Material properties of bone in the femoral head treated with ibandronate and BMP-2 following ischemic osteonecrosis

Abstract

Bone morphogenetic protein (BMP)-2 and ibandronate (IB) decrease the femoral head deformity following ischemic osteonecrosis of the femoral head (ONFH). The purpose of this study was to determine the effects of BMP-2 and IB on the mineral content and nanoindentation properties of the bone following ONFH. ONFH was surgically induced in the femoral head of piglets. There were five groups: normal control, untreated, IB, BMP, and BMP + IB (n = 5/group). Backscattered electron imaging, Raman spectroscopy, and nanoindentation testing were performed. Both BMP and BMP + IB groups showed calcium content in the trabecular bone similar to the normal group, while the IB and no-treatment groups showed a significant increase in the calcium content compared to the normal group. The carbonate content relative to phosphate was significantly increased in the IB and BMP + IB groups (p < 0.01) compared to the normal group. No significant difference was found between the BMP and the normal group. The nanoindentation modulus of the bone in the IB group was significantly increased compared to the normal group (p < 0.05). No significant differences were observed between the BMP and BMP + IB groups compared to the normal group. The nanoindentation hardness measurements in the IB group were also significantly increased compared to the BMP and BMP + IB groups (p < 0.05). In summary, trabecular bone treated with BMP or BMP + IB had material properties comparable to normal bone whereas the bone in the IB group retained the increased mineral content and the nanoindentation hardness found in the necrotic bone. Hence, BMP or BMP + IB better restores the normal mineral content and nanomechanical properties after ONFH than IB treatment alone. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1453-1460, 2017.

Efficacy of bisphosphonates in the treatment of femoral head osteonecrosis: A PRISMA-compliant meta-analysis of animal studies and clinical trials

“…A total of 49 full-text articles were assessed for eligibility, but 26 were excluded for different reasons (10 review articles, eight studies lacked a control group, and data for eight studies were unavailable). The remaining 23 articles including 16 animal studies 16 – 19 , 26 – 37 and seven human studies 14 , 15 , 20 , 21 , 38 – 40 were passed for synthetic evaluation for this meta-analysis. A summary of selected studies is shown in Table 1 , while the basic techniques of the included studies are shown in Table 2 .…”

“…Moreover, the animal studies of Aruwajoye OO, et al . 19 and Zou Y, et al . 18 showed that the use of ibandronate alone did not obviously improve osteonecrosis, while the combination of ibandronate and other drugs such as BMP-2 or simvastatin could exert better protective effects.…”

“…Bisphosphonates has also been considered a promising medication for early ONFH and preventing femoral head collapse 14 – 17 . However, the efficiency of this kind of drug in both animal studies 18 , 19 and clinical trials 20 , 21 remains controversial. Furthermore, a meta-analysis of a small number of clinical studies reported that the use of bisphosphonates cannot prevent femoral head collapse or delay total hip replacement after ONFH 22 .…”

Bone morphogenetic protein-2 exhibits therapeutic benefits for osteonecrosis of the femoral head through induction of cartilage and bone cells

“…Although the benefits of BMP-2 on arthritis have been previously investigated ( 21 ), the underlying mechanism of the rBMP-2/Fc-mediated signaling pathway for osteonecrosis of the femoral head in a mouse model remains unknown. It was observed that the expression of BMP-2 was positively associated with the gene signatures of NF-κB signaling, indicating that the NF-κB signaling pathway may be regulated by BMP-2 in bone synovial cells ( Fig.…”

“…Bone morphogenetic proteins (BMPs) belong to the transforming growth factor-β superfamily that regulates a number of cellular activities ( 20 ). Previous studies have demonstrated that BMPs serve important roles in different forms of arthritis and their disease activity ( 21 – 23 ). Grcevic et al ( 24 ) previously reported that the peripheral blood expression profiles of BMPs may act as predictive markers for the development of arthritis, its disease activity, therapeutic responsiveness and overall prognosis.…”