Effects of hybridization of decellularized allogenic nerves with adipose-derive stem cell sheets to facilitate nerve regeneration.

We developed a sheet of stem cells derived from adipose tissue (ADSC sheet). To improve transplantation, we wrapped decellularized nerves with ADSC sheets and examined the efficacy of this recellularized nerves in nerve regeneration. Decellularized nerves were prepared from sciatic nerves of Sprague-Dawley rats. Wistar rats were subjected to sciatic nerve injury and then randomly assigned to three groups (n = 7 per group), which were transplanted with 15-mm bridge grafts; the first group received a decellularized allogenic nerve implant, the second an ADSC sheet-wrapped decellularized allogenic nerve implant, and the third an autogenous nerves were implant. No significant differences were found in S100-positive and neurofilament-positive areas, axon density, and sciatic functional index (SFI) score between rats transplanted with ADSC sheet-wrapped nerve grafts and those that received autografts. In contrast, these parameters except SFI and the amplitude ratio were significantly larger in rats grafted with ADSC sheet-wrapped nerve than with the decellularized nerve. These results suggest that the number of regenerating axons, as well as their regenerating velocity, and the number of migrating Schwann cells into the implant in rats transplanted with ADSC sheet-wrapped nerves matched those in rats transplanted with autografts. These positive effects are possibly attributable to secretion of growth factors of ADSCs.

Enhanced new bone formation in canine maxilla by a graft of electrically polarized ß-tricalcium phosphate.

We succeeded in the electrical polarization of ß-tricalcium phosphate (ß-TCP) granules and performed an unprecedented attempt to implant them into maxillary bone defects in canines to confirm their ability to facilitate new bone formation. Two holes were drilled into each maxilla half of a canine and filled with electrically polarized and nonpolarized ß-TCP granules (grouping assignment was decided randomly). The implanted specimens were dissected en bloc and used for microcomputed tomography (µCT) observations and histological analyses 4 and 8 weeks after the operation. New bone ingrowth in the bone hole progressed over time from the superficial layer of the cortex toward the inner cancellous bone. The percentage area of new bone in the bone hole, as measured by µCT in the sagittal plane, was significantly larger after 4 and 8 weeks, and that measured by H&E-stained specimens in the transverse plane after 4 weeks was significantly larger in the polarized group than in the nonpolarized group. In addition to the structural stability and chemical characteristics of the ß-TCP granules, electrical stimulation bears influence not indirectly but directly on osteogenic and vessel cells, which might work cooperatively for the early initiation of the bone formation process.

Efficacy of electrical polarization on a rat femoral bone defect model with a custom-made external fixator.

BACKGROUND: We have developed a technology to electrically polarize living bone. OBJECTIVE: The effects of stored electrical charge in electrical polarized bone on the facilitation of new bone formation were assayed. METHODS: Stimulated depolarized current measurement was performed in electrically polarized and nonpolarized femora of SD rats. These bone specimens were implanted into bone defects of the rat femora and fixed with a custom-made external fixator. X-ray imaging of the implant was performed every week. After 3 weeks, micro-CT scanning was performed to evaluate the displacement rate. Histological observation was performed, and the occupancy ratio of the newly formed bone was calculated from tissue specimens stained with Villanueva's Goldner method. RESULTS: There was a tendency for the displacement rate of the implant to be smaller and the occupancy ratio of the newly formed bone to be larger, especially at the distal end, in the polarized group compared with the nonpolarized group. The time of callus appearance was significantly earlier in the polarized group than in the nonpolarized group, and bridging callus grew from the distal to the proximal end. CONCLUSIONS: Bone specimens can be electrically polarized, and the stored electrical charge can work effectively to facilitate new bone formation.

Availability of ultrasound screening for asymptomatic elbow injuries in judo athletes.

OBJECTIVE: We conducted ultrasonography (US) examination for asymptomatic elbow injuries in judo athletes to confirm availability of US screening for elbow. MATERIALS AND METHODS: One hundred and thirty-two black belts in judo (85 males and 47 females; mean age, 20.0 ± 1.6 years) participated in this screening. Forty-eight participants had a history of elbow injury (elbow-injury group), and 84 did not (no-elbow-injury group). All participants completed a survey in the form of a questionnaire. Subsequently, US scanning of both elbows was performed. RESULTS: The maximal thickness of the medial collateral ligament of both elbows was significantly larger in the elbow-injury group than in the no-elbow-injury group. The width of the joint space was significantly larger in the right radiohumeral joint in the elbow-injury group than in the no-elbow-injury group. Combination injuries involving ligament and bone and those involving both the medial and lateral collateral ligaments were most commonly seen in both elbows in the elbow-injury group; however, these combined lesions of both elbows were also found in the no-elbow-injury group. CONCLUSIONS: Because US screening can reveal abnormalities of the asymptomatic elbow, US is recommended as a complementary imaging modality that is useful for evaluation of elbow injuries in athletes.

Effectiveness of bisphosphonate combined with activated vitamin D in patients with aromatase inhibitor-induced osteoporosis after breast cancer operation.

OBJECTIVES: We compared the effectiveness of bisphosphonates combined with activated vitamin D administered for therapy of aromatase inhibitor-induced osteoporosis after a breast cancer operation and primary postmenopausal osteoporosis through propensity score matching. METHODS: Forty-eight postmenopausal patients with estrogen receptor-positive early breast cancer, who had postoperative adjuvant treatment with aromatase inhibitors and whose T-score of bone mineral density (BMD) decreased below -2.5 (AI group), and 48 patients of primary postmenopausal osteoporosis (PO group) enrolled in this retrospective observational study. They were administered monthly risedronate or minodronate, and daily alfacalcitol or eldecalcitol were combined. Their BMD (L2-4, L-BMD), serum-corrected calcium, serum phosphate, tartrate-resistant acid phosphatase 5b (TRACP-5b), bone alkaline phosphatase (BAP), estimated glomerular filtration rate, urine calcium/creatinine ratio, intact-parathyroid hormone, and 25-hydroxy vitamin D were measured before treatment and until 24 months. RESULTS: L-BMD values increased with time compared with the baseline values in each group, and there was no significant difference in the groups. Percentage value of TRACP-5b decreased rapidly after 6 months and maintained low level until 24 months in both groups. Percentage value of BAP in the AI group decreased continuously until 24 months. In contrast, the percentage change in the PO group plateaued after 6 months. CONCLUSIONS: It is suggested that monthly oral bisphosphonate combined with activated Vitamin D is an effective therapy to increase BMD in the aromatase inhibitor-induced osteoporosis after breast cancer operation. Monitoring of kidney function and concentration of Ca in blood and urine may be necessary.

Comparison of Treatment Results for Mallet Finger Fractures in Children Between Low-Intensity Pulsed Ultrasound Stimulation and Ishiguro's Method.

BACKGROUND: We compared the treatment results for displaced mallet finger fractures in children between low-intensity pulsed ultrasound (LIPUS) stimulation and Ishiguro's method, which involves extension block and arthrodesis of the distal interphalangeal (DIP) joint with pinning. METHODS: Eleven cases (5 females and 6 males; average age, 13.5 years) of mallet finger were operated with Ishiguro's method, and 8 cases (3 females and 5 males; average age, 13.0 years) were treated with LIPUS stimulation. Lateral radiographs were used to determine the distance of fragment displacement and the percentage of the articular surface involved in the fragments. Functional outcomes in flexion and extension and those estimated using Crawford's evaluation criteria at the final visits were assessed in each group. RESULTS: The duration needed for fracture healing was longer, however, active extension and flexion of the DIP joint were significantly larger in the LIPUS group compared with those in the pinning group. Functional recovery was excellent in all cases in the LIPUS group; however, recovery was good in 3 cases and excellent in 8 cases in the pinning group. Extension of the DIP joint was significantly larger when pins were removed in 35 or lesser days postoperatively compared with cases in which pin fixation was continued for more than 35 days. CONCLUSIONS: LIPUS therapy may be recommended as an option to treat type I mallet finger in children for whom initiation of treatment was delayed up to 8 weeks. When Ishiguro's method is applied to the displaced mallet fracture in children, arthrodesis of the DIP joint for more than 5 weeks should be avoided to prevent flexion contracture.

The efficacy and safety of combination therapy of low-intensity pulsed ultrasound stimulation in the treatment of unstable both radius and ulna fractures in children.

BACKGROUND: There are few reports of Low-intensity pulsed ultrasound (LIPUS) treatment for fresh forearm fractures in children. OBJECTIVES: LIPUS stimulation was applied after surgery of forearm fractures in children and the efficacy and safety of combination therapy of LIPUS treatment were evaluated. PATIENTS AND METHODS: Children with both radius and ulna fracture, twenty-five diaphysis (mid-R&U) and nineteen metaphysis (dist-R&U) fractures, were treated with intramedullary nailing followed by cast and splint mobilization. Thirteen patients in the mid-R&U fracture group and eight patients in the dist-R&U fracture group were combined with LIPUS stimulation postoperatively. RESULTS: Periosteal callus appeared significantly earlier after surgery in the LIPUS-treated groups than in the groups without LIPUS treatment. The duration of external fixation was significantly shorter in the dist-R&U fracture group treated with LIPUS stimulation compared with that in the mid-R&U fracture group without LIPUS treatment. Furthermore, the time span needed for bone union in the groups with LIPUS stimulation was significantly shorter than in the groups without LIPUS stimulation. CONCLUSIONS: It is suggested that LIPUS stimulation can lead to a reduction of treatment periods of unstable forearm fractures safely after operation even in children.

Influences of osteoarthritis and osteoporosis on the electrical properties of human bones as in vivo electrets produced due to Wolff's law.

We characterized the electrical properties of living bone obtained from patients who had undergone total hip arthroplasty (THA) or hemiarthroplasty by means of analysis of the electrically polarized and nonpolarized bone specimens, and we discussed the role of an organic and inorganic matrix of human bone in bone piezoelectricity.We used human femoral neck bone that was harvested during THA for advanced osteoarthritis of the hip joint (OA group) and hemiarthroplasty for femoral neck fracture (FNF group). The specimens were scanned to evaluate the cancellous bone structures using micro-computed tomography, and we quantified the carbonic acid by attenuated total reflection (ATR) spectra to estimate carbonate apatite. The stored electrical charge in the electrically polarized and nonpolarized bone specimens were calculated using thermally stimulated depolarized current (TSDC) measurements.Each TSDC curve in the groups had peaks at 100°C, 300°C and 500°C, which may be attributed to collagen, carbonate apatite and hydroxyapatite, respectively. It is suggested that organic substances are more effectively electrically polarized than apatite minerals by the polarization at room temperature and that the stored charge in living bone may be affected not only by total bone mass but also by bone quality, including 3-dimensional structure and structural component.

Comparison of effectiveness and safety of ibandronate and minodronate combined with eldecalcitol in primary osteoporosis of women: A 1-year follow-up study.

OBJECTIVES: This is an open labeled and retrospective cohort study which compared the effectiveness and safety of ibandronate (IBN) and minodronate (MIN) combined with eldecalcitol (ELD) in primary osteoporosis of women. METHODS: One hundred and forty-eight primary osteoporotic women were classified into 3 groups; 1) intravenous IBN combined with oral ELD (IBN + ELD group, N = 50; 81.8 ± 6.2 years), 2) oral MIN combined with oral ELD (MIN + ELD group, N = 50; 77.2 ± 6.9 years) and 3) oral ELD alone (ELD group, N = 48; 75.0 ± 8.3 years). For statistical analysis, lumbar spine bone mineral density (L-BMD), hip total bone mineral density (H-BMD), serum corrected calcium (Ca), serum inorganic phosphorus (iP), intact-parathyroid hormone (PTH), tartrate-resistant acid phosphatase 5b (TRACP-5b), bone alkaline phosphatase (BAP), serum homocysteine (Hcy), estimated glomerular filtration rate (eGFR) and urine calcium / creatinine (Ca/Cr) ratio were measured until 12 months after the start of therapy. RESULTS: L-BMD values increased significantly in both IBN + ELD and MIN + ELD group, however, H-BMD increased significantly in the IBN + ELD group only. TRACP-5b values decreased rapidly during the first 6 months in both IBN + ELD and MIN + ELD group. However, BAP value in the IBN + ELD group decreased more gradually compared with that in the MIN + ELD group. Both serum Ca value and urine Ca/Cr ratio tended to increase, and the eGFR value decreased significantly in each group. CONCLUSIONS: IBN combined with ELD administration can act more effectively to increase BMD compared with MIN combined with ELD administration. Differences of decreasing rate in TRACP-5b and BAP value may lead to differences of increased rate of BMD in the IBN + ELD and MIN + ELD group. Because many cases of osteoporosis are elderly persons associated with chronic kidney disease, monitoring of kidney function and concentration of Ca in blood and urine is essential.

The role of the collaborative functions of the composite structure of organic and inorganic constituents and their influence on the electrical properties of human bone.

BACKGROUND: The electrical potential, which is generated in bone by collagen displacement, has been well documented. However, the role of mineral crystals in bone piezoelectricity has not yet been elucidated. OBJECTIVE: We examined the mechanism that the composite structure of organic and inorganic constituents and their collaborative functions play an important role in the electrical properties of human bone. METHODS: The electrical potential and bone structure were evaluated using thermally stimulated depolarized current (TSDC) and micro computed tomography, respectively. After electrical polarization of bone specimens, the stored electrical charge was calculated using TSDC measurements. The CO3/PO4 peak ratio was calculated using attenuated total reflection to compare the content of carbonate ion in the bone specimens. RESULTS: The TSDC curve contained 3 peaks at 100, 300 and 500°C, which were classified into 4 patterns. The CO3/PO4 peak ratio positively correlated with the stored charges at approximately 300°C in the polarized bone. There was a positive correlation between the stored bone charge and the bone mineral density only. CONCLUSIONS: It is suggested that the peak at 300°C is attributed to carbonate apatite and the total bone mass of human bone, not the three-dimensional structure, affects the stored charge.

Significance of a Pronator Quadratus-Sparing Approach for Volar Locking Plate Fixation of Comminuted Intra-articular Fractures of the Distal Radius.

BACKGROUND: The preservation of the integrity of the pronator quadratus (PQ) muscle is expected to have many benefits, particularly in cases of highly comminuted intra-articular fractures of the distal radius. Therefore, we examined the significance of a PQ muscle-sparing approach for volar locking plate (VLP) fixation of these types of fractures. METHODS: Sixty-five patients who sustained AO Foundation and Orthopaedic Trauma Association (AO/OTA) type C2 and C3 distal radius fractures were treated with VLP fixation using either a PQ muscle release and repair (PQ-releasing group, n = 30) or a PQ muscle-sparing approach (PQ-sparing group, n = 35). Radiographic parameters, active range of motion (ROM), percentage of the grip power of the injured hand compared with that of the opposite hand, wrist pain visual analog scale (VAS) score, and Quick Disability of the Arm, Shoulder, and Hand (DASH) score (disability/symptom) were evaluated monthly up to 12 months after surgery. RESULTS: The mean VAS score was significantly lower in the PQ-sparing group at 2, 3, and 4 months postoperatively than in the PQ-releasing group. Furthermore, the mean Quick DASH score in the PQ-sparing group was significantly lower than that in the PQ-releasing group at 1 and 2 months postoperatively. There were no significant differences, however, in the other functional parameters in the groups through the observation period. CONCLUSIONS: The PQ muscle-sparing approach appears to achieve satisfactory results in patients undergoing VLP fixation of comminuted intra-articular fractures of the distal radius.

Comparison of nerve regenerative efficacy between decellularized nerve graft and nonwoven chitosan conduit.

BACKGROUND: Recently decellularized nerves with various methods are reported as highly functional nerve grafts for the treatment of nerve defects. OBJECTIVE: To evaluate the efficacy of decellularized allogeneic nerve, compared with oriented chitosan mesh tube, and an autologous nerve. METHODS: Sciatic nerves harvested from Sprague-Dawley (SD) rats were decellularized in combination with Sodium dodecyl sulfate and Triton X-100. A graft into the sciatic nerve in Wistar rats was performed with the decellularized SD rat sciatic nerves or oriented chitosan nonwoven nanofiber mesh tubes (15 mm in length, N=5 in each group). A portion of sciatic nerve of Wistar rat was cut, reversed and re-sutured in-situ as a control. Nerve functional and histological evaluations were performed 25 weeks postoperatively. RESULTS: It was revealed that functional, electrophysiological and histological recoveries in the decellularized nerve group match those in the autograft group. Recovery of sensory function and nerve maturation in the decellularized nerve group were superior to those in the chitosan mesh tube group. CONCLUSIONS: Nerve regeneration in the decellularized nerves could match that in the autografts and is somehow superior to artificial chitosan mesh tube. Detergents wash of SDS and Triton X-100 could obtain highly functional nerve grafts from allografts.

Comparative study of the efficacy of decellularization treatment of allogenic and xenogeneic nerves as nerve conduits.

The objective of this study was to compare the results of allogenic and xenogeneic nerve grafts that were treated using decellularization. The sciatic nerves of Sprague-Dawley rats and the median nerves of Japanese white rabbits were decellularized with sodium dodecyl sulfate and Triton X-100 and examined with a scanning electron microscope and immunofluorescence staining. A bridge-graft into the sciatic nerve in Wistar rats was performed with the decellularized nerves (10 mm in length for short-term evaluation; 15 mm in length for long-term evaluation). As a control, an isograft was performed. The specimens were harvested at 4 weeks postoperatively and prepared for immunohistochemistry. Function, electrophysiological and histomorphological analyses were performed to evaluate nerve recovery at 24 weeks postoperatively. The 3-dimensional structure of the basal lamina column, on which the cell adhesion molecules were integrated, was preserved through the decellularization protocols. Limited ED1-positive macrophage invasion was observed, and abundant NF 160-positive axons, which were accompanied by S-100-positive Schwann cells, penetrated through the implanted nerves. The sciatic nerve function and electrophysiological and histomorphological analyses suggest that the xenogeneic nerve graft was statistically indistinguishable from the allogenic nerve graft but slightly inferior to the isograft in supporting the axonal regeneration and functional recovery.

The cause of failure to return to the pre-fracture place of residence and solution to continue medical treatment for osteoporosis following an operation for hip fracture - Periodic observation of single center.

The purpose of this study was to investigate the causes of failure to return to the pre-fracture place of residence at hospital discharge following an operation for a hip fracture and to continue medical treatment for osteoporosis. Herein, we discuss methods for improving discharge protocols for these patients. We examined patients who sustained osteoporotic fractures and were operated on for a hip fracture between 2001 and 2003 (83 males and 386 females; 81.2 ± 9.0 years old) and between 2011 and 2013 (121 males and 462 females; 83.1 ± 9.3 years old). In a follow-up study, we examined patients who moved into our related rehabilitation institution over a 3-year period, from 2011 to 2013. The incidence of hip fractures had increased from 2001-2003 to 2011-2013 in both genders, and it tended to increase in patients greater than 80 years of age in male and 90 years of age in female. The most common destination residence after discharge from the rehabilitation institution was the pre-fracture place of residence. The Barthel Index at discharge from the rehabilitation institution was significantly lager in patients who returned to the pre-fracture place of residence compared to those who returned to nursing home and our hospital. These results suggest improved mobility and ADL level of patients enable them to return to the pre-fracture place of residence. We propose the construction of a feedback system that aids in a medical pass to increase the ambulant consultation rate for orthopedics and prevent fragile fractures.

In vivo evaluation of a Ti-based bulk metallic glass alloy bar.

Ti-based bulk metallic glasses are reported with high strength, low Young modulus and high corrosion resistance, suggesting their potentials in biomedical applications. However a thorough in vivo evaluation of its biocompatibilities has not been conducted yet. In this study, we implanted bars of Ti-based bulk metallic glass in the femoral bone of rats, followed up local tissue reaction as well as its component ions' diffusion in local area and whole body. The Ti-based BMG (Ti40Zr10Cu34Pd14Sn2) alloy exhibited favorable features of both high strength and high elasticity. In vivo implant evaluation showed that it has a good tissue compatibility, equivalent bone integration and bonding ability with Ti sample. No component ion diffusion was detected up to 3 months post implantation. The possibility and efficacy of its use for bone implant is confirmed. Thus further long term implant study is recommended.

An Experimental Study to Bridge a Nerve Gap with a Decellularized Allogeneic Nerve.

BACKGROUND: The authors evaluated the efficacy of decellularized nerve as a scaffold for nerve regeneration. METHODS: Sciatic nerves harvested from Sprague-Dawley rats were decellularized in combination with sodium dodecyl sulfate and Triton X-100, and examined with scanning electron microscopy and immunofluorescence staining. A graft into the sciatic nerve in Wistar rats was performed with the decellularized Sprague-Dawley rat sciatic nerves [allograft: 10 mm long (n = 3) for short term and 15 mm long (n = 5) for long term]. As a control, a portion of sciatic nerve of Wistar rats was cut, reversed, and resutured in situ [autograft: 10 mm long (n = 3) and 15 mm long (n = 5) for different terms, respectively]. Samples were harvested 4 weeks postoperatively and prepared for immunohistochemistry. Von Frey hair test, static toe spread factor measurement, and electrophysiologic and histomorphologic analyses were carried out to evaluate nerve recovery 24 weeks postoperatively. RESULTS: Scanning electron microscopic images revealed the honeycomb structure, and immunohistology showed that the three-dimensional structure of the basal lamina column on which cell adhesion molecules are integrated is preserved through the decellularization protocols. Limited ED1-positive macrophage invasion was found through the decellularized sciatic nerves, suggesting that antigenicity remained more or less after this treatment. Nevertheless, NF160-positive axons accompanied by S100-positive Schwann cells penetrated through the decellularized sciatic nerves. Sciatic nerve function had recovered, and there were no significant differences in the electrophysiologic and histomorphologic recovery in the groups. CONCLUSION: These results suggest that the decellularized allogeneic nerve is a suitable scaffold to bridge a nerve gap.

Closed traumatic rupture of the flexor pollicis longus tendon in zone T I: a case report.

A healthy 41-year-old male suffered a direct blow on the palmar side of his right thumb when folding a table, which slipped along his thumb until it was stopped at the inter-phalangeal (IP) joint, resulting in a complete rupture of the flexor pollicis longus (FPL) tendon in zone T I. The proximal tendon stump was passed through the oblique pulley, fixed to the base of the distal phalanx with a pull-out wire technique and augmented on it using a part of the distal tendon remnant. After removal of the cast and the pull-out wire three weeks postoperatively, range of motion exercise was initiated and good functional recovery was obtained.

The therapeutic effectiveness of the coadministration of weekly risedronate and proton pump inhibitor in osteoporosis treatment.

This trial was conducted to investigate the long-term effects of proton pump inhibitor (PPI) coadministration on the efficacy of weekly risedronate treatment for osteoporosis. Ninety-six women over 50 years old with low bone mineral density (BMD) participated in this trial. Subjects were randomly divided into 2 groups: a 17.5 mg dose of sodium risedronate was administered weekly, with or without a daily 10 mg dose of sodium rabeprazole (n = 49 and 47 in the BP + PPI and BP groups, resp.). The following biomarkers were measured at the baseline and every 3 months: bone-specific alkaline phosphatase, N-terminal telopeptide of type I collagen corrected for creatinine, parathyroid hormone, BMD of the lumbar spine, and physical parameters evaluated according to the SF-36v2 Health Survey. Statistical comparisons of these parameters were performed after 6, 12, 18, and 24 months. The Δ values of improvement in physical functioning after 12 months and bodily pain after 6 and 12 months in the BP + PPI group were significantly larger than those in the BP group. These results suggest that PPI does not adversely affect bone metabolism. Alternatively, approved bone formation by concomitant PPI treatment may have had favorable effects on the improvement of bodily pain and physical functions.

Enhancement of fracture healing by electrical stimulation in the comminuted intraarticular fracture of distal radius.

Effectiveness of an alternating electric current (AC) stimulation in prevention of bone deformity for comminuted intraarticular fracture of distal radius were verified by comparing postoperative results treated with a wrist-bridging external fixator combined with or without an AC stimulator (EF and NEF, respectively), and a palmar locking plate (LP). This study evaluated 92 cases (mean age 67.9 ± 11.4 years) of type C2 and 60 cases (mean age 69.7 ± 9.5 years) of type C3 distal radius fractures, as classified by the Association for Osteosynthesis. In total, 55 and 24 cases were treated with EF and NEF, respectively; and 73 cases were treated with LP. Callus appeared 27.5 ± 4.6 days postoperatively and the external skeletal fixation period was significantly shorter in the EF group than in the NEF group. The decrease in radial length was significantly lower in the EF group when compared to the LP group. There were no significant differences among the groups for the other radiographic and functional parameters. AC stimulation combined to the external fixation may be a promising method to prevent postoperative deformity in the severely comminuted intraarticular fractures by accelerating callus maturation and facilitating new bone bridging across the gap of fracture site.

The effects of risedronate administered in combination with a proton pump inhibitor for the treatment of osteoporosis.

This study was performed to investigate the effects of the co-administration of proton pump inhibitor (PPI) on the efficacy of bisphosphonate (BP) treatment for osteoporosis. A total of 180 women with low bone mineral density were randomly divided into four groups, one in which sodium risedronate was administered with sodium rabeprazole and one in which only risedronate was administered (BP + PPI and BP groups, respectively). The biomarkers were measured at the baseline and every 3 months, inlcuding: N-terminal telopeptide of type I collagen corrected for creatinine, bone-specific alkaline phosphatase (BAP), parathyroid hormone, bone mineral density (BMD) of the lumbar spine and physical parameters evaluated according to the SF-36v2™ Health Survey. Statistical comparisons of these parameters were performed after 9 months. Data were available for a total of 137 patients (62 in the BP group and 75 in the BP + PPI group). The Δ % value of increase in BMD and improvement of physical functioning in the BP + PPI group were significantly larger, and its decrease in BAP in the BP + PPI group was significantly smaller than that in the BP group. It is expected that risedronate administration in combination with a PPI may be more effective not only for treating osteoporosis but also improving physical fitness than treatment with risedronate alone.