Defective implant osseointegration under protein undernutrition: Prevention by PTH or pamidronate
Defective implant osseointegration under protein undernutrition: Prevention by PTH or pamidronate
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DOI：
10.1359/jbmr.070610
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发表时间：
2007-10-01
影响因子：
6.2
通讯作者：
Ammann, Patrick
中科院分区：
文献类型：
--
作者：
Dayer, Romain;Badoud, Isabelle;Ammann, Patrick
前言：蛋白质缺乏症在骨科病房住院的老年患者中非常普遍。蛋白质摄入量减少会损害大鼠钛的骨整合。在蛋白质缺乏的情况下，骨形成的刺激剂或骨吸收的抑制物是否能改善种植体的骨结合尚不清楚。在正常和等热量低蛋白摄入条件下，研究甲状旁腺素或帕米磷酸钠对植入大鼠胫骨近端钛棒的抗拔出能力的影响。材料和方法：测定49只成年雌性大鼠在正常和等热量低蛋白饮食条件下，植入胫骨近端1 mm直径钛棒的抗拔出能力。两种饲料喂养2wk后，植入种植体，给予甲状旁腺素(1-34)、帕米磷酸钠或生理盐水8wk。结果：与正常蛋白质摄入量(-29%)相比，等热量低蛋白饮食组大鼠的拔出强度较低。甲状旁腺素和帕米磷酸钠显著增加正常或低蛋白饮食动物的拔出强度，甲状旁腺素的作用更大。PTH或Pamidronate介导的拔出强度的增加与种植体周围的相对骨体积、骨与种植体的接触和骨小梁厚度的显著增加有关，而骨小梁间距减少。结论：我们证实等卡路里的低蛋白摄入量损害了钛种植体的骨整合。甲状旁腺素或帕米磷酸钠可防止蛋白质营养不良的不良影响，甚至显著改善种植体的骨结合。这些结果表明，全身性应用甲状旁腺素或帕米磷酸钠可以预防蛋白质营养不良患者非骨水泥型人工关节松动。
Introduction: Protein deficiency is highly prevalent among elderly patients hospitalized in orthopedic wards. Reduced protein intake impairs titanium osseointegration in rats. Whether stimulator of bone formation or inhibitor of bone resorption could improve implant osseointegration under protein deprivation is not known. We studied the effects of systemic treatment with PTH or pamidronate on the resistance to pull-out of titanium rods implanted into rats proximal tibia under normal and isocaloric low protein intake.Materials and Methods: We measured the resistance to pull-out 1-mm-diameter titanium rods implanted into the proximal tibias of 49 adult female rats receiving a normal or an isocaloric low protein diet. After 2 wk on either diet, the implants were inserted, and the rats received PTH(1-34), pamidronate or saline vehicle for 8 wk. The tibias were removed for mu CT morphometry, followed by the evaluation of pull-out strength.Results: Pull-out strength was lower in rats fed an isocaloric low protein diet compared with rats fed a normal protein intake (-29%). PTH and pamidronate significantly increased pull-out strength in animals fed a normal or a low protein diet, the effect of PTH being of higher magnitude. The PTH- or pamidronate-mediated increase in pull-out strength was associated with significant increases of relative bone volume, bone-to-implant contact, and trabecular thickness, whereas trabecular spacing was reduced, in the vicinity of the implants.Conclusions: We confirmed that isocaloric low protein intake impairs titanium implant osseointegration. PTH or pamidronate prevented the deleterious effects of protein undernutrition and even significantly improved the implant osseointegration. These results indicate that systemic administration of PTH or pamidronate could be considered for preventing uncemented arthroplasty loosening in protein undernourished patients.