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E R Bogoch

Publications and source records attributed to E R Bogoch.

At least 19 recordsLinked to original sources
PubMed2006

Development of an integrated-care delivery model for post-fracture care in Ontario, Canada.

INTRODUCTION: The purpose of this study was to develop an integrated-care model for patients at highest risk for osteoporosis, those with a low-trauma fracture. Specific objectives were to describe the current processes and patterns of post-fracture care in hospitals in Ontario; to examine health-care professional and patient awareness of osteoporosis and the roles and responsibilities of various organizations and health care professionals; and to identify barriers and facilitators and obtain feedback on the model. METHODS: In 2002, questionnaires were completed for 178 eligible hospitals. RESULTS: Only 65% of hospitals inform primary-care physicians of a fracture for all patients and only 4% indicated that they provide information about osteoporosis. The main themes that emerged from the four patient focus groups (n=21) were lack of continuity of care, the absence of a link between the fracture and osteoporosis by both patients and health care providers, and need for information. Most participants agreed that something was needed to prompt their primary-care physician to investigate for osteoporosis. The four physician focus groups (n=26) identified a role for orthopaedic surgeons to flag cases. CONCLUSIONS: From 34 key informant interviews with community-based organizations, we found a lack of integration between health care professionals who provide fracture care and those who provide osteoporosis management and fall prevention. Based on these data, we developed an integrated local-resource-based post-fracture care model, which we obtained feedback on at a stakeholder consultation workshop. The model focuses on improving emergency department/fracture clinic communication, emphasizes the need for follow-up investigation by family physicians for osteoporosis, and incorporates other health care professionals and a telemedicine multidisciplinary osteoporosis clinic. We are currently evaluating whether this model leads to an increase in appropriate investigation of and treatment for osteoporosis in patients with low-trauma fractures.

Attitude of Health Personnel↗
PubMed2004

Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review.

Fragility fractures are a strong indicator of underlying osteoporosis (OP). With the risk of future fracture being increased 1.5- to 9.5-fold following a fragility fracture, the diagnosis and treatment of OP in men and women with fragility fractures provides the opportunity to prevent future fragility fractures. This review describes the current status of practice in investigation and diagnosis of OP in men and women with fragility fractures, the rates and types of postfracture treatment in patients with fragility fractures and OP, interventions undertaken in this population, and the barriers to OP identification and treatment. A literature search performed in Medline, Healthstar, CINAHL, EMBASE, PreMedline, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews identified 37 studies on OP diagnosis, treatment, and interventions. The studies varied in design methodology, study facilities, types of fractures, and pharmacological treatments. Some studies revealed that no patients with fragility fractures received investigation or treatment for underlying OP. Investigation of OP by bone mineral density was low: 14 of 16 studies reported investigation of less than 32% of patients. Investigation by bone mineral density resulted in high rates of OP diagnosis (35-100%), but only moderate use of calcium and vitamin D (8-62%, median 18%) and bisphosphates (0.5-38%) in patients investigated postfracture. Studies on barriers to OP identification and treatment focused on various groups of health practitioners. Barriers included the cost of therapies, time and cost of resources for diagnosis, concerns about medications, and the lack of clarity regarding the responsibility to undertake this care.

Absorptiometry, Photon↗
PubMed2004

Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis.

BACKGROUND: Osteoarthritis (OA) of the hip is a progressive condition that has no cure and often requires a total hip arthroplasty (THA). The principal methods for THA are the posterior and direct lateral approaches. The posterior approach is considered to be easy to perform, however, increased rates of dislocation have been reported. The direct lateral approach facilitates cup positioning which may decrease rates of hip dislocation and diminishes the risk of injury to the sciatic nerve. However, there is an increased risk of limp. Dislocation of a hip prosthesis is a clinically important complication after THA, in terms of morbidity implications and costs. OBJECTIVES: To determine the risks of prosthesis dislocation, postoperative Trendelenburg gait and sciatic nerve palsy after a posterior approach, compared to a direct lateral approach, for adult patients undergoing THA for primary OA. SEARCH STRATEGY: MEDLINE, EMBASE, CINHAL and Cochrane databases were searched until 2002. No language restrictions were applied. SELECTION CRITERIA: Published trials comparing posterior and direct lateral surgical approaches to THA in participants 18 years and older with a diagnosis of primary hip OA. DATA COLLECTION AND ANALYSIS: Retrieved articles were assessed independently by the two reviewers for their methodological quality. MAIN RESULTS: Four prospective cohort studies involving 241 participants met the inclusion criteria. The primary outcome, dislocation, was reported in two studies. No significant difference between posterior and direct lateral surgical approach was found [1/77 (1.3%) versus 3/72 (4.2%); relative risk (RR) 0.35; 95% confidence intervals (CI) 0.04 to 3.22]. The presence of postoperative Trendelenburg gait was not significantly different between these surgical approaches. The risk of nerve palsy or injury was significantly higher among the direct lateral approaches [1/43 (2%) versus 10/49 (20%); RR 0.16, 95% CI 0.03 to 0.83]. However, there were no significant differences when comparing this risk nerve by nerve for both approaches, in particular for the sciatic nerve. Of the other outcomes considered only the average range of internal rotation in extension of the hip was significantly higher (weighted mean difference 16 degrees, 95% CI 8 to 23) in the posterior approach group (mean 35 degrees, standard deviation 13 degrees ) compared to the direct lateral approach (mean 19 degrees, standard deviation 13 degrees ). REVIEWER'S CONCLUSIONS: The quality and quantity of information extracted from the trials performed to date are insufficient to make any firm conclusion on the optimum choice of surgical approach in adult patients undergoing primary THA for OA.

Adult↗
PubMed2004

Assessing damage in individual joints in rheumatoid arthritis: a new method based on the Larsen system.

OBJECTIVES: To evaluate observer agreement using the Larsen system (LS) and a Modified Larsen system (ML) when assessing individual joints of the hands and wrists in rheumatoid arthritis, and to compare the two systems. To determine the minimally important difference (MID) for the ML. METHODS: Thirty radiographs of hands and wrists from 10 patients who presented with RA were graded by two blinded observers, using the LS and then the ML. Patients were followed for a mean of 7.2 years (range: 4-10 years). Inter- and intra-observer agreement were calculated using the kappa statistic with linear incremental weights. Inter-observer agreement was also computed for the summed score, using an intraclass correlation coefficient. Inter-observer error was estimated by calculating the mean and standard deviation of the grading differences between the two observers. Prevalence of damage was calculated as a ratio of damage: no damage and expressed as a percentage. Pairs of radiographs were comparatively graded using a seven-point Likert scale. RESULTS: The kappa statistic for inter-observer agreement was 0.38 (marginal reproducibility) for the LS and 0.52 (good reproducibility) for the ML (P = 0.004). Using a difference of one grade as perfect agreement, it was 0.56 (good reproducibility) for the LS and 0.87 (excellent reproducibility) for the ML (P = 0.001). Intra-observer agreement was high in both systems. The distribution of ML-grade differences varied according to the level of the Likert scale: for "a little bit worse", representing the smallest amount of detectable damage progression, the distribution differences peaked around two grades. This value represented a MID 87% of the time. CONCLUSIONS: The LS lacks precision for individual joints. The ML, it is proposed, has more detailed definitions of grades, and is more reliable. When pairs of radiographs were compared, a two-grade difference on the ML was the MID.

Arthritis, Rheumatoid↗
PubMed2004

Surgery of the hand in severe systemic sclerosis.

Ten patients with scleroderma and severe hand problems required surgery, and seven were available for follow-up (two died from scleroderma-related complications and one was lost to follow-up). The mean duration of follow-up was 4 (range 1.5-9) years. Thirty-three procedures were carried out, including five metacarpophalangeal joint excisional arthroplasties, 13 proximal interphalangeal joint fusions, ten distal interphalangeal joint fusions, and one thumb interphalangeal joint fusion. The metacarpophalangeal joint excision arthroplasties and proximal interphalangeal joint fusions were performed for the correction of severe fixed "finger-in-palm" deformities. Lesions of cutaneous calcinosis were removed in four patients. Fixation was satisfactory in all cases of interphalangeal joint fusion, with no cases of nonunion. Wound healing was satisfactory in six of seven patients. A second surgical procedure was required in three patients for the removal of tension band wires following interphalangeal fusion. Calcinosis was effectively removed using a high-speed dental burr. The results of hand surgery for systemic sclerosis are reliable, but goals must be limited and patient expectations should be modest.

Adult↗
PubMed2001

High frequency acoustic parameters of human and bovine articular cartilage following experimentally-induced matrix degradation.

Matrix degradation and proteoglycan loss in articular cartilag eare features of early osteoarthritis. To determine the effect of matrix degradation and proteoglycan loss on ultrasound propagation in cartilage, we used papain and interleukin-1alpha to degrade the matrix proteoglycans of human and bovine cartilage samples, respectively. There is also minor collagen alteration associated with these chemical degradation methods. We compared the speed of sound and frequency dependent attenuation (20-40 MHz) of control and experimental paired samples. We found that a loss of matrix proteoglycans and collagen disruption resulted in a 20-30% increase in the frequency dependent attenuation and a 2% decrease in the speed of sound in both human and bovine cartilage. We conclude that the frequency dependent attenuation and speed of sound in articular cartilage are sensitive to experimental modification of the matrix proteoglycans and collagen. These findings suggest that ultrasound can potentially be used to detect morphologic changes in articular cartilage associated with the progression of osteoarthritis.

Adult↗
PubMed2000

Investigation and treatment of osteoporosis in patients with fragility fractures.

BACKGROUND: Many patients who have undiagnosed osteoporosis and a recent fragility fracture present to fracture clinics in Canadian hospitals, where the focus of management is on fracture care. The rate of diagnosis and treatment of osteoporosis in this patient group is unknown. METHODS: Patients who presented with fractures at sites consistent with fragility-type fractures were identified through a retrospective chart review of fracture clinic visits in 3 Ontario community hospitals in selected weeks in February and November 1996 and August and May 1997. These patients were contacted by mail and telephone follow-up to obtain consent to participate in a telephone interview. Patients were excluded if the index fracture had been traumatic, if they were younger than 18 years, or if they had medical conditions known to be associated with secondary bone loss. Eligible patients were questioned about their history of prior fractures, diagnosis of osteoporosis, and investigation and treatment of osteoporosis before or after the index fracture. RESULTS: Among 2694 fracture clinic visits, we identified 228 patients (8.4%) with fragility-type fractures. Of the 228, 128 (56.1%) were contacted and agreed to participate in an interview about 1 year from the date of the index fracture. Of the 128 patients, 108 (83 postmenopausal and 13 premenopausal women and 12 men) were confirmed as eligible. Of the 108, 43 had experienced 53 fractures in addition to the index fracture in the preceding 10 years, of which 71% were of the fragility type. At interview, only 20 (18.5%) (all postmenopausal women) of the 108 patients reported that they had received a diagnosis of osteoporosis. Of the 20, 90% and 45% respectively had been advised to take calcium and vitamin D supplements; 8 (40%) were receiving hormone replacement therapy (HRT), and 8 (40%) were taking bisphosphonates. Of the 88 patients who had not received a diagnosis of osteoporosis, 4 (4.5%) were receiving HRT, none was taking bisphosphonates, and less than 20% had been advised to take supplemental calcium or vitamin D. INTERPRETATION: In a representative sample of patients at urban fracture clinics, less than 20% who presented with a fragility-type fracture had undergone investigation and adequate treatment of osteoporosis at 1-year follow-up. Since previous fracture significantly increases the risk for future fracture, this clearly is a deficiency in management. Through improved identification and treatment of patients with osteoporosis-related fractures who present to fracture clinics, there is a significant opportunity to reduce the rates of illness and death associated with this condition.

Calcium↗
PubMed2000

Changes in cross-sectional geometry of the distal femoral metaphysis associated with inflammatory arthritis are reduced by a bisphosphonate (zoledronate).

An increased risk of fracture is a feature of rheumatoid arthritis and of animal models of inflammatory arthritis. We examined geometrical changes in the metaphyseal cortex of the distal femur in an animal model of inflammatory arthritis. Additionally, we examined the effect of a bisphosphonate in preventing these changes. Five groups of rabbits were studied: normal controls, those with inflammatory arthritis, and three groups with arthritis treated with bisphosphonate. To determine geometrical properties, image analysis was performed on digitized cross sections of the femoral metaphyseal cortices. The results demonstrated that the posterior cortical wall was significantly less thick in rabbits with arthritis than in normal rabbits and in the rabbits in the three bisphosphonate treatment groups (p < 0.05). Moment of inertia about the lateral-medial axis was reduced in rabbits with arthritis compared with normal rabbits (p < 0.05). Cross-sectional area was not significantly different between groups. The changes suggest a mechanism of weakening of bone in arthritis; when the results are coupled with results of previous porosity studies, severe directional weakness is apparent. Bisphosphonate was effective in preserving bone integrity in inflammatory arthritis.

Animals↗
PubMed2000

Carrageenan-induced arthritis in the rat.

This study documents a model of carrageenan-induced chronic inflammatory arthritis in the rat, using quantitative histomorphometric assessment. Ten Sprague-Dawley female rats were randomly assigned to one of two groups. Arthritis was induced in the right tibiofemoral joint by 7 intra-articular injections of 0.02 mL of 1% carrageenan in the arthritic group over 24 days. The control (normal) group was injected with 0.02 mL of saline in the right tibiofemoral joint. Sagittal sections of the right knee joint (distal femur and proximal tibia) were assessed by histomorphometry using the LECO 2001 image analysis system. Articular cartilage thickness, epiphyseal plate thickness, subchondral bone plate thickness, trabecular bone volume and thickness of the synovial lining cell layer were measured. Differences between normal and arthritic groups were statistically significant for articular cartilage thickness of the femur, epiphyseal plate thickness of both the femur and tibia, subchondral bone plate thickness of the tibia and the thickness of the synovial lining cell layer. These findings demonstrate that carrageenan-induced arthritic changes are similar to other, established models of arthritis in the rat.

Animals↗
PubMed2000

Theoretical relationship between maximum pore size and toughness in experimental inflammatory arthritis.

Rheumatoid arthritis increases the risk of fracture. In an animal model of inflammatory arthritis, femoral diaphysis had a decreased toughness as well as increased cortical porosity, when compared to normal bone. Based on the hypothesis that stress concentration from the large porous defects reduces the ability of the cortical bone to resist failure, this work determined if the changes observed in porosity could explain the changes observed in toughness. Using theoretical relationships of the stress concentration and stress states, a model of the observed conditions was considered. A relationship was developed that indicated the relative difference in toughness between normal and arthritic specimens as a function of pore size. Results indicated that the increase in cortical pore size could theoretically reduce toughness by 55%. This decrease compares with the experimentally observed drop in toughness of 61%. Furthermore, the critical parameter for fracture in this situation is the ratio of pore diameter to cortical thickness. Efforts to reduce cortical porosity seen in inflammatory arthritis would be effective in enhancing the toughness of bone and may reduce morbidity in a human population.

Journal Article↗
PubMed2000

Conservation of the elastic and flexural moduli of osteopenic femoral cortical bone in experimental inflammatory arthritis in the rabbit.

Experimental inflammatory arthritis (EIA) produced by carrageenan injection provokes a rapid bone remodeling state with cortical and cancellous bone loss. The objective of this study was to determine whether changes in cortical mechanical properties and/or geometry occur in long bones, either near or remote to the site of inflammation. EIA was induced in the right tibio-femoral joint of rabbits over 56 days. The right humerus and right femur from 15 normal and 25 arthritis group animals were excized. Semi-cylindrical specimens of the medial cortical shaft were subjected to non-destructive four-point bending tests. Transverse sections at the four contact sites of the loading jig were photographed and digitized to obtain average cross-sectional area (A) and moment of inertia (I). Moment of inertia and slope of the load/deflection curve permitted calculation of modulus of elasticity (E) for each specimen. Load/time curves were also used to calculate per cent stress remaining in relaxation experiments. Per cent stress remaining, E, A, I and square root of I/A (radius of gyration) were examined for differences by bone (humerus, femur) and by treatment (N,A) using two way ANOVA. The induction of inflammatory arthritis did not significantly alter the modulus of elasticity in either the femur or humerus; however, arthritis reduced the moment of inertia from 34.54 +/- 2.88 x 10(-12) m4 to 25.06+/-1.80 x 10(-12) m4 (mean+/-SEM, p < 0.05). This was observed in the femur (near the arthritic joint), but not in the humerus (remote from arthritic joint). Analysis of area and ratio I/A demonstrated that this geometric effect of treatment was due to reduced area without gross cross-sectional shape changes. Per cent stress remaining in the femur (but not in the humerus) was higher in the arthritis specimens than in the normal specimens (N: 80.86 < 0.97%; A: 83.25 +/- 0.71%, p < 0.05). Thus, in this arthritis model, the principal mechanical or geometric effect on cortical bone was reduction of the cross-sectional area and moment of inertia. The viscoelastic relaxation response of bone was also altered, perhaps due to loss of water or collagen degradation.

Journal Article↗
PubMed2000

Acute metastatic infection of a revision total hip arthroplasty with oral bacteria after noninvasive dental treatment.

The risk of hematogenous bacterial infection of a total joint prosthesis is currently considered to be greatest in the 2 years after arthroplasty or when the patient is chronically ill or immunocompromised, for dental treatments that are considered invasive, with a higher incidence of bacteremia. We report the case of a healthy man who had undergone revision hip arthroplasty 11 months previously and who developed acute signs of infection of the hip prosthesis with an oral organism 30 hours after supragingival dental cleaning, performed with the specific intention to be noninvasive, without antibiotic prophylaxis.

Abscess↗
PubMed2000

Outcome of total hip replacement for avascular necrosis in systemic lupus erythematosus.

OBJECTIVE: To describe the short and medium term results of total hip arthroplasty (THA) for avascular necrosis in patients with systemic lupus erythematosus (SLE). METHODS: Nineteen patients with SLE and avascular necrosis of the femoral head (AVNFH), who underwent 26 THA were retrospectively reviewed with a minimum followup of 2 years. To determine whether these patients had results similar to those of patients with other conditions, we formed a control group of 19 patients who had 29 THA. They were matched for age, sex, and followup to the patients with SLE. Controls had THA for juvenile rheumatoid arthritis (n = 7), osteoarthritis (5), adult onset rheumatoid arthritis (8), developmental dysplasia of the hip (4), and other diagnoses (5). Outcome measures included a 10 point visual analog scale (VAS) for pain, the Harris hip score, and the SF-36 self-administered health outcome questionnaire. We used the methods of Delee, Harris, and Engh for radiological assessment. RESULTS: Mean age at surgery was 46 years (range 21-71 years) and average followup was 4 years, 7 months (range 1 yr 9 mo to 9 yrs 6 mo), similar in both groups. Technical problems, mostly consisting of small, nonpropagating cracks of the calcar in uncemented stems, were encountered in 4 SLE hips and 1 control hip. Six complications were noted in the SLE group, including 2 early, nonrecurrent dislocations, 1 patient with thigh pain for 1 year, 1 pericarditis, 1 sick-sinus syndrome, and 1 urinary tract infection. There was one case of urinary tract infection in the control group. One SLE patient developed a low grade prosthetic infection and underwent successful revision 2 years after primary surgery. Clinical outcome measures had similar scores in the 2 groups: average VAS pain score = 2.00 in SLE hips (maximum 10) and 1.97 in control hips; mean Harris hip score = 86.7 in SLE patients (maximum 100) and 81.9 in controls; average SF-36 score = 63.4 in SLE patients (maximum 100) and 60.5 in controls. There was no radiological evidence of implant loosening in controls; there was 1 asymptomatic cup migration in the SLE group. CONCLUSION: In the short and medium term, patients with SLE and AVN had good results after THA. Results were similar in patients who had hip replacement for other diagnoses. Less favorable clinical outcomes of hip replacement have been reported in young patients who have AVN of other etiology (e.g., alcoholic, post-traumatic), but this was not the case in our young patients who had AVN and SLE. Thus, AVNFH and SLE should not constitute a contraindication to hip replacement.

Adult↗
PubMed2000

Type and outcome of reconstructive surgery for different patterns of psoriatic arthritis.

OBJECTIVE: To describe our experience of musculoskeletal surgery in patients with different patterns of psoriatic arthritis (PsA). METHODS: From 1986 to 1996, 71 operations in 43 patients with established PsA were performed at our institution. The patterns of PsA recognized in this patient group were: distal PsA, oligoarticular PsA, and polyarticular PsA, with or without associated spondylitis. Surgical findings and procedure, intra- and postoperative complications were recorded. Nineteen patients were available for clinical evaluation, both by conventional surgeon generated and by patient generated self-administered questionnaires. RESULTS: The majority of patients had polyarticular PsA. All operations in patients with distal PsA were distal interphalangeal (DIP) and proximal interphalangeal (PIP) joint fusions. All operations in patients with oligoarticular PsA involved the hip or knee. Polyarticular patients underwent a range of procedures. Soft tissue contractures and bone loss required specific attention in 14 procedures. In the 19 patients who were reviewed clinically, conventional scoring of individual procedures showed good to excellent results. Patient oriented outcomes had low scores compared to a disease-free general population. CONCLUSION: The 3 principal patterns of PsA are associated with different types of surgery. Although traditional surgeon generated scores evaluating individual procedures indicated results comparable to patients who have osteoarthritis, patient generated outcome measures of global health and function scored substantially lower than a general, arthritis-free population, reflecting the burden of polyarticular involvement.

Adult↗
PubMed2000

Determinants and outcomes of inpatient versus home based rehabilitation following elective hip and knee replacement.

OBJECTIVE: There are large variations in practice patterns and costs of rehabilitation following total joint replacement (TJR). We evaluated the determinants of rehabilitation setting (home based vs inpatient) after TJR, and its influence on early functional outcomes. METHODS: We studied a retrospective cohort of 146 primary total hip and knee replacements. Ninety-six patients completed a mailed survey consisting of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the Medical Outcomes Survey Short Form-36 (SF-36), and a satisfaction questionnaire. RESULTS: The mean age of the cohort was 66 years, 70% were women, and osteoarthritis was the primary diagnosis in 79%. Thirty-nine percent received home based rehabilitation. Determinants of home based rehabilitation included preference for home based rehabilitation, male sex, and knowledge regarding TJR. At a mean followup of 8 months post TJR, there were no significant differences between the inpatient and home based rehabilitation groups with respect to the WOMAC, SF-36, and satisfaction scores. CONCLUSION. These results support continued use of home based rehabilitation.

Aged↗
PubMed2000

Improving patient satisfaction with time spent in an orthopedic outpatient clinic.

OBJECTIVE: To determine if patient satisfaction can be improved by changing patients' expectations of the clinic visit and by decreasing the total time spent in the clinic. DESIGN: A prospective comparative analysis carried out in 4 phases. SETTING: An university-affiliated orthopedic outpatient clinic. PATIENTS: All patients seen in the orthopedic outpatient clinic were eligible. Phase 1 determined the total clinic time required by patient type; phase 2 assessed baseline satisfaction; phase 3 altered patients' expectations; and phase 4 altered patients' expectations and scheduled visits by patient type. INTERVENTION: Patient questionnaires. MAIN OUTCOME MEASURE: Patient satisfaction with time spent in the clinic. RESULTS: Of 708 distributed questionnaires, 622 (88%) were completed (547 totally complete, 75 partially complete). Total time spent in the clinic decreased across phases 2, 3 and 4 (mean 99.2, 94.7 and 85.2 minutes, respectively, but was significantly different only between phases 3 and 4; p = 0.05, Duncan's multiple range test). The percentage of patients who rated their waiting time as "excellent" increased across phases 2, 3 and 4 (14.6%, 18.8% and 31.1%, respectively; p = 0.0004, chi 2 test). CONCLUSION: Patient satisfaction can be improved by altering patient expectations and by decreasing the total time spent in clinic.

Female↗
PubMed1999

Activated T cells regulate bone loss and joint destruction in adjuvant arthritis through osteoprotegerin ligand.

Bone remodelling and bone loss are controlled by a balance between the tumour necrosis factor family molecule osteoprotegerin ligand (OPGL) and its decoy receptor osteoprotegerin (OPG). In addition, OPGL regulates lymph node organogenesis, lymphocyte development and interactions between T cells and dendritic cells in the immune system. The OPGL receptor, RANK, is expressed on chondrocytes, osteoclast precursors and mature osteoclasts. OPGL expression in T cells is induced by antigen receptor engagement, which suggests that activated T cells may influence bone metabolism through OPGL and RANK. Here we report that activated T cells can directly trigger osteoclastogenesis through OPGL. Systemic activation of T cells in vivo leads to an OPGL-mediated increase in osteoclastogenesis and bone loss. In a T-cell-dependent model of rat adjuvant arthritis characterized by severe joint inflammation, bone and cartilage destruction and crippling, blocking of OPGL through osteoprotegerin treatment at the onset of disease prevents bone and cartilage destruction but not inflammation. These results show that both systemic and local T-cell activation can lead to OPGL production and subsequent bone loss, and they provide a novel paradigm for T cells as regulators of bone physiology.

Animals↗