Buds of new bone formation within the femoral head of hip fracture patients coincide with zones of low osteocyte sclerostin

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.

Cigarette smoke-associated inflammation impairs bone remodeling through NFκB activation

AUTHORS

Yi Lu, Yuanpu Peter Di, Ming Chang, Xin Huang, Qiuyan Chen, Ni Hong, Beth A. Kahkonen, Marissa E. Di, Chunyan Yu, Evan T. Keller & Jian Zhang

ABSTRACT

Background

Cigarette smoking constitutes a major lifestyle risk factor for osteoporosis and hip fracture. It is reported to impair the outcome of many clinical procedures, such as wound infection treatment and fracture healing. Importantly, although several studies have already demonstrated the negative correlation between cigarette consume and impaired bone homeostasis, there is still a poor understanding of how does smoking affect bone health, due to the lack of an adequately designed animal model. Our goal was to determine that cigarette smoke exposure impairs the dynamic bone remodeling process through induction of bone resorption and inhibition of bone formation.

Methods

We developed cigarette smoke exposure protocols exposing mice to environmental smoking for 10 days or 3 months to determine acute and chronic smoke exposure effects. We used these models, to demonstrate the effect of smoking exposure on the cellular and molecular changes of bone remodeling and correlate these early alterations with subsequent bone structure changes measured by microCT and pQCT. We examined the bone phenotype alterations in vivo and ex vivo in the acute and chronic smoke exposure mice by measuring bone mineral density and bone histomorphometry. Further, we measured osteoclast and osteoblast differentiation gene expression levels in each group. The function changes of osteoclast or osteoblast were evaluated.

Results

Smoke exposure caused a significant imbalance between bone resorption and bone formation. A 10-day exposure to cigarette smoke sufficiently and effectively induced osteoclast activity, leading to the inhibition of osteoblast differentiation, although it did not immediately alter bone structure as demonstrated in mice exposed to smoke for 3 months. Cigarette smoke exposure also induced DNA-binding activity of nuclear factor kappaB (NFκB) in osteoclasts, which subsequently gave rise to changes in bone remodeling-related gene expression.

Conclusions

Our findings suggest that smoke exposure induces RANKL activation-mediated by NFκB, which could be a “smoke sensor” for bone remodeling.