Bone microarchitecture and turnover in the irradiated human mandible |
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| Institution: | 1. Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam, the Netherlands;2. Department of Functional Anatomy, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands;3. Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Chemistry, the Netherlands;4. Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiotherapy, Amsterdam, the Netherlands;5. Alrijne Hospital, Department of Oral and Maxillofacial Surgery, Leiderdorp, the Netherlands;6. Institute of Dentistry, University of Eastern Finland, Kuopio Campus, and Educational Dental Clinic, Kuopio University Hospital, Kuopio, Finland;7. Leiden University Medical Center, Department of Internal Medicine, Division of Endocrinology and Center for Bone Quality, Leiden, the Netherlands;1. Department of Orthodontics, School of Dentistry, Chonnam National University, Gwangju, Republic of Korea;2. Department of Oral and Maxillofacial Surgery, School of Dentistry, Chonnam National University, Gwangju, Republic of Korea;3. Department of Oral and Maxillofacial Surgery, Dental Science Research Institute, School of Dentistry, Chonnam National University, Gwangju, Republic of Korea;1. Department of Maxillo-Facial Surgery, University Hospital of Amiens, Avenue Laennec, 80000 Amiens, France;2. EA CHIMERE, Picardie Jules Verne University, Avenue Laennec, 80000 Amiens, France;3. Department of Plastic and Reconstructive Surgery, Université Catholique de Louvain-Clinique Universitaire, St-Luc Avenue Hippocrate, 1200 Bruxelles, Belgium |
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| Abstract: | ObjectivesThe aim of this study was to assess the microarchitecture and turnover in irradiated cancellous mandibular bone and the relation with radiation dose, to elucidate the effects of radiotherapy on the mandible.Patients and methodsMandibular cancellous bone biopsies were taken from irradiated patients and controls. Micro-CT scanning was performed to analyze microstructural bone parameters. Bone turnover was assessed by histomorphometry. Local radiation dose at the biopsy site (Dmax) was estimated from radiotherapy plans.ResultsTwenty-seven irradiated patients and 35 controls were included. Osteoid volume (Osteoid Volume/Bone Volume, OV/BV) 0.066/0.168 (median/interquartile range (IQR), OV/BV; %), P < 0.001], osteoid surface (Osteoid Surface/Bone Surface, OS/BS) 0.772/2.17 (median/IQR, OS/BS; %), P < 0.001] and osteoclasts number (Osteoclasts per millimetre bone surface, Ocl/mmBS; mm2) 0.026/0.123 (median/IQR, Ocl/mmBS; mm2), P < 0.001] were decreased; trabecular number (Tb.N) was lower 1.63/0.63 (median/IQR, Tb.N; 1/mm?1), P = 0.012] and trabecular separation (Tb.Sp) 0.626/0.24 (median/IQR, Tb.Sp; μm), P = 0.038] was higher in irradiated mandibular bone. With higher Dmax, trabecular number increases (Spearman's correlation R = 0.470, P = 0.018) and trabecular separation decreases (Spearman's correlation R = ?0.526, P = 0.007). Bone mineral density (BMD, milligrams hydroxyappetite per cubic centimetre, mgHA/cm3) 1016/99 (median/IQR, BMD; mgHA/cm3), P = 0.03] and trabecular separation 0.739/0.21 (median/IQR, Tb.Sp; μm), P = 0.005] are higher whereas connectivity density (Conn Dens) 3.94/6.71 (median/IQR, Conn Dens), P = 0.047] and trabecular number 1.48/0.44 (median/IQR, Tb.N; 1/mm?1), P = 0.002] are lower in Dmax ≤50 Gy compared to controls.ConclusionsRadiotherapy dramatically impairs bone turnover in the mandible. Deterioration in microarchitecture only affects bone irradiated with a Dmax of <50 Gy. The 50 Gy value seems to be a critical threshold to where the effects of the radiation is more detrimental. |
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| Keywords: | Oral cancer Osteoradionecrosis Radiotherapy Mandible Bone turnover |
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