Biomechanical Properties of Metastatically Involved Osteolytic Bone
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BIOMECHANICS (G NIEBUR AND J WALLACE, SECTION EDITORS)
Biomechanical Properties of Metastatically Involved Osteolytic Bone Cari M. Whyne 1,2,3
&
Dallis Ferguson 1,3 & Allison Clement 1 & Mohammedayaz Rangrez 1 & Michael Hardisty 1,2
Accepted: 29 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Skeletal metastasis involves the uncoupling of physiologic bone remodeling resulting in abnormal bone turnover and radical changes in bony architecture, density, and quality. Bone strength assessment and fracture risk prediction are critical in clinical treatment decision-making. This review focuses on bone tissue and structural mechanisms altered by osteolytic metastasis and the resulting changes to its material and mechanical behavior. Recent Findings Both organic and mineral phases of bone tissue are altered by osteolytic metastatic disease, with diminished bone quality evident at multiple length-scales. The mechanical performance of bone with osteolytic lesions is influenced by a combination of tissue-level and structural changes. Summary This review considers the effects of osteolytic metastasis on bone biomechanics demonstrating its negative impact at tissue and structural levels. Future studies need to assess the cumulative impact of cancer treatments on metastatically involved bone quality, and its utility in directing multimodal treatment planning. Keywords Osteolytic metastases . Biomechanical properties . Bone quality . Multiscale . Cancer treatment effects
Introduction Bone metastases frequently occur in patients with breast, lung, prostate, and renal cancers [1–3]. Bone metastases can lead to skeletal-related events (SREs) which include pathologic fractures, pain, compression syndromes of the nerve root or spinal cord, and metabolic disturbances [4, 5]. SREs increase mortality and significantly impact a patient’s quality of life, physical function, and health resource utilization [6, 7]. The risk of SREs is increased for all types of bone metastases which can present as osteoblastic (bone generating), osteolytic (bone destructive), or a mixture of the two [8]. Osteolytic metastases are more common and aggressive than osteoblastic metastases and have been associated with a higher incidence of pathologic fractures [9, 10]. Bone strength assessment and fracture risk prediction are This article is part of the Topical Collection on Biomechanics * Cari M. Whyne [email protected]
critically important in guiding clinical treatment decisions aimed at preventing and/or lessening the burden of SREs, particularly as bone metastasis evolves to a more chronic disease state. A literature search was performed to evaluate the current understanding of the effects of osteolytic metastatic disease on bone biomechanics. This review focuses on the bone tissue and structural mechanisms altered by pathology and the resulting changes to material and mechanical behavior. Moreover, it also considers research spanning from in vitro studies through preclinical analys
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