The influence of disuse on bone microstructure and mechanics assessed by HR-pQCT.
The influence of disuse on bone microstructure and mechanics assessed by HR-pQCT.
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DOI：
10.1016/j.bone.2014.02.014
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发表时间：
2014-06
期刊：
影响因子：
4.1
通讯作者：
Ma, C. Benjamin
中科院分区：
文献类型：
--
作者：
Kazakia, Galateia J.;Tjong, Willy;Nirody, Jasmine A.;Burghardt, Andrew J.;Carballido-Gamio, Julio;Patsch, Janina M.;Link, Thomas;Feeley, Brian T.;Ma, C. Benjamin
许多临床队列暴露于骨骼负荷减少和相关的骨丢失，包括手术患者、中风和脊髓损伤患者以及妊娠期间卧床休息的女性。在这种情况下，了解废用相关的骨丢失是至关重要的发展干预措施，以防止骨折和相关的发病率，死亡率和医疗保健系统的成本。本初步研究的目的是使用高分辨率外周QCT（HR-pQCT）检查非负重（WB）期间和恢复正常WB后的恢复期间骨小梁和皮质微结构和生物力学的变化。需要6周非WB期的手术患者（n = 12，34.8 ± 7.7岁）在手术前、6周非WB期后以及恢复全WB后6周和13周对受累和对侧胫骨进行扫描。在受累的胫骨超远端，整体vBMD（包括骨小梁和皮质间室）相对于基线（-1.2%）降低，骨小梁数量增加（+5.6%），而骨小梁厚度（-5.4%）、分离（-4.6%）和异质性（-7.2%）降低（均p<0.05）。恢复全WB后6周，骨小梁结构测量恢复至基线水平。相比之下，完整WB治疗6周（− 2.0%，p < 0.05）和13周（− 2.5%，p = 0.07）后，积分vBMD继续下降。在受影响的远端部位，停用期导致孔隙率增加（+16.1%，p < 0.005），6周后（+16.8%，p < 0.01）和13周后（+16.2%，p < 0.05）孔隙率仍然升高。应用于胫骨远端皮质的新型拓扑分析表明，在废用期后，具有表面拓扑（“平板”+21.7%，p < 0.01）和曲线拓扑（“管”+15.0%，p < 0.05）的髓腔数量增加，髓腔连接处数量增加（+21.4%，p < 0.05）。孔隙率通过孔径和数量的增加而均匀增加。胫骨超远端的有限元分析显示，非WB后刚度和失效载荷降低（−2.8%和− 2.4%，p < 0.01）。这些生物力学预测在6周和13周的全WB后仍然很低。远端部位的有限元分析遵循类似趋势。我们的研究结果表明，可检测到的微观结构和生物力学退化发生-特别是在皮质区室-作为非WB的结果，并持续恢复到正常负荷。更好地了解这些微结构变化及其对生物力学的短期和长期影响可能在废用相关骨折预防方面具有临床意义。
Numerous clinical cohorts are exposed to reduced skeletal loading and associated bone loss, including surgical patients, stroke and spinal cord injury victims, and women on bed rest during pregnancy. In this context, understanding disuse-related bone loss is critical to developing interventions to prevent fractures and the associated morbidity, mortality, and cost to the health care system. The aim of this pilot study was to use high-resolution peripheral QCT (HR-pQCT) to examine changes in trabecular and cortical microstructure and biomechanics during a period of non weight bearing (WB) and during recovery following return to normal WB. Surgical patients requiring a 6-week non-WB period (n = 12, 34.8 ± 7.7 yrs) were scanned at the affected and contralateral tibia prior to surgery, after the 6-week non-WB period, and 6 and 13 weeks after returning to full-WB. At the affected ultradistal tibia, integral vBMD (including both trabecular and cortical compartments) decreased with respect to baseline (−1.2%), trabecular number increased (+5.6%), while trabecular thickness (−5.4%), separation (−4.6%), and heterogeneity (−7.2%) decreased (all p<0.05). Six weeks after return to full-WB, trabecular structure measures reverted to baseline levels. In contrast, integral vBMD continued to decrease after 6 (−2.0%, p < 0.05) and 13 weeks (−2.5%, p = 0.07) of full-WB. At the affected distal site, the disuse period resulted in increased porosity (+16.1%, p < 0.005), which remained elevated after 6 weeks (+16.8%, p < 0.01) and after 13 weeks (+16.2%, p < 0.05). A novel topological analysis applied to the distal tibia cortex demonstrated increased number of canals with surface topology (“slabs” +21.7%, p < 0.01) and curve topology (“tubes” +15.0%, p < 0.05) as well as increased number of canal junctions (+21.4%, p < 0.05) following the disuse period. Porosity increased uniformly through increases in both pore size and number. Finite element analysis at the ultradistal tibia showed decreased stiffness and failure load (−2.8% and −2.4%, p < 0.01) following non-WB. These biomechanical predictions remained depressed following 6 and 13 weeks of full-WB. Finite element analysis at the distal site followed similar trends. Our results suggest that detectable microstructural and biomechanical degradation occurs – particularly within the cortical compartment – as a result of non-WB and persists following return to normal loading. A better understanding of these microstructural changes and their short- and long-term influence on biomechanics may have clinical relevance in the context of disuse-related fracture prevention.
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