Understanding the eff ect of recreational drug use on bone health and musculoskeletal disease in the establishment of pain regimens

BACKGROUND:The widespread use of recreational drugs has raised concerns regarding their eff ects on various organ systems.The use of cannabis and opioids in chronic pain management increases their prevalence among patients with musculoskeletal conditions whose bone health may already be compromised.This article aims to review the pathophysiology and toxic eff ects of recreational drug use on musculoskeletal health to establish appropriate pain regimens for patients with substance use.METHODS:Medical literature published from 1970 until 2022 was identifi ed utilizing MEDLINE/PubMed and the Cochrane Library.In addition to the databases,references were obtained through the use of reference lists of published articles identifi ed by the aforementioned databases.The initial search terms included opioids,inhalants,hallucinogens,cannabis,stimulants,and bone health.There were no methodological limitations in relation to the initial acquisition and analysis of data.RESULTS:A total of 55 research articles were included in this review.Cannabis,stimulants,opioids,and inhalants impact bone maintenance,specifically osteoblast and osteoclast activity,as well as impede hormone production.These substances inhibit bone remodeling and development,manifesting as lower bone mineral density and increased fracture risk in chronic users.CONCLUSION:Although the current literature suggests a deleterious effect of recreational drugs on bone health and musculoskeletal disease,further research is warranted to evaluate the clinical effects of long-term substance use.The evaluation of such effects will aid in establishing appropriate pain regimens,as well as appropriate screening and treatment plans for recreational drug users.

Bone Health in Pediatric Fracture Patients: A DEXA Study

Vitamin D deficiency is widespread in children and is associated with increased fracture severity. Previous studies have shown mixed results on the impact of vitamin D supplementation on bone health parameters measured on dual-energy x-ray absorptiometry (DEXA) scan. This is the first longitudinal DEXA study in a pediatric fracture population. Pediatric fracture patients with vitamin D levels below 20 ng/mL were counseled to take vitamin D and calcium per a serum-based protocol. Patients underwent baseline DEXA within the initial 12 weeks post fracture and had follow-up scans at 6 and 12 months. 48 patients were enrolled, 32 patients completed two DEXA scans, and 19 completed three DEXA scans. There was a significant increase in lumbar spine BMC, TBLH BMD, and TBLH BMC between DEXA 1 and 2 (p 0.001). A positive trend in DEXA parameters is suggested between DEXA 1 and DEXA 3. Height adjusted z-scores (HAZ) were calculated which showed no statistical significance, p-values > 0.05. In this group, there are no significant changes in TBLH, BMC or BMD z-scores one year after fracturing despite vitamin D and calcium supplementation. This suggests that children returning to collision sports may be at continued risk for refracture and future studies are needed.

Growth and bone health in paediatric patients with Crohn's disease receiving subcutaneous tumor necrosis factor antibody

AIM:To study whether adalimumab(ADA) was associated with improvement in growth,bone mineraldensity(BMD) and bone metabolism.METHODS:In children with Crohn's disease(CD) there is a high prevalence of growth failure and reduced BMD.Treatment with infliximab is associated with an improvement in growth.Anthropometry,paediatric CD activity index(PCDAI),bone markers and BMD was measured in 18 patients(72% females) one year before and after start of ADA with a median age of 14.4 years(range:5-19 years) at treatment start.Outcomes were indicators of growth with treatment as well as interval growth.RESULTS:Eleven(61%) children experienced catchup growth after ADA.PCDAI significantly decreased from 52.1 ± 16 to 30.4 ± 23(P ≤ 0.001).Post ADA,body mass index(BMI) standard deviation score(SDS) 0.1[range:2.7-(-0.8)] vs-1 [range:0.1-(-3.6)],P = 0.04 and △BMI SDS in children 0.3 [range:0.7-(-0.2)] vs-1.1 [range:1.2-(-2.3)],P = 0.01 in remission were significantly higher compared to those with moderate to severe inflammation.The main predictors for growth were 25-hydroxycholecalciferol and for bone mineralisation weight and height SDS.ADA had no significant influence on bone markers and BMD.CONCLUSION:Next to improvement of PCDAI,half of the children achieved a positive catch-up growth.A better nutritional status with improvement in BMI and weight is positive predictor for improved growth and bone mineralisation.

Protective Effects of Phellodendron Species on Bone Health: A Novel Perspective on Their Potentials in Treating Osteoporosis and Osteoarthritis

Phellodendron(PN)species,traditionally used in Chinese medicine for centuries,hold promise as a potential treatment for osteoporosis(OP)and osteoarthritis(OA)due to their bioactive compounds.The bioactive compounds,including berberine and palmatine,exhibit anti-inflammatory,antioxidant,and bone-protective properties,contributing to their potential therapeutic benefits in promoting bone health and preventing bone loss.However,challenges such as the need for standardized preparation and dosing,limited clinical studies,and potential interactions with other medications hinder their clinical use.Nonetheless,the rich history of PN species in Chinese medicine provides a promising foundation for future investigation into their potential as alternative treatments for OP and OA.Further research is needed to fully understand the underlying mechanisms of action and explore the clinical implications of PN for bone health.

Clinical practice guidelines for full-cycle standardized management of bone health in breast cancer patients

Bone health management for breast cancer spans the entire cycle of patient care,including the prevention and treatment of bone loss caused by early breast cancer treatment,the adjuvant application of bone-modifying agents to improve prognosis,and the diagnosis and treatment of advanced bone metastases.Making good bone health management means formulating appropriate treatment strategies and dealing with adverse drug reactions,and will help to improve patients'quality of life and survival rates.The Breast Cancer Expert Committee of the National Cancer Center for Quality Control organized relevant experts to conduct an in-depth discussion on the full-cycle management of breast cancer bone health based on evidence-based medicine,and put forward reasonable suggestions to guide clinicians to better deal with health issues in bone health clinics.

Calcium deficiency： where does the diagnostic criterion come from and by what is bone health influenced？

Dietary surveys suggest that a considerable proportion of the population fail to consume recommended amounts of calcium m both developing and developed countries. Recommended allowance for dietary calcium has attracted many controversies and there are discrepant opinions on how to meet the recommendations in the global scientific community.

Combined effects of physical activity and calcium on bone health in children and adolescents:a systematic review of randomized controlled trials

Background A better understanding of the role of exercise and nutrition in bone health is significant for preventing osteoporosis.The aim of this review was to assess the combined effects of physical activity and calcium intake on improving bone mineral density in children and adolescents.Methods A search of electronic databases(MedLine,ISI Web of Science,Science Direct)and the literature references were performed.Randomized controlled trials published between 1997 and 2017,evaluating the effect of both physical activity and calcium intake intervention on bone mineral density or bone mineral content among children aged 3–18 years were selected.The Improved Jadad Rating Scale was used to assess the methodological quality of the included studies.Study characteristics were summarized in accordance with the review’s PICO criteria.Changes in bone mineral content were detected at several different bone sites.Results A total of nine studies involving 908 participants were included in this review.The combined intervention of physical activity and calcium increased bone mineral in children and adolescents,especially when baseline calcium intake level was low and among participants on the stage of early puberty.Conclusions Regular physical activity combined with high level of calcium intake is beneficial for bone health in young population.Further research is needed to evaluate the dose–response associations and long-term effects of the interaction between physical activity and calcium intake.

Feasibility study for bone health assessment based on photoacoustic imaging method

This study investigated the feasibility of photoacoustic(PA) imaging of bone and characterization of bone features. By conducting the experiments on bovine femoral heads ex vivo, the light and ultrasonic penetration in bones was studied, together with the depth of PA imaging and measurement in bones. Then, the possibility of three-dimensional(3 D) PA imaging of bones by raster scanning of the focusing transducer was studied. The micro-computerized tomography images of the bovine ribs with and without ethylenediaminetetraacetic acid(EDTA) treatment indicated that the 3 D PA images could present the changes of bone microstructure resulting from the EDTA treatment. By using PA spectral analysis, the bone samples with and without the treatment of EDTA solution can be distinguished, and the microstructures can be characterized. This study was based on the bovine bone whose size is comparable to human bones, suggesting that PA technology can be used as a novel bone diagnostic technique.

Muscle strength deficits are associated with low bone mineral density in young pediatric cancer survivors:The iBoneFIT project

Background Pediatric cancer survivors are at increased risk of muscle weakness and low areal bone mineral density(aBMD).However,the prevalence of muscle strength deficits is not well documented,and the associations of muscle strength with aBMD are unknown in this population.Therefore,this study aimed to investigate the prevalence of upper-and lower-body muscle strength deficits and to examine the associations of upper-and lower-body muscle strength with age-,sex,and race-specific aBMD Z-scores at the total body,total hip,femoral neck,and lumbar spine.Methods This cross-sectional study included 116 pediatric cancer survivors(12.1±3.3 years old,mean±SD;42.2%female).Upper-and lower-body muscle strength were assessed by handgrip and standing long jump test,respectively.Dual‑energy X‑ray absorptiometry was used to measure aBMD(g/cm2).Associations between muscle strength and aBMD were evaluated in multivariable linear regression models.Logistic regression was used to evaluate the contribution of muscle strength(1-decile lower)to the odds of having low aBMD(Z-score≤1.0).All analyses were adjusted for time from treatment completion,radiotherapy exposure,and body mass index.Results More than one-half of survivors were within the 2 lowest deciles for upper-(56.9%)and lower-body muscle strength(60.0%)in comparison to age-and sex-specific reference values.Muscle strength deficits were associated with lower aBMD Z-scores at all sites(B=0.133–0.258,p=0.001–0.032).Each 1-decile lower in upper-body muscle strength was associated with 30%–95%higher odds of having low aBMD Z-scores at all sites.Each 1-decile lower in lower-body muscle strength was associated with 35%–70%higher odds of having low aBMD Z-scores at total body,total hip,and femoral neck.Conclusion Muscle strength deficits are prevalent in young pediatric cancer survivors,and such deficits are associated with lower aBMD Z-scores at all sites.These results suggest that interventions designed to improve muscle strength in this vulnerable population may have the added benefit of improving aBMD.

Mechanotransduction in bone: Intervening in health and disease

Mechanotransduction has been proven to be one of the most significant variables in bone remodeling and its alterations have been shown to result in a variety of bone diseases. Osteoporosis, Paget's disease, orthopedic disorders, osteopetrosis as well as hyperparathyroidism and hyperthyroidism all comprise conditions which have been linked with deregulated bone remodeling. Although the significance of mechanotransduction for bone health and disease is unquestionable, the mechanisms behind this important process have not been fully understood. This review will discuss the molecules that have been found to be implicated in mechanotransduction, as well as the mechanisms underlying bone health and disease, emphasizing on what is already known as well as new molecules potentially taking part in conveying mechanical signals from the cell surface towards the nucleus under physiological or pathologic conditions. It will also focus on the model systems currently used in mechanotransduction studies, like osteoblast-like cells as well as three-dimensional constructs and their applications among others. It will also examine the role of mechanostimulatory techniques in preventing and treating bone degenerative diseases and consider theirapplications in osteoporosis, craniofacial development, skeletal deregulations, fracture treatment, neurologic injuries following stroke or spinal cord injury, dentistry, hearing problems and bone implant integration in the near future.

Comparing the methods of oral hygiene, over hanged removal and restoration—Changing on periodontal health and alveolar bone height of rest orated mandibular molars with proximal over hanged amalgam

Objective: Conservative restoration principles that accurately reduce plaque accumulation are the goals of restorative dentistry. Correct and perfect restoration has an important effect on health of periodontious tissues. This study was done to compare the methods of oral hygiene, over hanged removal and restoration changing on periodontal health and alveolar bone height of restored mandible molars with proximal over hanged amalgam. Materials and Methods: All patients with over hanged amalgam restoration were randomly divided into three groups. In order to survey the effect of over hanged removal on gingival and bleeding indices and alveolar bone height adjacent to mandible molar teeth, these indices were determined according to recurrent radio-graphical early signs of alveolar bone loss during three months. Sixty patients, 20 in each group, were studied. In the group I, overhang was removed with ultrasonic scale or bur and oral hygiene methods as usual were continued. In the group II, over-hang was left, but plaque controls as the prophylaxis and flossing were done. In the group III, restoration was changed and oral hygiene was done as usual. Plaque index and bleeding index were measured at the beginning of study and three months later. Findings: Statistical analysis of studied indices at the beginning and three months after treatment using paired test has shown significant differences in gingival inflammation, in all groups. Statistical analysis of indices using Tukey HSD test has also shown significant differences in decreasing gingival inflammation measure when the over hanged restoration was removed. While there is no difference between the other two groups. Conclusion: The results showed that plaque control causes subsidence of gingival inflammation and increasing of alveolar bone support, and it is more effective when the over hanged restoration is changed.

Effects of normobaric cyclic hypoxia exposure on mesenchymal stem-cell differentiation–pilot study on bone parameters in elderly

BACKGROUND Mesenchymal stem cells(MSC)of bone marrow are the progenitor of osteoblasts and adipocytes.MSC tend to differentiate into adipocytes,instead of osteoblasts,with aging.This favors the loss of bone mass and development of osteoporosis.Hypoxia induces hypoxia inducible factor 1αgene encoding transcription factor,which regulates the expression of genes related to energy metabolism and angiogenesis.That allows a better adaptation to low O2 conditions.Sustained hypoxia has negative effects on bone metabolism,favoring bone resorption.Yet,surprisingly,cyclic hypoxia(CH),short times of hypoxia followed by long times in normoxia,can modulate MSC differentiation and improve bone health in aging.AIM To evaluate the CH effect on MSC differentiation,and whether it improves bone mineral density in elderly.METHODS MSC cultures were induced to differentiate into osteoblasts or adipocytes,in CH(3%O2 for 1,2 or 4 h,4 d a week).Extracellular-matrix mineralization and lipid-droplet formation were studied in MSC induced to differentiate into osteoblast or adipocytes,respectively.In addition,gene expression of marker genes,for osteogenesis or adipogenesis,have been quantified by quantitative real time polymerase chain reaction.The in vivo studies with elderly(>75 years old;n=10)were carried out in a hypoxia chamber,simulating an altitude of 2500 m above sea level,or in normoxia,for 18 wk(36 CH sessions of 16 min each).Percentages of fat mass and bone mineral density from whole body,trunk and right proximal femur(femoral,femoral neck and trochanter)were assessed,using dual-energy X-ray absorptiometry.RESULTS CH(4 h of hypoxic exposure)inhibited extracellular matrix mineralization and lipid-droplet formation in MSC induced to differentiate into osteoblasts or adipocytes,respectively.However,both parameters were not significantly affected by the other shorter hypoxia times assessed.The longest periods of hypoxia downregulated the expression of genes related to extracellular matrix formation,in MSC induced to differentiate into osteoblasts.Interestingly,osteocalcin(associated to energy metabolism)was upregulated.Vascular endothelial growth factor an expression and low-density lipoprotein receptor related protein 5/6/dickkopf Wnt signaling pathway inhibitor 1(associated to Wnt/β-catenin pathway activation)increased in osteoblasts.Yet,they decreased in adipocytes after CH treatments,mainly with the longest hypoxia times.However,the same CH treatments increased the osteoprotegerin/receptor activator for nuclear factor kappa B ligand ratio in both cell types.An increase in total bone mineral density was observed in elderly people exposed to CH,but not in specific regions.The percentage of fat did not vary between groups.CONCLUSION CH may have positive effects on bone health in the elderly,due to its possible inhibitory effect on bone resorption,by increasing the osteoprotegerin/receptor activator for nuclear factor kappa B ligand ratio.

Osteoporosis knowledge, beliefs, and calcium intake of college students: Utilization of the health belief model

Objective: The purpose of this study was to examine the relationships between osteoporosis knowledge, beliefs and calcium intake among college students. This study also examined perceived susceptibility, severity, benefits, barriers and self-efficacy related to osteoporosis prevention. Participants: Seven hundred and ninety two (n = 792) men and women ages 17 - 31 of all ethnicities at a mid-western regional university in the US participated in the study. Methods: The Osteoporosis Knowledge Test, Osteoporosis Health Belief Scale, and Osteoporosis Preventing Behaviors Survey were utilized. Each of these tools were previously validated and found reliable. Correlation and multiple regression analyses were completed. Results: Participants did not perceive themselves as susceptible to osteoporosis and perceived minimal barriers to calcium intake. Their knowledge was minimal concerning alternate sources of calcium. Conclusions: Prevention programs should aim to increase osteoporosis knowledge of risk factors and osteoprotective behaviors and to decrease high-risk behaviors during college years when behavior changes can have the strongest impact on bone health.

Silk Fibroin/Poly-L-lactide Lactone Bi-layered Membranes for Guided Bone Regeneration

After removal of the caries or diseased teeth,the alveolar ridge will undergo absorption and atrophy.When the amount of alveolar bone is insufficient,it will cause an inability to perform effective dental implant restoration.In order to control the absorption and promote the repair and regeneration of alveolar ridge,a method of implanting guided bone regeneration(GBR)membranes at the extraction site is often used.In this study,silk fibroin(SF)and poly-L-lactide lactone(PLCL)were used to prepare bilayered guided bone regeneration membranes,and its morphology,hydrophilicity,surface roughness and mechanical properties were studied.At the same time,the drug release behaviors and cell compatibility of the bilayered membranes were studied.The results showed that SF/PLCL bi-layered membranes had good mechanical properties and surface hydrophilicity,and the drug-loaded bi-layered membranes had good cell compatibility.The bilayered membranes fabricated in this study are of potential for applying in the oral health field to promote bone regeneration.

构建中医药防控体系对实施骨健康计划的战略意义

随着人口老龄化及社会生活方式的转变,骨伤科疾病发病率呈逐年上升趋势,已成为威胁我国人民群众生命健康的重大公共卫生问题。近年来,党的二十大报告提出“实施积极应对人口老龄化国家战略”,《“健康中国2030”规划纲要》要求“开展健康骨骼专项行动”。相关政策与规划的出台,标志着在后疫情时代发展坐标系上,适时提出并开展骨健康计划,充分挖掘中医药服务骨健康潜在价值具有重大战略意义。

Targeting gut microbiota in osteoporosis:impact of the microbial based functional food ingredients

Osteoporosis is the most common bone disorder,characterized by low bone mineral density and microarchitectural deterioration of the bone tissue,which increases the susceptibility to fracture.In the past decade,emerging research findings reported the implication of gut microbiota on bone health and osteoporosis pathology.Osteoporotic patients or individuals with a lower bone mineral density exhibit an alteration of the gut microbiota at several taxonomic levels.Additional reports demonstrate that gut microbiota regulates bone metabolism through the modulation of the gut function(mineral availability and absorption,gut integrity),the immune system,and the endocrine system.Thus,based on the vital role of gut microbiota on bone health,it has emerged as a novel therapeutic target for the prevention of bone loss and the treatment of osteoporosis.Microbial-based functional food ingredients,such as probiotics,prebiotics,synbiotics,and fermented foods,have been developed to alter the gut microbiota composition and function and thus,to provide benefits to the host bone health.Despite promising initial results,microbial-based therapies are still under investigation.Moreover,additional animal studies and clinical trials are needed to understand the interactions between gut microbiota and bone metabolism before further applications.

The Effect of the Paleo Diet on People Suffering from Osteoporosis (Review Paper)

Osteoporosis is a disease that decreases bone mass and increases bone porosity, weakening bones. The Paleo diet is an eating plan that imitates the dietary patterns of the Stone Age. It excludes grains, dairy, and processed foods and emphasizes feeding on lean meats, fruits, vegetables, and nuts. Consumption of the Paleo diet has many positive sides, such as high protein intake and weight loss. Still, excluding dairy products risks calcium and vitamin D deficiencies, which are crucial for bone health. Statistics and simulations that have explored the relationship between the Paleo diet and bone health (especially for people suffering from low bone density) show mixed outcomes on bone health.). While the consumer does get lots of benefits from fruit and vegetable intake in a large sum due to them containing nutrients like magnesium, potassium, and vitamin K (which are also necessary for bone health), the lack of dairy products (gives the maximum amount of calcium and vitamin D) raises concerns about maintaining adequate bone mineral density (BMD). More information on this topic shows the negative impact of this diet on people suffering from osteoporosis due to a lack of nutrient intake that nourishes the bone. Although the Paleo diet can enhance overall health through nutrient-dense foods and reduced processed intake, it can’t be said the same for people suffering from osteoporosis.

咀嚼型洁齿骨活性成分体外抑菌试验和临床应用效果评估

为了评估咀嚼型洁齿骨对成年犬口腔健康状况的改善情况及其主要活性成分的体外抑菌效果,本试验采用牛津杯法定性检测咀嚼型洁齿骨中主要活性成分对变异链球菌、粘性放线菌、嗜酸乳杆菌、牙龈卟啉单胞菌和具核梭杆菌具核亚种的抑菌活性;并选取30只临床健康成年犬,经超声波洁牙后,随机分为3个组,对照组正常饲喂,试验1组和试验2组分别添加不同品牌的洁齿骨,每间隔30 d由同一名兽医对试验犬的牙菌斑、牙结石和牙龈炎进行医学评分并测定犬口气值。结果显示:咀嚼型洁齿骨中活性成分茶多酚、厚朴酚、杜仲提取物、金银花提取物、溶菌酶和保鲜复合酶对5种口腔常见致病菌的生长抑制效果相对较好;洁牙后90 d,试验1组和试验2组犬牙菌斑和牙结石评分均显著低于对照组(P<0.05);洁牙后30和90 d,试验2组犬牙龈炎评分显著低于对照组(P<0.05);与对照组相比,洁牙后饲喂咀嚼型洁齿骨明显改善了犬口臭情况,试验2组犬口气测定值均低于试验1组,差异不显著(P>0.05)。结果表明,咀嚼型洁齿骨一定程度上可以缓解犬口腔健康状况,且添加活性成分的洁齿骨效果相对较好。

低能量可利用性与运动人群的骨健康

运动人群会经历高能量消耗过程,尤其是在大强度训练期间,运动能量消耗高,能量摄入减少。低能量可利用性被认为是骨密度降低的起始因素。短期后果包括骨代谢的短期变化和骨应力损伤风险的增加,长期后果包括骨质疏松症和相关的脆性骨折。低能量可利用性降低骨骼健康的程度可能取决于能量缺失程度。应充分认识到适当饮食策略的重要性,以确保足够能量支持训练以及体育活动,运动干预策略应受到关注。

沈阳居民身体健康现状的实证研究

《“健康中国”2030规划纲要》明确指出:到2030年,人民身体素质明显增强,主要健康危险因素得到有效控制。目前,健康中国战略已取得显著成果,但在微观角度上,尚且缺乏有关于人民身体健康现状的实证研究。本文基于沈阳市国民体质监测活动,运用SPSS26.0软件,统计1616份沈阳居民健康数据,分析沈阳居民心肺功能、亚健康以及骨密度现状,丰富健康中国背景下有关人民身体素质的实证基料。研究发现:(1)目前心肺功能呈现“差、较差、一般、良好、优秀”状态的沈阳居民分别占0.9%、5.1%、20.3%、36.6%、37.1%。(2)目前亚健康呈现“亚健康、健康”状态的沈阳居民分别占22.1%、77.9%。(3)目前骨密度呈现“骨质疏松、低骨密度、骨质正常”的沈阳居民分别占0.4%、21.1%、78.5%。可见,目前沈阳居民整体身体健康水平较高,但仍然存在一部分居民身体健康水平较低。