Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Current Rheumatology Reports
Erschienen in: Current Rheumatology Reports 9/2015

01.09.2015 | Osteoarthritis (MB Goldring, Section Editor)

Bone Homeostasis and Repair: Forced Into Shape

verfasst von: Alesha B. Castillo, Philipp Leucht

Erschienen in: Current Rheumatology Reports | Ausgabe 9/2015

Einloggen, um Zugang zu erhalten

Abstract

Mechanical loading is a potent anabolic regulator of bone mass, and the first line of defense for bone loss is weight-bearing exercise. Likewise, protected weight bearing is the first prescribed physical therapy following orthopedic reconstructive surgery. In both cases, enhancement of new bone formation is the goal. Our understanding of the physical cues, mechanisms of force sensation, and the subsequent cellular response will help identify novel physical and therapeutic treatments for age- and disuse-related bone loss, delayed- and nonunion fractures, and significant bony defects. This review highlights important new insights into the principles and mechanisms governing mechanical adaptation of the skeleton during homeostasis and repair and ends with a summary of clinical implications stemming from our current understanding of how bone adapts to biophysical force.
Literatur
1.
Hind K, Burrows M. Weight-bearing exercise and bone mineral accrual in children and adolescents: a review of controlled trials. Bone. 2007;40:14–27.CrossRefPubMed
2.
Gunter K, Baxter-Jones AD, Mirwald RL, Almstedt H, Fuchs RK, Durski S, et al. Impact exercise increases BMC during growth: an 8-year longitudinal study. J Bone Miner Res. 2008;23:986–93.PubMedCentralCrossRefPubMed
3.•
Warden SJ, Mantila Roosa SM, Kersh ME, Hurd AL, Fleisig GS, Pandy MG. Physical activity when young provides lifelong benefits to cortical bone size and strength in men. Proc Natl Acad Sci U S A. 2014;111:5337–42. This study demonstrates that half of the benefit in bone size and one-third of the benefit in bone strength resulting from physical activity during youth are maintained throughout life.PubMedCentralCrossRefPubMed
4.
Wolff J. The classic on the inner architecture of bones and its importance for bone growth (reprinted from Virchows Arch Pathol Anat Physiol, vol 50, pg 389–450, 1870). Clin Orthop Relat Res. 2010;468:1056–65.PubMedCentralCrossRefPubMed
5.
Xing W, Baylink D, Kesavan C, Hu Y, Kapoor S, Chadwick RB, et al. Global gene expression analysis in the bones reveals involvement of several novel genes and pathways in mediating an anabolic response of mechanical loading in mice. J Cell Biochem. 2005;96:1049–60.CrossRefPubMed
6.
Zaman G, Saxon LK, Sunters A, Hilton H, Underhill P, Williams D, et al. Loading-related regulation of gene expression in bone in the contexts of estrogen deficiency, lack of estrogen receptor alpha and disuse. Bone. 2010;46:628–42.PubMedCentralCrossRefPubMed
7.
8.
Jacobs CR, Temiyasathit S, Castillo AB. Osteocyte mechanobiology and pericellular mechanics. Annu Rev Biomed Eng. 2010;12:369–400.CrossRefPubMed
9.
10.
Goodship AE, Kenwright J. The influence of induced micromovement upon the healing of experimental tibial fractures. J Bone Joint Surg (Br). 1985;67:650–5.
11.
Currey JD: Bones. Princeton University Press, 2013.
12.
13.
Nakahara H, Goldberg VM, Caplan AI. Culture-expanded human periosteal-derived cells exhibit osteochondral potential in vivo. J Orthop Res. 1991;9:465–76.CrossRefPubMed
14.
Frey SP, Jansen H, Doht S, Filgueira L, Zellweger R. Immunohistochemical and molecular characterization of the human periosteum. Sci World J. 2013;2013:341078–8.CrossRef
15.
16.
Lewis OJ. The blood supply of developing long bones with special reference to the metaphyses. J Bone Joint Surg (Br). 1956;38:928–33.
17.
18.
Robling AG, Castillo AB, Turner CH. Biomechanical and molecular regulation of bone remodeling. Annu Rev Biomed Eng. 2006;8:455–98.CrossRefPubMed
19.
Castillo AB, Jacobs CR. Mesenchymal stem cell mechanobiology. Curr Osteoporos Rep. 2010;8:98–104.CrossRefPubMed
20.
Trüssel A, Müller R, Webster D. Toward mechanical systems biology in bone. Ann Biomed Eng. 2012;40:2475–87.CrossRefPubMed
21.
22.
Price JS, Lanyon LE: The contribution of experimental in vivo models to understanding the mechanisms of adaptation to mechanical loading in bone. Front Endocrinol. 2014;5:154.
23.
Frost HM. A 2003 update of bone physiology and Wolff’s Law for clinicians. Angle Orthod. 2004;74:3–15.PubMed
24.
Warden SJ, Fuchs RK, Castillo AB, Nelson IR, Turner CH: Exercise when young provides lifelong benefits to bone structure and strength. J Bone Miner Res. 2007;22:251–9.
25.
Warden SJ, Galley MR, Hurd AL, Richard JS, George LA, Guildenbecher EA, et al. Cortical and trabecular bone benefits of mechanical loading are maintained long term in mice independent of ovariectomy. J Bone Miner Res. 2014;29:1131–40.PubMedCentralCrossRefPubMed
26.
Petit MA, Hughes JM: Exercise prescription for people with osteoporosis. In: ACSM’s resource manual for guidleines for exercise testing and prescription. Baltimore, MD: Lippincott Williams & Wilkins; 2013. pp. 699–712.
27.
Wagner E, Ortiz C, Villalon IE, Keller A, Wagner P. Early weight-bearing after percutaneous reduction and screw fixation for low-energy lisfranc injury. Foot Ankle Int. 2013;34:978–83.CrossRefPubMed
28.
29.
Kershaw CJ, Cunningham JL, Kenwright J: Tibial external fixation, weight bearing, and fracture movement. Clin Orthop Relat Res 1993;293:28–36.
30.
Martelli S, Pivonka P, Ebeling PR. Femoral shaft strains during daily activities: implications for atypical femoral fractures. Clin Biomech. 2014;29:869–76.CrossRef
31.
Milgrom C, Finestone A, Levi Y, Simkin A, Ekenman I, Mendelson S, et al. Do high impact exercises produce higher tibial strains than running? Br J Sports Med. 2000;34:195–9.PubMedCentralCrossRefPubMed
32.
Piekarski K, Munro M. Transport mechanism operating between blood-supply and osteocytes in long bones. Nature. 1977;269:80–2.CrossRefPubMed
33.
Birmingham E, Kreipke TC, Dolan EB, Coughlin TR, Owens P, McNamara LM, et al. Mechanical stimulation of bone marrow in situ induces bone formation in trabecular explants. Ann Biomed Eng. 2015;43:1036–50.CrossRefPubMed
34.
Weinbaum S, Cowin SC, Zeng Y. A model for the excitation of osteocytes by mechanical loading-induced bone fluid shear stresses. J Biomech. 1994;27:339–60.CrossRefPubMed
35.
Thi MM, Suadicani SO, Schaffler MB, Weinbaum S, Spray DC. Mechanosensory responses of ostoecytes to physiological forces occur along processes and not cell body and require αvβ3 integrin. Proc Natl Acad Sci U S A. 2013;110:21012–7.
36.
Cowin SC, Weinbaum S, Zeng Y. A case for bone canaliculi as the anatomical site of strain generated potentials. J Biomech. 1995;28:1281–97.CrossRefPubMed
37.
Dickerson DA, Sander EA, Nauman EA. Modeling the mechanical consequences of vibratory loading in the vertebral body: microscale effects. Biomech Model Mechanobiol. 2008;7:191–202.CrossRefPubMed
38.
Metzger TA, Kreipke TC, Vaughan TJ, McNamara LM, Niebur GL: The in situ mechanics of trabecular bone marrow: the potential for mechanobiological response. J Biomech Eng. 2015;137. doi:10.​1115/​1.​4028985
39.
Verbruggen SW, Vaughan TJ, McNamara LM. Strain amplification in bone mechanobiology: a computational investigation of the in vivo mechanics of osteocytes. J R Soc Interface. 2012;9:2735–44.PubMedCentralCrossRefPubMed
40.••
Verbruggen SW, Mc Garrigle MJ, Haugh MG, Voisin MC, McNamara LM. Altered mechanical environment of bone cells in an animal model of short- and long-term osteoporosis. Biophys J. 2015;108:1587–98. This study reports that osteocytes and osteoblasts experience different strain levels in response to mechanical loading, and that strain levels experienced change as a function of estrogen status.CrossRefPubMed
41.
Turner CH, Forwood MR, Forwood MR, Rho JY, Rho JY, Yoshikawa T, et al.: Mechanical loading thresholds for lamellar and woven bone formation. J Bone Miner Res. 1994;9:87–97.
42.
You J, Yellowley CE, Donahue HJ, Zhang Y, Chen Q, Jacobs CR. Substrate deformation levels associated with routine physical activity are less stimulatory to bone cells relative to loading-induced oscillatory fluid flow. J Biomech Eng. 2000;122:387–93.CrossRefPubMed
43.
Frost HM. Perspectives: the role of changes in mechanical usage set points in the pathogenesis of osteoporosis. J Bone Miner Res. 1992;7:253–61.CrossRefPubMed
44.
Hsieh YF, Robling AG, Ambrosius WT, Burr DB, Turner CH. Mechanical loading of diaphyseal bone in vivo: the strain threshold for an osteogenic response varies with location. J Bone Miner Res. 2001;16:2291–7.CrossRefPubMed
45.
Lee KCL, Maxwell A, Lanyon LE. Validation of a technique for studying functional adaptation of the mouse ulna in response to mechanical loading. Bone. 2002;31:407–12.CrossRefPubMed
46.
De Souza RL, Matsuura M, Eckstein F, Rawlinson SCF, Lanyon LE, Pitsillides AA. Non-invasive axial loading of mouse tibiae increases cortical bone formation and modifies trabecular organization: a new model to study cortical and cancellous compartments in a single loaded element. Bone. 2005;37:810–8.CrossRefPubMed
47.
Norman SC, Wagner DW, Beaupre GS, Castillo AB. Comparison of three methods of calculating strain in the mouse ulna in exogenous loading studies. J Biomech. 2015;48:53–8.CrossRefPubMed
48.
Sugiyama T, Browne WJ, Galea GL, Price JS, Lanyon LE. Bones’ adaptive response to mechanical loading is essentially linear between the low strains associated with disuse and the high strains associated with the lamellar/woven bone transition. J Bone Miner Res. 2012;27:1784–93.PubMedCentralCrossRefPubMed
49.
Schulte FA, Ruffoni D, Lambers FM, Christen D, Webster DJ, Kuhn G, et al. Local mechanical stimuli regulate bone formation and resorption in mice at the tissue level. PLoS ONE. 2013;8, e62172.PubMedCentralCrossRefPubMed
50.
Birkhold AI, Razi H, Duda GN, Weinkamer R, Checa S, Willie BM. Mineralizing surface is the main target of mechanical stimulation independent of age: 3D dynamic in vivo morphometry. Bone. 2014;66:15–25.CrossRefPubMed
51.•
Birkhold AI, Razi H, Weinkamer R, Duda GN, Checa S, Willie BM. Monitoring in vivo (re)modeling: a computational approach using 4D microCT data to quantify bone surface movements. Bone. 2015;75:210–21. This study describes a novel method utilizing in vivo microCT imaging and a 4D computational approach to visualize and quantify bone turnover, which will allow tracking of bone formation and resorption surfaces over time in a subject-specific manner.CrossRefPubMed
52.
Razi H, Birkhold AI, Weinkamer R, Duda GN, Willie BM, Checa S: Skeletal maturity leads to a reduction in the strain magnitudes induced within the bone: a murine tibia study. Acta Biomater. 2015;13:301–10.
53.••
Razi H, Birkhold AI, Weinkamer R, Duda GN, Willie BM, Checa S. Aging leads to a dysregulation in mechanically driven bone formation and resorption. J Bone Miner Res. 2015. doi:10.​1002/​jbmr.​2528. This important new study demonstrates that as bone ages, its response to mechanical loading becomes less specific; that is, there is no longer a positive quasi-linear relationship between strain and bone formation, and high strains are less effective at attenuating bone resorption.PubMed
54.
Birkhold AI, Razi H, Duda GN, Weinkamer R, Checa S, Willie BM. The influence of age on adaptive bone formation and bone resorption. Biomaterials. 2014;35:9290–301.CrossRefPubMed
55.
Turner CH, Takano Y, Owan I. Aging changes mechanical loading thresholds for bone-formation in rats. J Bone Miner Res. 1995;10:1544–9.CrossRefPubMed
56.
Lynch ME, Main RP, Xu Q, Schmicker TL, Schaffler MB, Wright TM, et al. Tibial compression is anabolic in the adult mouse skeleton despite reduced responsiveness with aging. Bone. 2011;49:439–46.PubMedCentralCrossRefPubMed
57.
58.
Holguin N, Brodt MD, Sanchez ME, Silva MJ: Aging diminishes lamellar and woven bone formation induced by tibial compression in adult C57BL/6. Bone. 2014;65:83–91.
59.
Ajubi NE, Ajubi NE, Klein-Nulend J, Klein-Nulend J, Alblas MJ, Alblas MJ, et al. Signal transduction pathways involved in fluid flow-induced PGE2 production by cultured osteocytes. Am J Physiol. 1999;276:E171–8.PubMed
60.
Jing D, Baik AD, Lu XL, Zhou B, Lai X, Wang L, et al. In situ intracellular calcium oscillations in osteocytes in intact mouse long bones under dynamic mechanical loading. FASEB J. 2014;28:1582–92.PubMedCentralCrossRefPubMed
61.
Vatsa A, Smit TH, Klein-Nulend J. Extracellular NO signalling from a mechanically stimulated osteocyte. J Biomech. 2007;40 Suppl 1:S89–95.CrossRefPubMed
62.
Santos A, Bakker AD, Zandieh-Doulabi B, de Blieck-Hogervorst JMA, Klein-Nulend J. Early activation of the beta-catenin pathway in osteocytes is mediated by nitric oxide, phosphatidyl inositol-3 kinase/Akt, and focal adhesion kinase. Biochem Biophys Res Commun. 2010;391:364–9.CrossRefPubMed
63.
Kitase Y, Barragan L, Qing H, Kondoh S, Jiang JX, Johnson ML, et al. Mechanical induction of PGE2 in osteocytes blocks glucocorticoid-induced apoptosis through both the β-catenin and PKA pathways. J Bone Miner Res. 2010;25:2657–68.PubMedCentralCrossRefPubMed
64.
Plotkin LI, Mathov I, Aguirre JI, Parfitt AM, Manolagas SC, Bellido T. Mechanical stimulation prevents osteocyte apoptosis: requirement of integrins, Src kinases, and ERKs. Am J Physiol Cell Physiol. 2005;289:C633–43.CrossRefPubMed
65.
Heino TJ, Hentunen TA, Väänänen HK. Conditioned medium from osteocytes stimulates the proliferation of bone marrow mesenchymal stem cells and their differentiation into osteoblasts. Exp Cell Res. 2004;294:458–68.CrossRefPubMed
66.
Leucht P, Temiyasathit S, Russell A, Arguello JF, Jacobs CR, Helms JA, et al. CXCR4 antagonism attenuates load-induced periosteal bone formation in mice. J Orthop Res. 2013;31:1828–38.PubMed
67.
Govey PM, Jacobs JM, Tilton SC, Loiselle AE, Zhang Y, Freeman WM, et al. Integrative transcriptomic and proteomic analysis of osteocytic cells exposed to fluid flow reveals novel mechano-sensitive signaling pathways. J Biomech. 2014;47:1838–45.PubMedCentralCrossRefPubMed
68.
Robling AG, Niziolek PJ, Baldridge LA, Condon KW, Allen MR, Alam I, et al. Mechanical stimulation of bone in vivo reduces osteocyte expression of Sost/sclerostin. J Biol Chem. 2008;283:5866–75.CrossRefPubMed
69.
Kennedy OD, Laudier DM, Majeska RJ, Sun HB, Schaffler MB. Osteocyte apoptosis is required for production of osteoclastogenic signals following bone fatigue in vivo. Bone. 2014;64:132–7.PubMedCentralCrossRefPubMed
70.
Dolan EB, Haugh MG, Voisin MC, Tallon D, McNamara LM. Thermally induced osteocyte damage initiates a remodelling signaling cascade. PLoS ONE. 2015;10, e0119652.PubMedCentralCrossRefPubMed
71.
Le Y, Zhou Y, Iribarren P, Wang JM. Chemokines and Chemokine receptors: their manifold roles in homeostasis and disease. Cell Mol Immunol. 2004;1:95–104.PubMed
72.
van Bezooijen RL, Roelen BAJ, Visser A, van der Wee-Pals L, de Wilt E, Karperien M, et al. Sclerostin is an osteocyte-expressed negative regulator of bone formation, but not a classical BMP antagonist. J Exp Med. 2004;199:805–14.PubMedCentralCrossRefPubMed
73.
Li X, Ominsky MS, Niu Q-T, Sun N, Daugherty B, D’Agostin D, et al. Targeted deletion of the sclerostin gene in mice results in increased bone formation and bone strength. J Bone Miner Res. 2008;23:860–9.CrossRefPubMed
74.
Lau K-HW, Baylink DJ, Zhou X-D, Rodriguez D, Bonewald LF, Li Z, et al. Osteocyte-derived insulin-like growth factor I is essential for determining bone mechanosensitivity. Am J Physiol Endocrinol Metab. 2013;305:E271–81.CrossRefPubMed
75.
Javaheri B, Stern AR, Lara N, Dallas M, Zhao H, Liu Y, et al. Deletion of a single β-catenin allele in osteocytes abolishes the bone anabolic response to loading. J Bone Miner Res. 2014;29:705–15.PubMedCentralCrossRefPubMed
76.
Sun Y-X, Li L, Corry KA, Zhang P, Yang Y, Himes E, et al. Deletion of Nrf2 reduces skeletal mechanical properties and decreases load-driven bone formation. Bone. 2015;74:1–9.CrossRefPubMed
77.
Engler AJ, Sen S, Sweeney HL, Discher DE. Matrix elasticity directs stem cell lineage specification. Cell. 2006;126:677–89.CrossRefPubMed
78.
McBeath R, Pirone DM, Nelson CM, Bhadriraju K, Chen CS. Cell shape, cytoskeletal tension, and RhoA regulate stem cell lineage commitment. Dev Cell. 2004;6:483–95.CrossRefPubMed
79.
Chen Q, Shou P, Zhang L, Xu C, Zheng C, Han Y, et al. An osteopontin-integrin interaction plays a critical role in directing adipogenesis and osteogenesis by mesenchymal stem cells. Stem Cells. 2014;32:327–37.PubMedCentralCrossRefPubMed
80.
Alimperti S, You H, George T, Agarwal SK, Andreadis ST. Cadherin-11 regulates both mesenchymal stem cell differentiation into smooth muscle cells and the development of contractile function in vivo. J Cell Sci. 2014;127:2627–38.PubMedCentralCrossRefPubMed
81.
Arnsdorf EJ, Tummala P, Kwon RY, Jacobs CR. Mechanically induced osteogenic differentiation—the role of RhoA, ROCKII and cytoskeletal dynamics. J Cell Sci. 2009;122:546–53.PubMedCentralCrossRefPubMed
82.
Dupont S, Morsut L, Aragona M, Enzo E, Giulitti S, Cordenonsi M, et al. Role of YAP/TAZ in mechanotransduction. Nature. 2011;474:179–83.CrossRefPubMed
83.
Azzolin L, Zanconato F, Bresolin S, Forcato M, Basso G, Bicciato S, et al. Role of TAZ as mediator of Wnt signaling. Cell. 2012;151:1443–56.CrossRefPubMed
84.
Azzolin L, Panciera T, Soligo S, Enzo E, Bicciato S, Dupont S, et al. YAP/TAZ incorporation in the β-catenin destruction complex orchestrates the Wnt response. Cell. 2014;158:157–70.CrossRefPubMed
85.
Low BC, Pan CQ, Shivashankar GV, Bershadsky A, Sudol M, Sheetz M. YAP/TAZ as mechanosensors and mechanotransducers in regulating organ size and tumor growth. FEBS Lett. 2014;588:2663–70.CrossRefPubMed
86.
Carter DR, Beaupré GS: Mechanobiology of skeletal regeneration. Clin Orthop Relat Res. 1998;355:S41–55.
87.
Claes LE, Heigele CA, Neidlinger-Wilke C, Kaspar D, Seidl W, Margevicius KJ, et al.: Effects of mechanical factors on the fracture healing process. Clin Orthop Relat Res. 1998;355:S132–47.
88.
Lacroix D, Prendergast PJ, Li G, Marsh D. Biomechanical model to simulate tissue differentiation and bone regeneration: application to fracture healing. Med Biol Eng Comput. 2002;40:14–21.CrossRefPubMed
89.
Gardner MJ, van der Meulen MCH, Demetrakopoulos D, Wright TM, Myers ER, Bostrom MP: In vivo cyclic axial compression affects bone healing in the mouse tibia. 2006;24:1679–86.
90.
Palomares KTS, Gleason RE, Mason ZD, Cullinane DM, Einhorn TA, Gerstenfeld LC, et al.: Mechanical stimulation alters tissue differentiation and molecular expression during bone healing. 2009;27:1123–32.
91.
Boerckel JD, Kolambkar YM, Stevens HY, Lin ASP, Dupont KM, Guldberg RE: Effects of in vivo mechanical loading on large bone defect regeneration. 2012;30:1067–75.
92.
Boerckel JD, Uhrig BA, Willett NJ, Huebsch N, Guldberg RE. Mechanical regulation of vascular growth and tissue regeneration in vivo. Proc Natl Acad Sci U S A. 2011;108:E674–80.PubMedCentralCrossRefPubMed
93.
Simanski CJP, Maegele MG, Lefering R, Lehnen DM, Kawel N, Riess P, et al. Functional treatment and early weightbearing after an ankle fracture: a prospective study. J Orthop Trauma. 2006;20:108–14.CrossRefPubMed
94.
González M, Peña J, Gil FJ, Manero JM. Low modulus Ti-Nb-Hf alloy for biomedical applications. Mater Sci Eng C Mater Biol Appl. 2014;42:691–5.CrossRefPubMed
95.
Rodriguez JA, Deshmukh AJ, Klauser WU, Rasquinha VJ, Lubinus P, Ranawat CS. Patterns of osseointegration and remodeling in femoral revision with bone loss using modular, tapered, fluted, titanium stems. J Arthroplasty. 2011;26:1409–17.CrossRefPubMed
Metadaten
Titel
Bone Homeostasis and Repair: Forced Into Shape
verfasst von
Alesha B. Castillo
Philipp Leucht
Publikationsdatum
01.09.2015
Verlag
Springer US
Erschienen in
Current Rheumatology Reports / Ausgabe 9/2015
Print ISSN: 1523-3774
Elektronische ISSN: 1534-6307
DOI
https://doi.org/10.1007/s11926-015-0537-9

Weitere Artikel der Ausgabe 9/2015

Current Rheumatology Reports 9/2015 Zur Ausgabe

Inflammatory Muscle Disease (Myositis) (R Aggarwal, Section Editor)

Role of Jo-1 in the Immunopathogenesis of the Anti-synthetase Syndrome

Spondyloarthritis (MA Khan, Section Editor)

The ASAS Criteria for Axial Spondyloarthritis: Strengths, Weaknesses, and Proposals for a Way Forward

Imaging (P Conaghan, Section Editor)

Recent Advances in Imaging of the Axial Skeleton in Spondyloarthritis for Diagnosis, Assessment of Treatment Effect, and Prognostication

RHEUMATOID ARTHRITIS (LW MORELAND, SECTION EDITOR)

Lipid and Metabolic Changes in Rheumatoid Arthritis

Spondyloarthritis (MA Khan, Section Editor)

Acute Anterior Uveitis and Spondyloarthritis: More Than Meets the Eye

Health Economics and Quality of Life (M Harrison, Section Editor)

A Review of Patient Preferences for Osteoporosis Drug Treatment

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise