Gerstenfeld Louis C, Sacks Daniel J, Pelis Megan, Mason Zachary D, Graves Dana T, Barrero Mauricio, Ominsky Michael S, Kostenuik Paul J, Morgan Elise F, Einhorn Thomas A
Orthopaedic Research Laboratory, Department of Orthopedic Surgery, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
J Bone Miner Res. 2009 Feb;24(2):196-208. doi: 10.1359/jbmr.081113.
The role of osteoclast-mediated resorption during fracture healing was assessed. The impact of two osteoclast inhibitors with different mechanisms of action, alendronate (ALN) and denosumab (DMAB), were examined during fracture healing. Male human RANKL knock-in mice that express a chimeric (human/murine) form of RANKL received unilateral transverse femur fractures. Mice were treated biweekly with ALN 0.1 mg/kg, DMAB 10 mg/kg, or PBS (control) 0.1 ml until death at 21 and 42 days after fracture. Treatment efficacy assessed by serum levels of TRACP 5b showed almost a complete elimination of TRACP 5b levels in the DMAB-treated animals but only approximately 25% reduction of serum levels in the ALN-treated mice. Mechanical testing showed that fractured femurs from both ALN and DMAB groups had significantly increased mechanical properties at day 42 compared with controls. muCT analysis showed that callus tissues from DMAB-treated mice had significantly greater percent bone volume and BMD than did both control and ALN-treated tissues at both 21 and 42 days, whereas ALN-treated bones only had greater percent bone volume and BMC than control at 42 days. Qualitative histological analysis showed that the 21-and 42-day ALN and DMAB groups had greater amounts of unresorbed cartilage or mineralized cartilage matrix compared with the controls, whereas unresorbed cartilage could still be seen in the DMAB groups at 42 days after fracture. Although ALN and DMAB delayed the removal of cartilage and the remodeling of the fracture callus, this did not diminish the mechanical integrity of the healing fractures in mice receiving these treatments. In contrast, strength and stiffness were enhanced in these treatment groups compared with control bones.
评估了破骨细胞介导的吸收在骨折愈合过程中的作用。在骨折愈合期间,研究了两种作用机制不同的破骨细胞抑制剂阿仑膦酸盐(ALN)和地诺单抗(DMAB)的影响。表达嵌合(人/鼠)形式RANKL的雄性人RANKL基因敲入小鼠接受单侧股骨横向骨折。小鼠每两周接受一次0.1 mg/kg的ALN、10 mg/kg的DMAB或0.1 ml的PBS(对照)治疗,直至在骨折后21天和42天死亡。通过血清TRACP 5b水平评估的治疗效果显示,在接受DMAB治疗的动物中,TRACP 5b水平几乎完全消除,但在接受ALN治疗的小鼠中,血清水平仅降低约25%。力学测试表明,与对照组相比,在第42天时,ALN组和DMAB组的骨折股骨力学性能显著提高。微计算机断层扫描(muCT)分析显示,在第21天和第42天时,接受DMAB治疗的小鼠的骨痂组织的骨体积百分比和骨密度均显著高于对照组和接受ALN治疗的组织,而接受ALN治疗的骨骼在第42天时仅骨体积百分比和骨矿含量高于对照组。定性组织学分析显示,与对照组相比,第21天和第42天的ALN组和DMAB组有更多未吸收的软骨或矿化软骨基质,而在骨折后42天的DMAB组中仍可看到未吸收的软骨。虽然ALN和DMAB延迟了软骨的清除和骨折骨痂的重塑,但这并未削弱接受这些治疗的小鼠愈合骨折的力学完整性。相反,与对照骨骼相比,这些治疗组的强度和刚度有所增强。