Abstract
The pathogenesis of nontraumatic osteonecrosis (ON) remains unclear. Some studies have suggested that nontraumatic ON is attributed to increased osteocytic apoptosis. To test this hypothesis, a controlled study must compare the apoptosis of osteocytes and osteoblasts in cases of ON and osteoarthritis (OA). To assess either the localized or diffuse patterns of this increased osteocytic and osteoblastic apoptosis, we evaluated both the proximal and distal regions of necrotic areas. Femoral heads resected for total hip prosthesis were included for this study. Of these, 10 were ON cases—three were induced by corticosteroids, three by alcohol abuse, one resulted from trauma, one resulted from hyperlipemia, and two were idiopathic—10 were osteoarthritis cases, and 1 from a patient suffering from a subcapital fracture. The TUNEL reaction was used to detect the apoptosis in osteoblasts and osteocytes. A semi-quantitative evaluation was conducted, at both distal and proximal areas relative to the lesions, specifically in the area surrounding the necrotic region in the osteonecrosis cases, in the eburnated bone in the osteoarthritis cases, and in the subchondral bone fracture. The apoptosis of osteoblasts and osteocytes was statistically more frequent in the regions close to the necrotic areas in the ON group. No difference was found in the unpaired areas. In the ON group, no difference was found in terms of the etiological factors. During ON, the apoptosis of osteocytes and osteoblasts is increased proximally to the necrotic regions in the patients presenting with osteoarthritis and subcapital fractures. This increase was found not only in the corticosteroid-induced ON cases but also in the idiopathic and alcohol abuse- and trauma-induced ON cases.
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References
Hernigou P, Beaujean F, Lambotte JC (1999) Decrease in the mesenchymal stem-cell pool in the proximal femur in corticosteroid-induced osteonecrosis. J Bone Joint Surg (Br) 81:349–55
Gangji V, Hauzeur JP, Schoutens A, Hinsenkamp M, Appelboom T, Egrise D (2003) Abnormalities in the replicative capacity of osteoblastic cells in the proximal femur of patients with osteonecrosis of the femoral head. J Rheumatol 30:348–51
Weinstein RS, Jilka RL, Parfitt AM, Manolagas SC (1998) Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. Potential mechanisms of their deleterious effects on bone. J Clin Investig 102:274–82
Weinstein RS, Nicholas RW, Manolagas SC (2000) Apoptosis of osteocytes in glucocorticoid-induced osteonecrosis of the hip. J Clin Endocrinol Metab 85:2907–12
Phemister DB (1949) Treatment of the femur in adults. J Bone Joint Surg 31-A:55–66
Kabata T, Kubo T, Matsumoto T, Nishino M, Tomita K, Katsuda S, Horii T, Uto N, Kitajima I (2000) Apoptotic cell death in steroid induced osteonecrosis: an experimental study in rabbits. J Rheumatol 27:2166–71
Hauzeur JP, Pasteels JL, Schoutens A, Hinsenkamp M, Appelboom T, Chochrad I, Perlmutter N (1989) The diagnostic value of magnetic resonance imaging in non-traumatic osteonecrosis of the femoral head. J Bone Joint Surg Am 71-A(5):641–9
Labat-Moleur F, Guillermet C, Lorimier P, Robert C, Lantuejoul S, Brambilla E, Negoescu A (1998) TUNEL apoptotic cell detection in tissue sections: critical evaluation and improvement. J Histochem Cytochem 46(3):327–34
Waltregny D, Bellahcène A, Van Riet I, Fisher LW, Young M, Fernandez P, Dewé W, de Leval J, Castronovo V (1998) Prognostic value of bone sialoprotein expression in clinically localized human prostate cancer. J Nat Cancer Inst 90:1000–8
Hauzeur JP, Sintzoff S Jr, De Maertelaer V, Appelboom T, Bentin J, Pasteels JL (1992) Relationship between magnetic resonance imaging and in vivo histology in non traumatic osteonecrosis of the femoral head. J Rheumatol 19:385–92
Glimcher MJ, Kenzora JE (1979) The biology of osteonecrosis of the human femoral head and its clinical implications. III. Discussion of the etiology and genesis of the pathological sequelae; comments on treatment. Clin Orthop Relat Res 140:273–312
Jeffery AK (1973) Osteogenesis in the osteoarthritic femoral head. A study using radioactive 32 P and tetracycline bone markers. J Bone Joint Surg (Br) 55(2):262–72
Hauzeur JP, Perlmutter N, Appelboom T, Pasteels JL (1991) Medullary impairment at early stage of non traumatic osteonecrosis of the femoral head. Rheumatol Int 11:215–7
Yamamoto T, Schneider R, Bullough PG (2000) Insufficiency subchondral fracture of the femoral head. Am J Surg Pathol 24(3):464–8
Calder JD, Buttery L, Revell PA, Pearse M, Polak JM (2004) Apoptosis—a significant cause of bone cell death in osteonecrosis of the femoral head. J Bone Joint Surg (Br) 86:1209–13
Youm YS, Lee SY, Lee SH (2010) Apoptosis in the osteonecrosis of the femoral head. Clin Orthop Surg 2:250–5
Ko JY, Wang FS, Wang CJ, Wong T, Chou WY, Tseng SL (2010) Increased Dickkopf-1 expression accelerates bone cell apoptosis in femoral head osteonecrosis. Bone 46:584–91
Weinstein RS (2012) Glucocorticoid-induced osteonecrosis. Endocrine 41:183–90
Acknowledgments
This work was supported by a grant from the Belgian Foundation for the Scientific Research in Medicine.
We thank Pierre Cullus, PhD, for his contribution during the statistical analysis.
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Mutijima, E., De Maertelaer, V., Deprez, M. et al. The apoptosis of osteoblasts and osteocytes in femoral head osteonecrosis: its specificity and its distribution. Clin Rheumatol 33, 1791–1795 (2014). https://doi.org/10.1007/s10067-014-2607-1
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DOI: https://doi.org/10.1007/s10067-014-2607-1