Changes in bone after high-dose irradiation. Biomechanics and histomorphology

Sugimoto, Masayuki; Takahashi, Shinobu; Toguchida, Junya; Kotoura, Yoshihiko; Shibamoto, Yuta; Yamamuro, Takao

doi:10.1302/0301-620x.73b3.1670456

Cited by 102 publications

(71 citation statements)

References 9 publications

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“…We investigated various parameters of strength, composition and formation in cortical bone; the results confirmed that bone loss after proton irradiation is specific to trabecular bone at moderate doses. Other studies investigating cortical bone after irradiation have found changes in cortical bone strength and porosity after very high doses (30,31). However, fractionation of high doses mitigated changes in fracture strength (31), suggesting that lower or fractionated doses of radiation may not affect cortical bone.…”

Section: Discussionmentioning

confidence: 95%

Long-Term Dose Response of Trabecular Bone in Mice to Proton Radiation

et al. 2008

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Astronauts on exploratory missions will experience a complex environment, including microgravity and radiation. While the deleterious effects of unloading on bone are well established, fewer studies have focused on the effects of radiation. We previously demonstrated that 2 Gy of ionizing radiation has deleterious effects on trabecular bone in mice 4 months after exposure. The present study investigated the skeletal response after total doses of proton radiation that astronauts may be exposed to during a solar particle event. We exposed mice to 0.5, 1 or 2 Gy of whole-body proton radiation and killed them humanely 117 days later. Tibiae and femora were analyzed using microcomputed tomography, mechanical testing, mineral composition and quantitative histomorphometry. Relative to control mice, mice exposed to 2 Gy had significant differences in trabecular bone volume fraction (−20%), trabecular separation (+11%), and trabecular volumetric bone mineral density (−19%). Exposure to 1 Gy radiation induced a nonsignificant trend in trabecular bone volume fraction (−13%), while exposure to 0.5 Gy resulted in no differences. No response was detected in cortical bone. Further analysis of the 1-Gy mice using synchrotron microCT revealed a significantly lower trabecular bone volume fraction (−13%) than in control mice. Trabecular bone loss 4 months after exposure to 1 Gy highlights the importance of further examination of how space radiation affects bone.

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Section: Discussionmentioning

confidence: 95%

Long-Term Dose Response of Trabecular Bone in Mice to Proton Radiation

et al. 2008

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“…However, radiation regimens in these studies differed (eg, no high-dose radiation) from ours and those studies focused on radiation to visceral tumors in the pelvis rather than primary bone tumors. Radiation is a recognized risk factor for the development of insufficiency fractures; it decreases bone strength and the number and resiliency of trabeculae [5,19,21]. It seems plausible that higher doses of radiation would increase the risk of a fracture developing.…”

Section: Discussionmentioning

confidence: 99%

Sacral Insufficiency Fractures are Common After High-dose Radiation for Sacral Chordomas Treated With or Without Surgery

Osler

Bredella

Hess

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Surgery with high-dose radiation and highdose radiation alone for sacral chordomas have shown promising local control rates. However, we have noted frequent sacral insufficiency fractures and perceived this rate to be higher than previously reported. Questions/purposes We wished (1) to characterize the incidence of sacral insufficiency fractures in patients with chordomas of the sacrum who received high-dose radiation, and (2) to determine whether patients treated with surgery plus high-dose radiation or high-dose radiation alone are more likely to experience a sacral fracture, and to compare time to fracture in these groups. Methods Sixty-two patients who received high-dose radiation for sacral chordomas with (n = 44) or without surgical resection (n = 18) between 1992 and 2013 were included in this retrospective study. At our institution, sacral chordomas generally are treated by preoperative radiotherapy, followed by en bloc resection, and postoperative radiotherapy. Radiation alone, with an intent to cure, is offered to patients who otherwise are not good surgical candidates or patients who elect radiotherapy based on tumor location and the anticipated morbidity after surgery (such as sexual, bowel, or bladder dysfunction). MRI and CT scans were evaluated for evidence of sacral insufficiency fractures. Complete followup was available at a minimum of 2 years (or until fracture or death) for all 18 patients who underwent radiation alone, whereas 14% (six of 44 patients) in the surgery plus radiation group (9% [three of 33] after high sacrectomy and 27% [three of 11] after low sacrectomy) were lost to followup before 2 years. Results Sacral insufficiency fractures occurred in 29 of the 62 patients (47%). A total of 25 of 33 patients (76%)One author (SJJ) certifies that he has received, an amount less than USD 10,000 from the Anna Foundation (Oegstgeest, The Netherlands), an amount less than USD 10,000 from the De Drie Lichten Foundation (Hilversum, The Netherlands), an amount less than USD 10,000 from the KWF Kankerbestrijding (Amsterdam, The Netherlands), and an amount less than USD10,000 from the Michael van Vloten Foundation (Rotterdam, The Netherlands). One author (JHS) certifies that he or a member of his family has or may receive payments or benefits, an amount less than USD 10,000 from Stryker (Kalamazoo, MI, USA), and an amount less than USD 10,000 from Biom'up (Saint-Priest, Lyon, France). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved or waived approval for the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at Massachusetts General Hospital, Boston, MA, USA. with high sacrectomy had fractures develop compared with zero of 11 (0%) after low sacrectomy, and four of the 18 patients (22%) w...

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“…Animal studies have shown that radiation has adverse effects on the biomechanical as well as biological properties of bone [3,12,29]. A canine model has shown that early postoperative irradiation resulted in a substantial reduction in stiffness of the iliac crest strut used for a partial corpectomy defect [3].…”

Section: Discussionmentioning

confidence: 99%