AUTHORS
Hiroshige Sano, Tristan Whitmarsh, Linda Skingle, Taketoshi Shimakura, Noriaki Yamamoto, Juliet E. Compston, Hideaki E. Takahashi, Kenneth E. S. Poole
ABSTRACT
Romosozumab treatment reduces the rate of hip fractures and increases hip bone density, increasing bone formation by inhibiting sclerostin protein. We studied the normal pattern of bone formation and osteocyte expression in the human proximal femur because it is relevant to both anti-sclerostin treatment effects and fracture. Having visualized and quantified buds of new bone formation in trabeculae, we hypothesized that they would coincide with areas of a) higher mechanical stress and b) low sclerostin expression by osteocytes. In patients with hip fracture, we visualised each bud of active modeling-based formation, (Forming Minimodeling Structure, FMiS) in trabecular cores taken from different parts of the femoral head. Trabecular bone structure was also measured with high resolution imaging.
More buds of new bone formation (by volume) were present in the higher stress supero-medial zone (FMiS density, N.FMiS/T.Ar) than lower stress supero-lateral (p < 0.05), and inferomedial (p < 0.001) regions. There were fewer sclerostin expressing osteocytes close to, or within FMiS. FMiS density correlated with greater amount, thickness, number and connectivity of trabeculae (bone volume BV/TV, r = 0.65, p < 0.0001; bone surface BS/TV, r = 0.47, p < 0.01; trabecular thickness Tb.Th, r = 0.55, p < 0.001; trabecular number Tb.N, r = 0.47, p < 0.01; and connectivity density Conn.D, r = 0.40, p < 0.05) and lower trabecular separation (Tb.Sp, r = −0.56, p < 0.001).
These results demonstrate modeling-based bone formation in femoral trabeculae from patients with hip fracture as a potential therapeutic target to enhance bone structure.