Trabecular Reorganization in Consecutive Iliac Crest Biopsies when Switching from Bisphosphonate to Strontium Ranelate Treatment

Jobke, Björn; Burghardt, Andrew J.; Muche, Burkhard; Hahn, Michael; Semler, Jutta; Amling, Michael; Majumdar, Sharmila; Busse, Björn

doi:10.1371/journal.pone.0023638

Title: Trabecular Reorganization in Consecutive Iliac Crest Biopsies when Switching from Bisphosphonate to Strontium Ranelate Treatment

Journal Article · Tue Aug 16 00:00:00 EDT 2011 · PLoS ONE

DOI:https://doi.org/10.1371/journal.pone.0023638· OSTI ID:1627471

Jobke, Björn ^[1]; Burghardt, Andrew J. ^[2]; Muche, Burkhard ^[3]; Hahn, Michael ^[4]; Semler, Jutta ^[3]; Amling, Michael ^[4]; Majumdar, Sharmila ^[2]; Busse, Björn ^[5]

Univ. of California, San Francisco, CA (United States). Dept. of Radiology. Musculoskeletal Quantitative Imaging Research Group; Helios Klinikum Berlin-Buch, Berlin (Germany). Inst. of Radiology
Univ. of California, San Francisco, CA (United States). Dept. of Radiology. Musculoskeletal Quantitative Imaging Research Group
Immanuel Hospital Berlin-Wannsee, Berlin (Germany). Dept. of Bone Metabolism and Osteology
Univ. Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Osteology and Biomechanics
Univ. Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Osteology and Biomechanics; Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Materials Sciences Division

Background: Several agents are available to treat osteoporosis while addressing patient-specific medical needs. Individuals’ residual risk to severe fracture may require changes in treatment strategy. Data at osseous cellular and microstructural levels due to a therapy switch between agents with different modes of action are rare. Our study on a series of five consecutively taken bone biopsies from an osteoporotic individual over a six-year period analyzes changes in cellular characteristics, bone microstructure and mineralization caused by a therapy switch from an antiresorptive (bisphosphonate) to a dual action bone agent (strontium ranelate). Methodology/Principal Findings: Biopsies were progressively taken from the iliac crest of a female patient. Four biopsies were taken during bisphosphonate therapy and one biopsy was taken after one year of strontium ranelate (SR) treatment. Furthermore, serum bone markers and dual x-ray absorptiometry measurements were acquired. Undecalcified histology was used to assess osteoid parameters and bone turnover. Structural indices and degree of mineralization were determined using microcomputed tomography, quantitative backscattered electron imaging, and combined energy dispersive x-ray/mx-ray-fluorescence microanalysis. Conclusions/Significance: Microstructural data revealed a notable increase in bone volume fraction after one year of SR treatment compared to the bisphosphonate treatment period. Indices of connectivity density, structure model index and trabecular bone pattern factor were predominantly enhanced indicating that the architectural transformation from trabecular rods to plates was responsible for the bone volume increase and less due to changes in trabecular thickness and number. Administration of SR following bisphosphonates led to a maintained mineralization profile with an uptake of strontium on the bone surface level. Reactivated osteoclasts designed tunneling, hook-like intratrabecular resorption sites. The appearance of tunneling resorption lacunae and the formation of both mini-modeling units and osteon-like structures within increased plate-like cancellous bone mass provides additional information on the mechanisms of strontium ranelate following bisphosphonate treatment, which may deserve special attention when monitoring a treatment switch.

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Research Organization:: Lawrence Berkeley National Laboratory (LBNL), Berkeley, CA (United States)

Sponsoring Organization:: USDOE Office of Science (SC), Biological and Environmental Research (BER). Biological Systems Science Division

OSTI ID:: 1627471

Journal Information:: PLoS ONE, Vol. 6, Issue 8; ISSN 1932-6203

Publisher:: Public Library of ScienceCopyright Statement

Country of Publication:: United States

Language:: English

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Title: Trabecular Reorganization in Consecutive Iliac Crest Biopsies when Switching from Bisphosphonate to Strontium Ranelate Treatment

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