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Is high-dose estrogen-induced osteogenesis in the mouse mediated by an estrogen receptor?

Although estrogen is known to induce new bone formation in the long bones of female mice, this response is only thought to occur following administration of high doses, suggesting that it may not be mediated by a conventional estrogen receptor. To address this question further, we first examined the stereospecificity of this response by comparing the potency of 17beta-estradiol (E(2)) in stimulating cancellous bone formation at the proximal tibial metaphysis of intact female mice with that of the relatively inactive stereoisomer, 17alpha-estradiol (alphaE(2)). We found that E(2) was significantly more potent than alphaE(2), as assessed by histomorphometry. To provide further evidence for an estrogen-receptor-mediated process, we examined whether E(2)-induced osteogenesis in intact female mice could be inhibited by the estrogen receptor antagonist, ICI 182,780 (ICI). Although ICI itself had no effect on histomorphometric indices of the proximal tibial metaphysis when given alone, it significantly inhibited the osteogenic response to E(2). Finally, we examined the dose dependency of E(2)-induced osteogenesis at the proximal tibial metaphysis in intact mice. We found that E(2) stimulated cancellous bone formation in a dose-dependent manner over a wide dose range (i. e., 1-4000 microg/kg per day), with significant increases observed at doses of 4 microg/kg per day and beyond. Our results raise the possibility that estrogen-induced osteogenesis in the mouse represents an estrogen-receptor-mediated response that is not confined solely to supraphysiological estrogen levels.

Animals↗

Temporal and spatial expression of bone morphogenetic protein-2, -4, and -7 during distraction osteogenesis in rabbits.

The Ilizarov method of limb lengthening makes use of the fact that osteogenesis is induced at an osteotomy site when distraction is applied. It is unknown at present how the mechanical forces created by distraction are translated into biological signals. Because bone morphogenetic proteins (BMPs) are potent inducers of osteogenesis in many experimental systems, they are obvious candidates for playing a role in this process. In this study, we investigated the temporal and spatial expression of BMP-2, -4, and -7 proteins during distraction osteogenesis using immunohistochemistry. An osteotomy was performed on the right tibiae of white New Zealand rabbits. After a delay of 7 days, distraction was started at a rate of 0.25 mm/12 h for 3 weeks, followed by a 3 week consolidation phase. Each week after osteotomy one rabbit was killed for immunohistochemical studies. Staining for BMP-2, -4, and -7 was evident before distraction was applied and was mainly localized to mesenchymal cells and osteoblastic cells in the periosteal region. After distraction was started, the typical fibrous interzone developed between the osteotomy fragments, where both intramembranous and endochondral ossification were noted. In this area, cells resembling fibroblasts and chondrocytes, but not mature osteoblasts, showed intense staining for all three BMPs. This high level of expression was maintained during the entire distraction phase and then gradually disappeared during the consolidation phase. These results are compatible with the hypothesis that BMPs play an important role in the signaling pathways that link the mechanical forces created by distraction to biological responses.

Animals↗

Alendronate affects long bone length and growth plate morphology in the oim mouse model for Osteogenesis Imperfecta.

Alendronate, a bisphosphonate drug, has shown promise in reducing remodeling and bone loss in postmenopausal osteoporosis. Alendronate acts directly on the osteoclast, inhibiting its resorption capability. This inhibition of osteoclast activity has led to the use of bisphosphonates in the treatment of the osteogenesis imperfecta condition. Treatment of osteogenesis imperfecta with bisphosphonates enhances bone strength, but the consequences on linear bone growth are not well defined. Using the oim mouse model for type III osteogenesis imperfecta, two doses of alendronate, low (0.125 mg/kg/wk) and high (2.5 mg/kg/wk) were administered weekly via intraperitoneal injection starting at 4 weeks of age and ending at 12 weeks of age to assess the effects of alendronate on humerus and ulna length. The higher dose of alendronate reduced humerus and ulna length in the oim/wt and wt/wt genotypes for both sexes (P < 0.05). The oim/oim humerus and ulna were not significantly affected by the higher dose of alendronate in females, but reduced bone length in males (P < 0.0085). Proximal humerus growth plate area was affected by both genotype and alendronate dose and growth plate diameter was increased at the chondro-osseous junction by both alendronate doses (P < 0.011). Genotype and alendronate dose affected growth plate height. The oim/oim genotype displayed taller growth plates. The high dosage of alendronate increased overall growth plate height, particularly within the hypertrophic zone, which suggests a failure of vascular invasion-induced apoptosis in the hypertrophic cells. In conclusion, these results indicate that high doses of alendronate (>2.5 mg/kg/wk) inhibit long bone length in mice through alteration of the growth plate and possibly reduced resorption at the chondro-osseous junction.

Alendronate↗

Bone mineral content in osteogenesis imperfecta tarda and in otosclerosis.

In 22 patients with osteogenesis imperfecta and in 63 patients with otosclerosis the bone mineral content in peripheral bones was determined by photon absorptiometry. The bone mineral content proved significantly reduced in patients with osteogenesis imperfecta as compared with normals and with patients with otosclerosis. In the latter patients the bone mineral content was normal. These findings support the assumption that stapedial fixation in otosclerosis and in osteogenesis imperfecta is of different aetiology.

Adolescent↗

Temporal and spatial gene expression of major bone extracellular matrix molecules during embryonic mandibular osteogenesis in rats.

It is not known how gene expression of bone extracellular matrix molecules is controlled temporally and spatially, or how it is related with morphological differentiation of osteoblasts during embryonic osteogenesis in vivo. The present study was designed to examine gene expressions of type I collagen, osteonectin, bone sialoprotein, osteopontin, and osteocalcin during mandibular osteogenesis using in situ hybridization. Wistar rat embryos 13-20 days post coitum were used. The condensation of mesenchymal cells was formed in 14-day rat embryonic mandibles and expressed genes of pro-alpha 1 (I) collagen, osteonectin, bone sialoprotein and osteopontin. Cuboidal osteoblasts surrounding the uncalcified bone matrix were seen as early as in 15-day embryonic mandibles, while flat osteoblasts lining the surface of the calcified bone were seen from 16-day embryonic mandibles. Cuboidal osteoblasts expressed pro-alpha 1(I) collagen, osteonectin and bone sialoprotein intensely but osteopontin very weakly. In contrast, flat osteoblasts expressed osteopontin very strongly. Osteocytes expressed the extracellular matrix molecules actively, in particular, osteopontin. The present study demonstrated the distinct gene expression pattern of type I collagen, osteonectin, bone sialoprotein, osteopontin and osteocalcin during embryonic mandibular osteogenesis in vivo.

Animals↗

Continuous mandibular distraction osteogenesis using superelastic shape memory alloy (SMA).

Distraction osteogenesis is a well-established method of endogenous tissue engineering. It is a biological process of bone neo-formation between segments subjected to tension. The concept of this study was to investigate the distraction osteogenesis with a device capable of creating a permanent and constant force during the whole process as if a very large number of small elongations were applied constantly. The mechanical testing of the device used to produce the constant force and the in vivo analysis of the bone growth after it was implanted in rabbits are presented on this work. The device consists of a NiTi coil spring, superelastic at body temperature, in order to have a stress plateau during the austenitic retransformation during the unloading. The in vivo analysis was made on six female rabbits of 12 months old. A segmental mandibulectomy at the horizontal arm of the mandible and a corticotomy at 5mm distant from the gap were made. Next, following a latency period of five days, the SMA springs were implanted to induce the bone neo-formation. The displacement at the unloading plateau shows that it is necessary to have longer springs or to use several (available commercially) in series in order to fulfil the requirements of a human distraction. The temperature variations induced changes in the spring force. However, when the temperature returns to 37 degrees C the distraction force recovers near the initial level and does so completely when the distraction process continues. For the in vivo study, all six rabbits successfully completed the distraction. The radiographies showed the gap as distraction advanced. A continuity in the newly formed bone with similar transversal and horizontal dimensions than the original bone can be observed on the histologies. In conclusion, the application of a constant force on distraction osteogenesis, using SMA springs, may be a successful alternative to the conventional gradual distraction.

Animals↗

Total intravenous anaesthesia and the use of an intubating laryngeal mask in a patient with osteogenesis imperfecta.

Osteogenesis imperfecta is a genetically determined rare disease of the connective tissue, associated with abnormalities of type 1 collagen. The primary bone lesion is the lack of normal ossification of the endochondrial bone. Patients with osteogenesis imperfecta present several problems for anaesthetists. They have a tendency to develop malignant or non-malignant hyperthermia. During laryngoscopy and tracheal intubation, the mandible, teeth and cervical spine may be fractured or injured, and mucosal bruising or bleeding may occur. Renal or ureteral stones are common. The main problems are thus with airway control and intubation, and the risk of anaesthetic agents triggering malignant hyperthermia. We describe the successful anaesthetic management of a patient with osteogenesis imperfecta, undergoing nephrolithotomy and ureterolithotomy with total intravenous anaesthesia including propofol, remifentanil and cisatracurium, using an intubating laryngeal mask.

Adolescent↗

Increased expression of the gene for the pro alpha 1(IV) chain of basement-membrane procollagen in cultured skin fibroblasts from two variants of osteogenesis imperfecta.

Fibroblasts from two lethal variants of osteogenesis imperfecta were shown to synthesize increased amounts of type IV procollagen. Previous studies established that one of these variants had a non-functional allele for the pro alpha 2 chain of type I procollagen, whereas the other pro alpha 2(I) allele contained a mutation leading to synthesis of shortened pro alpha 2(I) chains. In the two variants, the relative level of mRNA for pro alpha 1(IV) was 31 and 42% of the level of mRNA for pro alpha 1(I) chains. A value of less than 2% was found for a third lethal and four non-lethal variants of osteogenesis imperfecta. Immunofluorescent staining of fibroblasts from the two variants synthesizing increased amounts of type IV procollagen indicated that a homogeneous population of cells synthesized both type IV and type I procollagen. The results suggest that mutations in the type I procollagen genes that result in osteogenesis imperfecta can be associated with increased expression of the genes for type IV procollagen.

Basement Membrane↗

Characterization of a type I collagen alpha 2(I) glycine-586 to valine substitution in osteogenesis imperfecta type IV. Detection of the mutation and prenatal diagnosis by a chemical cleavage method.

A chemical cleavage method for detecting mismatched bases in heteroduplexes formed between patient mRNA and control cDNA probes was employed to identify a single base mutation in a heterozygous case of osteogenesis imperfecta type IV. The parents' fibroblast mRNA did not contain the mutation. The region of the mRNA mismatch was amplified by using the polymerase chain reaction, cloned and sequenced. A point mutation of G to U at base-pair 2162 of the collagen alpha 2(I) mRNA resulted in the substitution of glycine by valine at amino acid position 586 of the helix. This substitution disrupted the critical Gly-Xaa-Yaa repeating unit of the collagen triple helix and resulted in helix destabilization, as evidenced by a decreased thermal stability. This local disturbance to helix propagation from the C-terminus to the N-terminus led to the overmodification of the collagen helix downstream towards the N-terminus. However, collagen secretion in vitro was normal, and the clinical phenotype probably resulted from the secretion into the extracellular matrix of the mutant collagen combined with a decrease in collagen production to 65% of control values. The rapid detection of the osteogenesis imperfecta mutation by using the chemical cleavage method afforded the opportunity to apply the technique to prenatal diagnosis in the next pregnancy of the mother of the osteogenesis imperfecta patient. The absence of a mismatched base in chorionic villus mRNA and control cDNA heteroduplexes indicated that the foetus did not carry the mutation, which was confirmed by the subsequent delivery of a normal baby.

Amino Acid Sequence↗

Dentine is biochemically abnormal in osteogenesis imperfecta.

In osteogenesis imperfecta the bones are brittle but the teeth, whose dentine contains the same genetic collagen as bone (type I), may be clinically normal. To investigate this paradox we have measured the amino acid composition of insoluble dentine collagen from 16 deciduous and 18 permanent teeth in control subjects and in 59 patients with different forms of osteogenesis imperfecta. In 55 of the patient samples significant differences from normal were found, especially in the number of lysine residues, and in the relative amounts of hydroxylysine to lysine. These results demonstrate the high frequency of biochemical abnormalities in osteogenesis imperfecta. They also suggest that classifications of this disorder based on the presence or absence of clinical dentiogenesis imperfecta are likely to be unsound.

Amino Acids↗

Soft tissue to hard tissue advancement ratios for mandibular elongation using distraction osteogenesis in children.

Distraction osteogenesis is extensively used for the elongation of hypoplastic mandibles in children, yet the soft tissue profile response to this is not well understood. The pre- and posttreatment lateral cephalometric radiographs of 27 pediatric patients who underwent bilateral mandibular elongation using distraction osteogenesis were analyzed retrospectively to correlate horizontal soft tissue advancement with horizontal underlying bone advancement at B point and pogonion. Horizontal advancement (in millimeters) of bone and overlying soft tissue at these points was collected from the radiographs of each patient, and linear regression analysis was performed to determine the relationship of hard to soft tissue horizontal advancement at these points. A 1:0.90 mean ratio of bone to soft tissue advancement was observed at B point/labiomental sulcus and at pogonion/soft tissue pogonion (linear regression analysis demonstrated slopes [beta1 values] of 0.94 and 0.92, respectively). These ratios were consistent throughout the sample population and are highly predictive of the soft tissue response that can be anticipated. Magnitude of advancement, age, and sex of the patient had no effect on these ratios in our population. This study assists with our understanding of the soft tissue response that accompanies bony elongation during distraction osteogenesis which will allow us to more effectively treatment plan the orthodontic and surgical intervention that will optimize the patients' functional and esthetic outcome.

Adolescent↗

Simultaneous maxillary distraction osteogenesis using a twin-track distraction device combined with alveolar bone grafting in cleft patients: preliminary report of a technique.

The simultaneous use of cleft reduction and maxillary advancement by distraction osteogenesis has not been applied routinely because of the difficulty in three-dimensional control and stabilization of the transported segments. This report describes a new approach of simultaneous bilateral alveolar cleft reduction and maxillary advancement by distraction osteogenesis combined with autogenous bone grafting. A custom-made Twin-Track device was used to allow bilateral alveolar cleft closure combined with simultaneous maxillary advancement, using distraction osteogenesis and a rigid external distraction system in a bilateral cleft lip and palate patient. After a maxillary Le Fort I osteotomy, autogenous iliac bone graft was placed in the cleft spaces before suturing. A latency period of six days was observed before activation. The rate of activation was one mm/d for the maxillary advancement and 0.5 mm/d for the segmental transport. Accordingly, the concave facial appearance was improved with acceptable occlusion, and complete bilateral cleft closure was attained. No adjustments were necessary to the vector of the transported segments during the activation and no complications were observed. The proposed Twin-Track device, based on the concept of track-guided bone transport, permitted three-dimensional control over the distraction processes allowing simultaneous cleft closure, maxillary distraction, and autogenous bone grafting. The combined simultaneous approach is extremely advantageous in correcting severe deformities, reducing the number of surgical interventions and, consequently, the total treatment time.

Adult↗

Is it necessary to screen for hearing loss in the paediatric population with osteogenesis imperfecta?

The aim of the study was to assess the necessity of a screening service to detect early hearing loss in the paediatric population with osteogenesis imperfecta. Twenty-two children were assessed over a 5-year period. Five children (22.7%) had normal hearing. Fourteen (63.6%) had conductive hearing loss, with 12 children in this group having otitis media with effusion (OME); all had resolution of hearing loss with appropriate therapy. Two children had persistent conductive losses unrelated to OME. Three children (13.6%) had sensorineural hearing loss, with one being detected at the age of 1 year. Existing evidence suggests that hearing loss associated with osteogenesis imperfecta has its onset in the second to third decade of life. Contrary to this, hearing loss was detected in 77.3% (17) of this population with a median and mean age of 9 years. This study would suggest that routine screening is worthwhile in children with osteogenesis imperfecta.

Adolescent↗

An in vitro study of the accuracy of a new protocol for planning distraction osteogenesis of the mandible.

PURPOSE: The purpose of this study was to determine the in vitro accuracy of a new protocol for distraction osteogenesis of the mandible that involves a planning process and a surgical technique. MATERIALS AND METHODS: An experimental design was developed to simulate distraction osteogenesis on stereolithographic models of patients with craniofacial deformities. All patients had previously undergone 3-dimensional computerized scans of the craniofacial skeleton. The data from these scans were used to generate stereolithographic models. Before the fabrication of the models, the computed tomography (CT) data were manipulated to add a series of rulers and markers to the models. The 3-dimensional computerized scans were also used as the basis of the planning process. They were imported into an animation software (3D-Studio Max; Discreet, Montreal, Canada), and a virtual distractor was built and installed on the model, and the osteotomies and distraction processes were simulated. Finally, a recipe for sequencing the linear and angular changes of the distractor were calculated. A surgical technique was developed to facilitate the precise installation of the distractor as indicated in the presurgical plan. The transfer of information regarding pin position and orientation from the computer model to the patient was accomplished by creating a surgical template. This template was designed in the computer and fabricated by use of stereolithography. Mock surgery was performed on the stereolithographic models, and the results were compared with those predicted by the computer. The difference between the actual position and the predicted position was recorded. RESULTS: On the X-axis, the difference between the predicted position for the condylar marker and the actual position of the marker on the stereolithographic models was 0.6 +/- 1.1 mm. On the Y-axis, the difference between the predicted position for the condylar marker and the actual position of the marker on the stereolithographic models was -0.9 +/- 2.6. On the Z-axis, the difference between the predicted position for the condylar marker and the actual position of the marker on the stereolithographic models was 0.04 +/- 0.8 mm. There was excellent correlation between the predicted and the actual measurements for the X, Y, and Z axes: 0.98, 0.93, and 0.98, respectively. CONCLUSIONS: The results indicate that the combination of this planning process and surgical technique was very accurate. This in vitro study is the first step in determining the clinical usefulness of this protocol. If the results of this study are validated in clinical practice, this protocol will allow clinicians to improve the clinical outcomes of patients treated with distraction osteogenesis.

Analysis of Variance↗

Minor complications arising in alveolar distraction osteogenesis.

PURPOSE: This study evaluates complications that arise during mandibular alveolar distraction osteogenesis and suggests treatments. METHODS: We monitored complications that arose during alveolar distraction osteogenesis in 5 patients who underwent a total of 7 distractions, in all cases using an intraosseous distractor (Lead System, Leibinger, Germany). We report our responses to each type of complication. RESULTS: All 7 distractions were followed by the placement of 2 implants. The restoration was ideal in 4 of the 7 cases and functional but not ideal in the remaining 3. In all 7 distractions, we observed complications, although many were minor complications readily avoided by the use of appropriate technique. The complications were, first, intraoperative complications, namely 1) fracture of the transport segment (1 of 7 cases; RESPONSE: appropriate preventative measures), 2) difficulties in finishing the osteotomy on the lingual side (7 of 7 cases; RESPONSE: use of fine chisels made from cement spatulas), and 3) excessive length of the threaded rod (1 of 7 cases; RESPONSE: cut the rod). Second, complications arose during distraction: 1) incorrect direction of distraction (2 of 7 cases; no corrective measures necessary in the present cases), 2) perforation of the mucosa by the transport segment (2 of 7 cases; response: smooth the crest of the segment with a bone rongeur), and 3) suture dehiscence (1 of 7 cases; no significant implications). Third, there were postdistraction complications, namely bone formation defects (4 of 7 cases; response: guided bone regeneration). CONCLUSIONS: A number of complications may arise during alveolar distraction osteogenesis. Most of these complications can be considered minor and are readily avoided or resolved by the use of appropriate procedures.

Dental Implantation, Endosseous↗

Effect of calcium sulphate on the rate of osteogenesis in distracted bone.

The effect of applying resorbable calcium sulphate material to newly distracted bone to hasten osteogenesis and consolidation was investigated using 24 New Zealand rabbits. The animals were divided into four groups each containing six rabbits. Groups 1 and 2 were test groups and Groups 3 and 4 were controls. A custom-made submerged distractor was used to distract the rabbit mandibles. The distractor was first used on the third postoperative day at a rate of 1 mm/day for a total of 10 mm. After the completion of distraction, a medical grade resorbable calcium sulphate mixture was applied on the distracted bones in the test groups, whereas the distracted bones in the control groups were exposed postdistraction and closed without intervention. Groups 1 and 3 were sacrificed 11 days postdistraction and Groups 2 and 4 were sacrificed 21 days postdistraction. Undecalcified sections of the distracted bone were examined. Half of the distracted mandibles in each group were stained with Goldner's trichome stain to identify the amount and maturity of the new bone in the distraction zone. The other half of each group was stained with von Kossa stain to identify the amount of calcification and calcium deposition in the distracted bone. Osteogenesis was seen as early as 11 days postdistraction in test animals. Rich lamellar bone deposition was noted in Group 2 (21 days postdistraction +CaSO4). Calcification of the newly formed bone was predominant in the distraction zone in the test groups, especially Group 2, compared to the control groups, which showed incomplete bone deposition and calcification. In conclusion, the application of calcium sulphate to newly distracted bone increased the rate of osteogenesis and calcification.

Animals↗

Intraoral mandibular distraction osteogenesis in facial asymmetry patients with unilateral temporomandibular joint bony ankylosis.

Gap arthroplasty and costochondral rib bone graft are commonly performed by oral and maxillofacial surgeons to reconstruct the temporomandibular joint with ankylosis. However, unpredictable and unsatisfactory results such as re-ankylosis, growth disturbance, and facial asymmetry often occur. Even if the costochondral graft is successful, donor-site morbidity is inevitable. More recently, surgeons have become interested in distraction osteogenesis as a means of temporomandibular joint reconstruction. This case series presents the results of intraoral mandibular distraction osteogenesis and gap arthroplasty in two patients with facial asymmetry and unilateral temporomandibular joint bony ankylosis. Both patients had experienced failed gap arthroplasty and costochondral graft for the reconstruction of the temporomandibular joint. Distraction osteogenesis with gap arthroplasty proved successful in these two patients with follow-up of longer than 2 years.

Adolescent↗

Closure of vertical alveolar bone defects with guided horizontal distraction osteogenesis: an experimental study in pigs and first clinical results.

PURPOSE: To evaluate the option of treating alveolar clefts by guided distraction osteogenesis instead of applying osteoplasty with autologous bone grafts from iliac crest, rib or fibula. MATERIAL AND METHODS: At first, 30 land-bred pigs were operated upon. Treatment of each animal included creating bony defects measuring 2, 4 or 8 mm in the maxilla, anterior to the canine region and up to the nasal periosteum. In 15 of the 30 animals, a new horizontal segment distractor was tested. The device was placed in situ prior to creating an alveolar segment posterior to the defect. This segment was then transported gradually by distraction, thus crossing and closing the defect. At the end of the distraction and stabilization periods the newly formed bony tissue was examined. RESULTS: The critical size of defects was found to be larger than 4 mm. In five of six animals with a horizontal defect of 8 mm, complete ossification of the defect had occurred following distraction osteogenesis. This technique was then applied to five patients successfully. CONCLUSION: It was shown that distraction osteogenesis is a valid alternative for treating alveolar clefts.

Adolescent↗