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International audience; The recent progress in oncologic management of patients with localized cancer or metastatic disease has permitted a significant improvement in life expectancy. Nevertheless, bone metastases and their consequent skeletal-related events (SREs) are still associated with unfavorable prognosis and greatly affect quality of life. Global management of these bone metastases includes traditional local approaches (surgery, radiotherapy, etc.) and systemic administration of chemotherapeutic agents. This review focuses on treatments specific for bone metastases and, in particular, on inhibitors of bone resorption that are effective for preventing and delaying the development of SREs.

International audience; Gallium (Ga) is a semi-metallic element that displays antitumor, antiresorptive, anti-inflammatory and immunosuppressive properties. Among all these properties, antitumor properties were the most extensively applied and have shown efficacy in treatment of Paget's disease, myeloma and hypercalcemia in cases of malignancy. By contrast, no clinical trials have been conducted in prevention and/or treatment of osteoporosis. In this article I focus on Ga effects on bone tissue and cells, as well as on molecular mechanisms governing Ga internalization into cells. Eventually, the potential of Ga as an antiosteoporotic agent is discussed.

The dynamic, fluid-filled RCCS! bioreactor, based on the operational principle of relative micro-gravity condition, is a new efficient system devised to perform long-term three-dimensional (3D) culture of cells and tissue explants. In the present study, we evaluated the impact of the RCCS!-produced hydrodynamic condition on an innovative 3D in vitro model of osteocytes’ differentiation and bone matrix formation, obtained by coupling primary human osteoblasts with biphasic calcium phosphate (BCP) ceramic particles.

Macroporous biphasic calcium phosphate (BCP) bioceramics, for bone substitution applications, have been synthesized, cold isostatically pressed and pressureless sintered, using naphthalene particles as a porogen to produce macropores. The resulting materials are mixtures of P-tricalcium phosphate and hydroxyapatite with various microporosities and macroporosities. Mechanical properties (Young's modulus, compressive strength and fracture toughness) were measured on specimens over the widest attainable ranges of porosities, and compared to previously proposed analytical models and hypotheses. These models describe the evolution of the mechanical properties as functions of macroporosity and microporosity separately, the strength model considering macropores as critical flaws in the ceramic. Results show that the presence of macropores strongly influences the critical flaw size, but the latter appears to increase with macroporosity. This phenomenon can be explained by the presence of clusters of macropores, acting as critical flaws, becoming larger as macroporosity increases. (C) 2009 Elsevier Ltd. All rights reserved.

In the domain of implantable materials, the porosity and pore size distribution of a material in contact with bone is decisive for bone ingrowth and thus the control of the porosity is of great interest. The use of a new porogen agent, i.e. sucrose is proposed to create a porosity in biphasic calcium phosphate blocks. The technological procedure is as follows: sucrose and mineral powder are mixed, then compressed by isostatic compression and sintering finally eliminates sucrose. Blocks obtained were compared to a manufactured product: Triosite (R) (Zimmer, Etupes, France) which porosity is created through a naphthalene sublimation process. Results have shown that the incorporation of sucrose allows the preparation of porous blocks with controlled porosity varying from 40 to 80% and with macro-, meso- and microporosity characteristics depending on the percentage of sucrose added as well as on the granulometry of both sucrose and mineral powder. (C) 2009 Elsevier Ltd and Techna Group S.r.l. All rights reserved.

The fixation of an orthopedic implant depends strongly upon its initial stability. Peri-implant bone may resorb shortly after the surgery. This resorption is directly followed by new bone formation and implants fixation strengthening, the so-called secondary fixation. If the initial stability is not reached, the resorption continues and the implant fixation weakens, which leads to implant loosening. Studies with rats and dogs have shown that a solution to prevent peri-implant resorption is to deliver bisphosphonate from the implant surface. The aims of the study were, first, to develop a model of bone remodeling around an implant delivering bisphosphonate, second, to predict the bisphosphonate dose that would induce the maximal peri-implant bone density, and third to verify in vivo that peri-implant bone density is maximal with the calculated dose. The model consists of a bone remodeling equation and a drug diffusion equation. The change in bone density is driven by a mechanical stimulus and a drug stimulus. The drug stimulus function and the other numerical parameters were identified from experimental data. The model predicted that a dose of 0.3 microg of zoledronate on the implant would induce a maximal bone density. Implants with 0.3 microg of zoledronate were then implanted in rat femurs for 3, 6 and 9 weeks. We measured that peri-implant bone density was 4% greater with the calculated dose compared to the dose empirically described as best. The approach presented in this paper could be used in the design and analysis processes of experiments in local delivery of drug such as bisphosphonate.

Macroporous biphasic calcium phosphate bioceramics, for use as bone substitutes, have been fabricated by cold isostatic pressing and conventional sintering, using naphtalen particles as a porogen to produce macropores. The resulting ceramics, composite materials made of hydroxyapatite and β-tricalcium phosphate (TCP) containing ∼45% macropores and with various microporosities, have been submitted to compression and three-point bending tests, toughness tests by single-edge-notched-bending (SENB), and spherical indentation tests. By combining two approaches at two different scales, one for closed porosity and one for open porosity, a model is established to describe mechanical properties as a function of the amount and morphology of porosity. The model assumes a quasi-continuous matrix containing macropores, the matrix being itself microporous, and considers that fracture always initiates on a macropore. The preliminary mechanical tests performed on the sintered ceramics tend to validate the modelling approach.

This in vivo study investigated the efficiency of an injectable calcium phosphate bone substitute (IBS) for bone regenerative procedures through non-destructive three-dimensional (3D) micro-tomographic (microCT) imaging, biomechanical testing with a non-destructive micro-indentation technique and 2D scanning electron microscopy (SEM) analysis. The injectable biomaterial was obtained by mixing a biphasic calcium phosphate (BCP) ceramic mineral phase and a cellulosic polymer. The BCP particles were 200-500 microm or 80-200 microm in diameter. The injectable material was implanted for 6 weeks into critical-sized bone defects at the distal end of rabbit femurs. Extensive new bone apposition was noted with both 2D and 3D techniques. Micro-CT showed that newly formed bone was in perfect continuity with the trabecular host bone structure and demonstrated the high interconnectivity of the restored bone network. For both IBS formulations, SEM and microCT gave very close measurements. The only detected significant difference concerned the amount of newly formed bone obtained with IBS 80-200 that appeared significantly higher with microCT analysis than with SEM (p=0.00007). Student t-tests did not show any significant difference in the amount of newly formed bone and remaining ceramic obtained from microCT analysis or SEM. Regression analysis showed satisfactory correlation between both the amount of newly formed bone and remaining ceramic obtained from microCT or SEM. For IBS 200-500, the newly formed bone rate inside the defect was 28.0+/-5.2% with SEM and yield strength of the samples was 18.8+/-5.4 MPa. For IBS 80-200, the newly formed bone rate inside the defect was 31.7+/-5.1% with SEM and yield strength of the samples was 26.8+/-4.5 MPa. Yield strength appeared well correlated with the amount of newly formed bone, specially observed with microCT. This study showed the ability of non-destructive techniques to investigate biological and mechanical aspects of bone replacement with injectable biomaterials.

Despite the increasing number of techniques for the preservation of bone ridges after dental avulsion, no precise evaluation of alveolar filling has been performed to date. The criteria of available measurement techniques (probes, retroalveolar or panoramic radiography, and lateral teleradiography) are not sufficiently reliable and precise. This study investigated the reliability of evaluation based on CT images in comparison with retroalveolar radiography (the most precise radiographic technique, providing standardised images), direct measurements, and images obtained in scanning electron microscopy. After a preliminary investigation ex vivo, a study was performed in vivo on three beagles. Mandibular premolars were extracted, and the corresponding alveoli were filled with an injectable bone substitute composed of a calcium phosphate mineral load associated with hydroxypropyl methylcellulose. Measurements performed on CT images relative to visual and automatic detection of density changes and studies of density curves provided better precision than those obtained by retroalveolar radiography.

We studied a new injectable biomaterial for bone and dental surgery consisting of a hydrophilic polymer as matrix and bioactive calcium phosphate (CaP) ceramics as fillers. This material is composed of complex fluids whose flow is determined by the laws of rheology. We investigated the macromolecular effects on this composite in a tube. The stability of the polymer and the mixture is essential to the production of a ready-to-use injectable biomaterial. These flow properties are necessary to obtain CaP bioactivity in a dental canal or bone defect during percutaneous surgery. Macromolecules provide spaces between CaP ceramic granules and facilitate the role of the biological agents of bone substitution.

Biodegradation processes (both intra- and extracellular) occur immediately after implantation of calcium phosphate (CaP) ceramics. Monocytes and macrophages, among the first cells to appear in wound healing, are largely implicated in phagocytosis and may be involved in CaP degradation because of their sensitivity to secreted cytokines. We tested the behaviour of human monocytes placed on the surface of hydroxyapatite (HA) and biphasic calcium phosphate (BCP) tablets in the presence of vitamin D-3 (VD3) and interferon gamma (INF gamma). After short-term culture (6 days), morphological events were observed in histological and scanning electron microscopy studies, and degradation lacunae were characterized. There were cell prints but no pits on the HA surface, but pits appeared near cells on the BCP surface. Preincubation of biomaterial in culture medium was essential. Variations in cell morphology were observed in different culture types. In the presence of VD3, degradation was greater than in the control, and cells were more polarized and rounded. With INF gamma, cells were extensively spread out on the sample surface, and the biomaterial seemed to be extracted from the surface by cells. Thus, monocytes are clearly influenced by soluble factors (vitamins, cytokines) and could be key cells in initiating the degradation of biomaterial. (C) 1996 Elsevier Science Limited

9th European Meeting on Injectable Bone and Joint Substitution Materials, LAUSANNE, SWITZERLAND, MAR 01-02, 1999; Calcium phosphate materials have been increasingly employed in orthopedic and dental applications in recent years and are now being developed for use in noninvasive surgery or as carriers for drug delivery systems. We developed an injectable bone substitute (IBS) constituted of biphasic calcium phosphate and a hydrosoluble polymer as a carrier. In vivo biocompatibility and biofunctionality of IBS were tested in rabbits using implants in osseous and nonosseous areas, The results obtained demonstrated that the concept of IBS, a filler without initial mechanical properties but able to be rapidly resorbed and replaced by newly formed bone, can be applied to new surgical applications in orthopedic surgery, maxillofacial surgery, and dentistry for pulp capping and root filling. (Bone 25:59S-61S; 1999) (C) 1999 by Elsevier Science Inc. All rights reserved.