphometric parameters using a digitalizing table with osteomeasure to obtain normative data of means and standard deviations, as well as median and range. Due to the small sample, a Monte Carlo simulation was applied. Structural, static, dynamic, and resorptic histomorphometric parameters were evaluated by age and gender following the American Society for Bone and Mineral Research recommendations. Results: Bone volume (in the older children) and mineral apposition rate (in the younger children), the eroded surface (in boys), and the new bone wall thickness (in girls) were significantly increased. On the trabecular area of mineralization front, the modeling and the remodeling bone formation were similar (16 and 18%). The rest of the histomorphometric bone parameters by age and gender showed no significant difference. Conclusion: In healthy children, these bone histomorphometric findings, with these techniques and for this ages could be used as reference values.
Introducción: El análisis histomorfométrico del tejido óseo para el estudio de las enfermedades metabólicas óseas, cuando se correlacionan los hallazgos clínicos, sigue siendo la herramienta con mayor sensibilidad y especificidad para la mayoría de los diagnósticos. En los niños existen pocos reportes histomorfométricos del tejido óseo metabólico normal, por lo que nuestro propósito es reportar más datos de referencia e investigar si hay diferencias histomorfométricas entre edades y sexos. Métodos: Estudio realizado en 19 niños de 8 a 17 años (13 masculinos) sin anomalías clínicas ni bioquímicas evidentes. Se tomaron muestras de tejido óseo transilíaco marcadas con tetraciclina. Se obtuvieron medias, desviaciones y rangos histomorfométricos totales, y correlación por edad y sexo, siguiendo las recomendaciones para la histomorfometría de la American Society for Bone and Mineral Research. Se realizó una simulación Montecarlo. Resultados: El volumen óseo (en niños mayores), la velocidad de agregación del mineral (en niños menores), la erosión trabecular periférica (en niños) y el grosor de la pared ósea nueva (en niñas) exhibieron aumentos significativos. En el área trabecular del frente de mineralización, el modelado y el remodelado de la formación ósea fueron similares (16 y 18%). El resto de los parámetros histomorfométricos óseos no mostraron diferencias significativas. Conclusiones: Estos hallazgos histomorfométricos del tejido óseo de niños normales con estas técnicas y para estas edades pueden ser utilizados como valores de referencia.