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Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Denosumab is a monoclonal antibody that reduces osteoclastic activity and hence reduces bone breakdown. It is a biological agent that reports fewer adverse events in comparison to other treatments. Denosumab is recommended as an alternative treatment option for the secondary prevention of osteoporotic fragility fractures in post-menopausal women at increased risk of fractures, who are intolerant of other treatment regimes such as bisphosphonates. Denosumab is administered as a 60 mg subcutaneous injection once every 6 months and is an ideal treatment for administration in primary care. It is a particularly useful drug for those with gastrointestinal contraindications, malabsorption complications or those patients that have exhibited side-effects with oral bisphosphonates. It is also useful in patients with renal dysfunction because it has no renal toxicity. As with all the other treatments, Vitamin D status needs to be evaluated in all patients where denosumab maybe be considered, and if the patient is depleted, a supplementation regime needs to be implemented.
A unified framework of cell population dynamics and mechanical stimulus using a discrete approach in bone remodelling
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Diego Quexada, Salah Ramtani, Olfa Trabelsi, Kalenia Marquez, Dorian Luis Linero Segrera, Carlos Duque-Daza, Diego Alexander Garzón Alvarado
More recently, models with higher complexity have been proposed, building on classical works such as that of Komarova or Pivonka. For example, Jerez and Chen (2015) added a term that acts as an external regulator of the bone remodelling process, and analytically derived conditions for the existence of positive periodic simulations that correspond to those found experimentally. Hambli et al. (2016) developed a model that combines pharmacokinetic and mechanical dynamics to predict the effect of denosumab (monoclonal antibody) in bone remodelling by coupling the model of Komarova et al. (2003) with a mechanical model that accounts for fatigue damage (Li et al. 2007). This model is able to predict both bone formation and the effect of denosumab on bone mass density over time. Another model which takes into account a biological model coupled with mechanical factors is that of Barkaoui et al. (2019) where the effect of paracrine and autocrine factors was analyzed in a 20 year period of cyclic load in the human femur head, represented by various displacements, showing an increment in density with an isotropic behavior. A notable model which builds on the previous models of Pivonka et al. (2008) and Komarova et al. (2003) is that of Kahla et al. (2021) which proposes a mechano-pharmaco-biological model which studies the effects of cyclic loading and bone remodeling regulators such as sex hormones, cortisol, TGF- β, and PTH on healthy persons and in pathologies such as Cushing disease. To account for the mechanical stimulus, an additional paracrine factor acting on osteoblast concentration was considered.