Insufficiency Fractures After Radiation Therapy: An Update

Fusco, Vincenzo; Caivano, Rocchina; Parisi, Salvatore; Troiano, Michele; Corsa, Pietro; Raguso, Arcangela; Munafò, Tindara; Clemente, Maria Antonietta; Guglielmi, Giuseppe

doi:10.1007/s40134-018-0280-x

Cited by 1 publication

(2 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…( 1‐3 ) However, exposure to radiation therapy has been associated with an increased risk of fracture at sites directly exposed to radiation, particularly at the pelvis, hips, and vertebrae. ( 4‐11 )…”

Section: Introductionmentioning

confidence: 99%

“…(1)(2)(3) However, exposure to radiation therapy has been associated with an increased risk of fracture at sites directly exposed to radiation, particularly at the pelvis, hips, and vertebrae. (4)(5)(6)(7)(8)(9)(10)(11) The observed increased risk of fracture is presumably due to a radiation-induced reduction in whole-bone strength, although the exact mechanisms causing the decrease in strength have not been fully elucidated. Although one possible mechanism is lower overall bone mass, changes in bone mass do not well explain the increased fracture risk after cancer radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Relative Effects of Radiation‐Induced Changes in Bone Mass, Structure, and Tissue Material on Vertebral Strength in a Rat Model

Emerzian

Vaidya

et al. 2023

J of Bone & Mineral Res

View full text Add to dashboard Cite

The observed increased risk of fracture after cancer radiation therapy is presumably due to a radiation‐induced reduction in whole‐bone strength. However, the mechanisms for impaired strength remain unclear, as the increased fracture risk is not fully explained by changes in bone mass. To provide insight, a small animal model was used to determine how much of this whole‐bone weakening effect for the spine is attributable to changes in bone mass, structure, and material properties of the bone tissue and their relative effects. Further, because women have a greater risk of fracture after radiation therapy than men, we investigated if sex had a significant influence on bone's response to irradiation. Fractionated in vivo irradiation (10 × 3 Gy) or sham irradiation (0 Gy) was administered daily to the lumbar spine in twenty‐seven 17‐week‐old Sprague–Dawley rats (n = 6–7/sex/group). Twelve weeks after final treatment, animals were euthanized, and lumbar vertebrae (L4 and L5) were isolated. Using a combination of biomechanical testing, micro‐CT‐based finite element analysis, and statistical regression analysis, we separated out the effect of mass, structural, and tissue material changes on vertebral strength. Compared with the sham group (mean ± SD strength = 420 ± 88 N), the mean strength of the irradiated group was lower by 28% (117 N/420 N, p < 0.0001). Overall, the response of treatment did not differ with sex. By combining results from both general linear regression and finite element analyses, we calculated that mean changes in bone mass, structure, and material properties of the bone tissue accounted for 56% (66 N/117 N), 20% (23 N/117 N), and 24% (28 N/117 N), respectively, of the overall change in strength. As such, these results provide insight into why an elevated clinical fracture risk for patients undergoing radiation therapy is not well explained by changes in bone mass alone. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

show abstract

Section: Introductionmentioning

confidence: 99%