Age-related Differences in Volumetric Bone Mineral Density, Structure, and Bone Strength of Surgical Neck of Humerus in Postmenopausal Women.

OBJECTIVE: Postmenopausal changes in bone mass and structure compromise the mechanical properties of proximal humerus, predisposing it to low-energy fractures with complex morphology. The aim of the study is to investigate associations of bone quality and estimated bone strength of the surgical neck with age after menopause. METHODS: A total of 122 healthy postmenopausal women were recruited from December 2016 to December 2022 and assigned to three groups: the 50-59 years group, the 60-69 years group, and the older than 70 years group. Bone properties of the surgical neck, including volumetric bone mineral density (vBMD), cortical thickness (CTh), the periosteal and medullary size, and estimated indices of bone strength were evaluated by quantitative computed tomography. RESULTS: Compared to the 50-59 years group, postmenopausal women aged over 70 years were characterized by lower cortical thickness (13.9%) and vBMD (6.65%), as well as reduced strength indices including the minimum and maximum section modulus (Zmin 18.11%, Zmax 21.71%), polar section modulus (Zpol 20.21%), and the minimum and maximum second moments of area (Imax 21.01%, Imin 21.43%). Meanwhile, the difference in periosteal diameter and perimeter, total area in three groups did not reach statistical significance. Both cortical thickness and vBMD value were inversely associated with age, showing 10.56% and 23.92% decline. Imax showed the greatest age-related decrease between age of 54 and 86 years (39.08%), followed by Zmax (-35.77%), Imin (-35.73%), Zpol (-34.90%) and Imin (-23.92%).The strength indices had stronger correlations with cortical thickness than with bone size or density. CONCLUSION: In postmenopausal women, aging is associated with a significant decline in cortical bone thickness and mechanical strength of the proximal humerus, especially over the age of 70 years.

A Feasibility Study on Using Hanging Arm Test to Assess Elbow Stability During Surgical Treatment for Varus Posteromedial Rotatory Instability.

Objectives: The aim of this study to investigate the safety and effectiveness of performing the hanging arm test during surgical treatment for elbow varus posteromedial rotatory instability (VPMRI) to assess elbow stability and determine whether to repair the lateral ulnar collateral ligament (LUCL). Methods: In a retrospective study from August 2014 to March 2019, 27 patients with VPMRI who had a negative result in the hanging arm test after fixation of coronoid fracture were selected. Intraoperative bleeding, operative time, elbow range of motion (ROM), and complications were recorded. Elbow function was evaluated with the Mayo elbow performance score (MEPS) and the disabilities of the arm, shoulder, and hand (DASH) score. Results: The operation time was 85.9 ± 11.06 min (range 65-110). The intraoperative blood loss was 70.7 ± 9.31 ml (range 60-100). At the last follow-up, the elbow joint averaged 73.8° ± 2.931° in pronation, 78.9° ± 2.941° in supination, 7.2° ± 3.207° in extension, and 123.3° ± 6.651° in flexion. The MEPS score was 90.7 ± 4.36 (range 74-95), and the DASH score was 9.8 ± 2.58 (range 6.67-13.3). One patient presented with symptoms of ulnar nerve entrapment 2 months after operation and was treated with ulnar nerve release. The symptom of numbness went away completely 1 week after operation. No complications such as wound infection, arthritis, or chronic instability of the elbow were found in the other patients. Conclusion: Our findings suggest that not all VPMRI patients need the LUCL to be repaired, and the hanging arm test is a safe and reliable method to assess whether to repair the LUCL in the treatment of elbow VPMRI. Level of evidence: Level IV; Retrospective studies.

Changes in bone density and structure of proximal humerus with aging in Chinese women.

AIMS: This study aimed to investigate age- and menopause-related differences in bone mineral density (BMD), bone structure and estimated bone strength at surgical neck of humerus in Chinese female sample. METHODS: We conducted a cross-sectional cohort study of 171 Chinese women. Bone mass, indices of geometric properties and estimated mechanical strength of the surgical neck were evaluated by quantitative computed tomography (QCT). Comparisons were performed across menstrual status categories. Age-related changes in QCT-derived bone parameters were calculated. RESULTS: The age-related difference of BMD and cortical thickness was 40.25 % and 32.86 % between the age of 20 and 86 years. Progressive periosteal and endosteal expansion was associated linearly with age. Estimated mechanical strength indexes showed significant quadratic associations with age, with their peak occurred at the age of 46-55 years. The quartile of women with the greatest medullary diameter also had the lowest valve of BMD and cortical thickness and the greatest in skeletal width. Compared to premenopausal individuals, perimenopausal women were distinguished by lower cortical thickness (18.63 %) and BMD (20.05 %). The continued decrease in cortical thickness and BMD was noted after menopause. The medullary and periosteal diameter increased by 17.98 % and 9.34 % respectively in perimenopausal period, but not after menopause. The accelerated loss of the maximum and polar section modulus was observed in late postmenopausal women. CONCLUSIONS: The increase in bone size only occurred during the menopause transition. Obvious loss of resistance to bending was in late postmenopausal period.

[Retracted] Tanshinone­IIA attenuates the deleterious effects of oxidative stress in osteoporosis through the NF­κB signaling pathway.

Following the publication of this paper, it was drawn to the Editor's attention by a concerned reader that the images shown in Fig. 1E to represent the results from osteoclast differentation experiments were strikingly similar to data appearing in different form in another article written by different authors at different research institutes [Yang Y, Su Y, Wang D, Chen Y, Wu T, Li G, Sun X and Cui L: Tanshinol attenuates the deleterious effects of oxidative stress on osteoblastic differentiation via Wnt/FoxO3a signaling. Oxid Med Cell Longev 6: 351895, 2013]. Owing to the fact that the contentious data in the above article had already been published prior to its submission to Molecular Medicine Reports, the Editor has decided that this paper should be retracted from the Journal. The authors were asked for an explanation to account for these concerns, but the Editorial Office did not receive a reply. The Editor apologizes to the readership for any inconvenience caused. [Molecular Medicine Reports 17: 6969­6976, 2018; DOI: 10.3892/mmr.2018.8741].

Intrinsic Cortical Property Analysis of the Medial Column of Proximal Humerus.

OBJECTIVE: Adequate mechanical support of the medial column is paramount to maintain fracture reduction in locking plating of proximal humerus fractures. However, intrinsic cortical properties of the medial column are rarely discussed. The purpose of the study is to describe regional variation of cortex in the medial column. METHODS: A total of 147 healthy participants were eligible for enrollment between December 2016 and December 2018. Subjects were divided into three groups: group A (20-39 years), group B (40-59 years), and group C (>60 years). For each individual, a color 3D thickness map for proximal humerus was created by cortical bone mapping (CBM) technique after bilateral shoulders were imaged by computed tomography. Measurement Indices including the cortical thickness (CTh), cortical mass surface density (CM) and the endocortical trabecular density (ECTD) were determined, after six regions of interest (ROI) were defined in metaphyseal region. Regional parameter variations were analyzed by one-way ANOVA. RESULTS: The CTh, CM and ECTD values were approximately equivalent between genders in the proximal part of the medial column across all ages (P > 0.05).The greatest difference between sexes was found in CTh and CM values of middle and distal part (P < 0.05). The CTh and CM within medial column were negatively associated with age (P < 0.05). The proximal cortical bone of the medial column was thicker and more dense, compared to the lateral column (P < 0.05). Significant regional variation was found in all measured parameters in group A, but not in groups B and C. CONCLUSION: Our finding proved that regional differences in the distribution of cortical bone in the medial column The attenuation of cortical bone heterogeneity in the medial column was found after the age of 40 years.

Circulating exosomal lncRNA contributes to the pathogenesis of spinal cord injury in rats.

Exosome-derived long non-coding RNAs (lncRNAs) are extensively engaged in recovery and repair of the injured spinal cord, through different mechanisms. However, to date no study has systematically evaluated the differentially expressed lncRNAs involved in the development of spinal cord injury. Thus, the aim of this study was to identify key circulating exosome-derived lncRNAs in a rat model of spinal cord injury and investigate their potential actions. To this end, we established a rat model of spinal cord hemisection. Circulating exosomes were extracted from blood samples from spinal cord injury and control (sham) rats and further identified through Western blotting and electron microscopy. RNA was isolated from the exosomes and sequenced. The enrichment analysis demonstrated that there were distinctively different lncRNA and mRNA expression patterns between the two groups. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis and Gene Ontology (GO) functional analysis were performed to determine the possible involvements of upregulated and downregulated lncRNAs in various pathways and different biological processes, as well as their cellular locations and molecular functions. Furthermore, quantitative reverse transcription-polymerase chain reaction showed that the expression of five lncRNAs--ENSRN0T00000067908, XR_590093, XR_591455, XR_360081, and XR_346933--was increased, whereas the expression of XR_351404, XR_591426, XR_353833, XR_590076, and XR_590719 was decreased. Of note, these 10 lncRNAs were at the center of the lncRNA-miRNA-mRNA coexpression network, which also included 198 mRNAs and 41 miRNAs. Taken together, our findings show that several circulating exosomal lncRNAs are differentially expressed after spinal cord injury, suggesting that they may be involved in spinal cord injury pathology and pathogenesis. These lncRNAs could potentially serve as targets for the clinical diagnosis and treatment of spinal cord injury.

Open reduction through original fracture line and fixation with locking plate is a feasible approach for extra-articular distal radius fracture malunion.

OBJECTIVES: This study aims to investigate the effectiveness of open reduction through original fracture line and fixation with locking plate in treatment of extra-articular distal radius fracture (DRF) malunion. PATIENTS AND METHODS: Between January 2015 and December 2018, a total of 69 patients (27 males, 42 females; mean age: 62.0±8.9 years; range, 46 to 70 years) suffering from symptomatic extra-articular DRF malunion were included. All patients were followed for more than six months. Patient's demographics, hand dominance, data including Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, pain on a Visual Analog Scale (VAS) score, radius height, ulnar variance, wrist range of motion, volar tilt and radial inclination before and after surgery were analyzed. RESULTS: The median follow-up was 14.13 months, and the median time to fracture healing after the operation was 14.25 weeks. The mean QuickDASH score and VAS score were significantly reduced from 63.4±13.97 and 4.6±1.23 preoperatively to 7.8±4.67 and 1.3±0.76 at the final follow-up, respectively. Radius height, ulnar variance, volar tilt, radial inclination and wrist range of motion (flexion, extension, pronation, supination) were all significantly improved (p<0.001). Images showed good radius height, ulnar variance, volar tilt and radial inclination. The range of motion of wrist and forearm were improved substantially. Among 69 patients, two patients received allograft due to osteoporotic bone collapse. No serious complication was developed, except for minor pain in three patients during follow-up. CONCLUSION: Open reduction through original fracture line and fixation with locking plate is a feasible and effective treatment for selective DRF malunion.

Menopause-related cortical loss of the humeral head region mainly occurred in the greater tuberosity.

Aims: Proximal humerus fractures are commonly observed in postmenopausal women. The goal of this study was to investigate menopause-related changes in cortical structure of the humeral head. Materials and methods: Clinical computed tomography (CT) scans of 75 healthy women spanning a wide range of ages (20-72 years) were analyzed. For each subject, cortical bone mapping (CBM) was applied to create a color three-dimensional (3D) thickness map for the proximal humerus. Nine regions of interest (ROIs) were defined in three walls of the humeral head. Cortical parameters, including the cortical thickness (CTh), cortical mass surface density (CM), and the endocortical trabecular density (ECTD), were measured. Results: Compared to premenopausal women, postmenopausal women were characterized by a significantly lower CTh and CM value in the lateral part of the greater tuberosity. Similar changes were only found in ROI 4, but not in ROIs 5-6 in the lesser tuberosity. Linear regression analysis revealed that the CTh and CM value of ROIs 1, 3, and 4 were negatively associated with age. These results showed that menopause-related loss in CTh and CM was mainly in the greater tuberosity besides the proximal part of the lesser tuberosity. Trabecular bone variable measured as ECTD showed a notably lower value in ROIs 1-9 in postmenopausal vs. premenopausal group. Inverse linear associations for ECTD and age were found in ROIs 2, 3, 5, 6, 7, and 9, indicating no site-specific differences of endocortical trabecular bone loss between the greater and lesser tuberosity. Conclusions: Menopause-related cortical loss of the humeral head mainly occurred in the lateral part of the greater tuberosity. The increased rate of humeral bone loss in the greater tuberosity may contribute materially to complex proximal humerus fractures.

MutiLoc Nail Versus Philos Plate in Treating Proximal Humeral Fractures: A Retrospective Study Among the Alderly.

BACKGROUND: Proximal humeral fractures (PHFs) account for 4-5% of all fractures in the elderly. There is still a controversy among the treatments in the displaced PHFs. Our aim was to explore the clinical outcome of PHFs with the treatment of MultiLoc nail or Philos plate in the elderly patients. METHODS: A total of 82 sustained elderly patients with PHFs were finally recruited between Dec 2016 and Dec 2017. 34 patients were treated with MultiLoc nail and 48 patients were treated with Philos plate. The demographics, fracture types, blood loss, operation time, union time, postoperative complications, visual analog scores (VASs), Constant scores, American Shoulder and Elbow Scores (ASESs), and neck-shaft-angle (NSA) between the two groups were compared. RESULTS: No differences were observed in the demographics, fracture types, VAS, Constant scores, and ASES scores between the two groups at final follow-up. Compared with the plate group, the blood loss, operation time, and union time were significantly lower in the nail group (all P < .05). The rate of general complications was 54.17% in the plate group, which was higher than that in the nail group (26.47%, P = .01). Three patients experienced reoperation in the plate group (3/48; 6.25%), but none in the nail group. Although there were no significant differences in intraoperative NSA between the two groups, the NSA at final follow-up in the nail group was much higher than the plate group (137.55 ± 5.53°vs 134.47 ± 5.92°, P = .02). CONCLUSIONS: Multiloc intramedullary nail showed the similar effectiveness of final VAS, final Constant scores, and ASES scores in PHFs treatment with Philos plate. However, MultiLoc nail is superior to Philos plate in blood loss, operation time, complications, reoperation rate, and the change of NSA.

Tanshinone­IIA attenuates the deleterious effects of oxidative stress in osteoporosis through the NF­κB signaling pathway.

Osteoclasts are responsible for bone resorption caused by bone microstructural damage and bone-related disorders. Evidence shows that tanshinone IIA (Tan­IIA), a traditional Chinese medicine, is used clinically as a drug for the treatment of cardiovascular and cerebrovascular diseases. However, the efficacy and mechanism underlying the effect of Tan­IIA on the viability of osteoclasts remain to be fully elucidated. The present study investigated the therapeutic effects of Tan­IIA on osteoblast differentiation and oxidative stress in vitro and in vivo. Cell viability was analyzed and oxidative stress was examined in the osteoblasts. Wnt1sw/sw mice were used to investigate the therapeutic effects of Tan­IIA on spontaneous tibia fractures and severe osteopenia. The bone strength, collagen and mineral were examined in the tibia. Osteoblast activity was also analyzed in the experimental mice. The Tan­IIA­induced differentiation of osteoclasts and the mechanism of action were investigated in osteocytes. The data showed that Tan­IIA treatment improved cell viability. The data also demonstrated that Tan­IIA decreased the levels of H2O2, accumulation of reactive oxygen species and apoptosis of osteoblasts. Tan­IIA inhibited the deleterious outcomes triggered by oxidative stress. In addition, Tan­IIA inhibited the activation of nuclear factor (NF)­κB and its target genes, tumor necrosis factor (TNF)­α, inducible nitric oxide synthase and cyclooxygenase 2, and increased the levels of TNF receptor­associated factor 1 and inhibitor of apoptosis protein­1/2 in the osteocytes. Furthermore, it was shown that Tan­IIA reduced the propensity to fractures and severe osteopenia in mice with osteoporosis. Tan­IIA also exhibited improved bone strength, mineral and collagen in the bone matrix of the experimental mice. It was found that the Tan­IIA­mediated benefits on osteoblast activity and function were through the NF­κB signaling pathway. Taken together, the data obtained in the present study suggested that Tan­IIA had protective effects against oxidative stress in osteoblastic differentiation in mice with osteoporosis by regulating the NF­κB signaling pathway.

Effect of Methionine Restriction on Bone Density and NK Cell Activity.

Methionine restriction (MR) is proven to increase the lifespan; and it also affects the bone density and the innate immune system. The aim of this study is to explore the effect of methionine restriction on bone density and natural killer (NK) cells. C57BL/6J mice were subjected to either basal diet (BD, containing 0.80% methionine) or methionine-restricted diet (containing 0.14% methionine). Mice with MR diet displayed reduced bone mass and decrease in the cytotoxicity of NK from the spleen, compared to BD animals. Also, mice with MR diet had an inferior body weight (P < 0.05) and higher plasma levels of adiponectin and FGF21 (P < 0.05) but lower concentrations of leptin and IGF-1 (P < 0.05). Overall, the investigation shows that methionine affects bone density and NK cell cytotoxicity.

High-Methionine Diet Attenuates Severity of Arthritis and Modulates IGF-I Related Gene Expressions in an Adjuvant Arthritis Rats Model.

Rheumatoid arthritis, a synthesized form of adjuvant arthritis exhibited throughout many animal species, inhibits liver function and circulation of IGF-I and contributes to the degradation of skeletal muscle mass. One of the primary goals of the present study is determining whether a high-Methionine (high-Met) diet is capable of reducing the adverse effects of arthritis, namely, loss of body mass. Following adjuvant injection, forty arthritic rats were randomly assigned to either a control group with a basal diet or a high-Met group with the same basal diet + 0.5% Methionine. After 14 days all rats were terminated. The high-Met group exhibited an increase in body weight and food intake in comparison with the control group (P < 0.05). High-Met diet debilitated arthritis-induced surges in the gastrocnemius in both atrogin-1 and the MuRF1 expressions; however, it was observed to have little to no effect on atrogin-1 and MuRF1 gene expression in soleus. At the same time, high-Met diet rats experienced a rise in IGF-I, with lowering of IGFBP-3 gene expression in the gastrocnemius and the soleus. These data suggest that arthritis severity can be partly attenuated by high-Met diet.

Vascularised iliac bone grafting in the treatment of femoral neck nonunion in young adults: a retrospective study.

INTRODUCTION: Revision internal fixation for femoral neck nonunion in young patients can pose a surgical challenge. Hip salvage protocols include osteotomy and osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularised or nonvascularised fibular graft). The purpose of this study was to evaluate the clinical outcomes of vascularised iliac grafting for femoral neck nonunion in patients younger than 50 years. MATERIALS AND METHODS: A total of 22 patients underwent vascularised iliac grafting and internal fixations for femoral neck nonunion were retrospectively analysed. Their mean age was 36.6 years. The cases were evaluated radiographically and clinically. RESULTS: All the patients were followed-up for an average of 64.6 months. The mean time to union for all patients was 5.4 months. The mean Harris Hip Score had increased from 55.3 preoperatively to 85.2 at the latest follow-up. The average neck-shaft angle had changed from 127.4° preoperatively to 128.3° postoperatively. Postoperative progression of osteonecrosis of the femoral head was seen in 3 patients, 2 patients were pain free and 1 patient required total hip arthroplasty 9 years after the revision procedure. There was no further progression in 3 patients with preoperative radiological evidence of the femoral head osteonecrosis. CONCLUSIONS: This study indicates that vascularised iliac grafting is a viable option in treatment of femoral neck nonunion in the young adult.

Sanders II type calcaneal fractures: a retrospective trial of percutaneous versus operative treatment.

OBJECTIVE: The purpose of this study was to compare the clinical results of percutaneous reduction and Steinman pin fixation for Sanders II calcaneal fractures with those of operative management through an extensile lateral approach. METHODS: Fifty-three patients treated with standard open reduction and internal fixation (ORIF group) and 54 patients who had undergone percutaneous reduction and Steinman pin fixation (CRIF group) were retrospectively reviewed. There were no differences between the groups regarding sex, age or fracture classification. Pain and functional outcome were evaluated with a visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Wound complications and radiological results were compared. RESULTS: At a mean follow-up of 40.4 months (24 to 56 months), there were no differences between the two groups in mean AOFAS score, VAS score or radiologically determined variables. Two cases of deep infection and six of poor wound healing occurred in the ORIF group and none in the CRIF group. Subtalar and ankle motion was found to be better in the CRIF group. CONCLUSIONS: Percutaneous reduction and Steinman pin fixation minimizes complications and achieves functional outcomes comparable to those of the open techniques in patients with Sanders II calcaneal fractures.