Bone

Bone strain and remodeling are important factors for bone health. Improved characterization of relationships between these factors in response to acute loading will improve our understanding of bone maintenance, adaptation to load, and pathophysiology. The purpose of this study was to evaluate colocalization between finite-element-estimated bone strain and [18F]sodium fluoride positron emission tomography imaging-estimated subchondral bone remodeling in the tibial diaphysis in response to acute exercise. We hypothesized that the exercise-induced change in standardized uptake values would be greatest in regions of higher strain. 26 participants underwent bilateral positron emission tomography/magnetic resonance scans before and after a bout of stair ascent and descent exercise. Finite element analysis was performed to calculate principal strain distributions in the tibial diaphysis. [18F]sodium fluoride standardized uptake values were calculated from pre- and post-exercise positron emission tomography data and mapped to the tibial surface. Mean pre-exercise and exercise-induced change in standardized uptake values were calculated and compared between regions defined by strain percentile. Both normalized mean pre-exercise and exercise-induced change in standardized uptake values increased with maximum principal strain in a pattern suggesting an exponential relationship. Pre-exercise and exercise-induced change in standardized uptake value were notably much greater in the region of highest maximum principal strains (estimated marginal means = 76.9 and 71.0 percentile, respectively) when compared to all other regions of the tibial diaphysis ([&le;] 61.1 and [&le;] 57.0 percentile, respectively, p < 0.001). This study is the first to directly show a relationship between bone mechanical loads and acute [18F]sodium fluoride uptake in humans in vivo. Our results highlight the influence of tensile strain magnitude on bone metabolic activity in response to acute loading. Furthermore, we demonstrate the utility of a combined finite element analysis and positron emission tomography approach to interrogate relationships between bone loading and bone metabolic response to acute exercise.

Many hormones and substances acting through G-protein coupled receptors and protein kinase A (PKA) activation inhibit the salt-inducible kinases (SIKs) by phosphorylation. SIKs tonically phosphorylate CREB-regulated transcriptional coactivators (CRTC1, 2 and 3), sequestering them in the cytoplasm and, thus, preventing their translocation into the nucleus. Once in the nucleus, CRTCs bind CREB family member transcription factors and enhance their activity. We and others have shown that parathyroid hormone (PTH) activation of PKA and resultant SIK2/3 inhibition allows CRTC2/3 nuclear translocation. One of the major actions of CRTC2/3 in the osteoblast lineage is the regulation of transcription of Rankl, as well as other PTH-controlled genes. However, little is known about the role of these co-activators in the osteoblast lineage in vivo. Here, we have investigated whether there are basal effects in vivo on bone examined at 2 different ages of conditional deletion of these two co-activators in the osteoblast lineage using Col2.3-Cre. We found significant increases in body weight, length, bone mineral density, bone volume/total volume, trabecular thickness and number with decreased trabecular separation in young (2 months old) male mice, all of which dissipated by 6 months of age. Female mice showed minimal changes in the bone phenotype at either age. Nevertheless, there were gene expression changes in bones of both sexes at both ages, and in particular decreases in Rankl, Runx2 and Sost, and accompanying changes in Wnt pathway genes. These effects may explain the changes in the bone phenotype in the young male mice, but it is notable that there is a sexual dimorphism in the action of CRTC2 and CRTC3. Overall, the work supports the data from research in vitro and forms a basis for investigation of the role of these co-activators in PTH action in vivo.

Mechanical stability critically influences bone fracture healing, yet how the early mechanical environment directs the transition from inflammation to regeneration remains unclear. Using a murine femoral osteotomy model, we compared rigid, semirigid, and dynamically adjusted semirigid-to-rigid fixation. Semirigid fixation delayed healing on day 21, whereas a strategy of early compliance followed by increased stiffness after 7 days restored bridging and improved bone regeneration beyond constant rigid fixation, pointing to a critical early mechanosensitive window after fracture. Single-cell RNA sequencing across the first week, comparing semirigid with rigid fixation, showed that fixation stiffness altered intercellular signaling within one day of injury. Signaling among myeloid populations was more broadly increased under semirigid fixation, with monocytes the single exception, and signaling associated with resolution of inflammation was reduced. From day 5, periosteal and skeletal progenitor populations increasingly directed cartilage-associated matrix and growth factor signaling toward macrophages and chondrocytes, accompanied by increased Sox9 regulon activity and increased COL10+ hypertrophic cartilage matrix by day 7. Reduced fixation stiffness therefore promotes a chondrogenic trajectory of repair, but increasing stiffness is required to redirect this response toward bone formation. Piezo1 was expressed across the responding populations and shifted between compartments as healing progressed. PIEZO1 activation with Yoda1 under rigid fixation enhanced bone formation but provided no additional benefit under semirigid or dynamically adjusted fixation, whereas inhibition of mechanosensitive signaling with GsMTx4 impaired repair across all conditions. Together, these findings establish the early mechanical environment as a determinant of fracture-healing trajectory, shaping the transition from inflammation to regeneration, and show that successful repair depends not on maximal stability but on when stiffness is applied. Increasing either early mechanical stimulation or cellular mechanosensitivity enhanced regeneration, supporting mechanosensitive signaling as a key component of the early healing response.

In the murine osteochondral unit, morphology of chondrocyte lacunae (CCL) within calcified articular cartilage and osteocyte lacunae (OCL) within the underlying subchondral bone reflects local biomechanical conditions that are altered in disease, making reliable discrimination of both lacunar populations important for studying osteochondral physiology and pathology. Histology is generally considered the gold standard for identifying CCL and OCL. However, it is inherently limited to two-dimensional assessment and a relatively small tissue section, restricting comprehensive characterisation of three-dimensional lacunar structure. Synchrotron-radiation micro-computed tomography (SR-microCT) enables volumetric quantification of lacunae; where classification is typically based on the position of each lacuna relative to the cement line separating calcified cartilage from bone, requiring manual delineation of this convoluted interface. Such approaches are labour-intensive, operator-dependent, and rely on access to specialised synchrotron infrastructure that is not widely available. To address these limitations, we present a fully automated, annotation-free pipeline for classifying OCL and CCL in the mouse osteochondral unit based on desktop micro-computed tomography (microCT), independent of cement line identification. The proposed unsupervised workflow requires neither tissue separation nor labelled training data, enabling objective and scalable discrimination of lacunar populations directly from volumetric image data. Seven morphometric and positional features per lacuna were extracted from SR-microCT and desktop microCT datasets and analysed using Uniform Manifold Approximation and Projection (UMAP). Validation of the pipeline outcome on SR-microCT against manual classification across specimens yielded very-high agreement, with Gwet's AC1, the Matthews correlation coefficient, and balanced accuracy each approaching 0.99, in both healthy and post-traumatic osteoarthritis specimens. Such a workflow can be readily adapted for the investigation of osteochondral interface in various other species.

Postmenopausal osteoporosis is a highly prevalent disease characterized by low bone mass and structural deterioration of bone tissue leading to increased bone fragility and fracture risk. Osteocytes orchestrate local bone (re)modeling and therefore, characterizing their 3D morphological and spatial distribution across distinct (re)modeling microenvironments is essential for understanding the cellular mechanisms underlying divergent tissue-level responses. To address this, we used a 3D-3D multiscale registration framework mapping endpoint osteocyte lacunae onto dynamic, time-lapsed in vivo (re)modeling sites. Ovariectomized 15-week-old mice were subjected to 4 weeks of anabolic parathyroid hormone (PTH) or anti-catabolic bisphosphonate (BIS) treatment as monotreatment or combined with cyclic mechanical loading (ML). Biweekly in vivo micro-computed tomography (micro-CT) to identify (re)modeling sites and endpoint ultra-high resolution (ultra-HR) micro-CT to characterize osteocyte lacunae was performed. Osteocyte lacunae were characterized by lacunar density, volume and sphericity. Our findings showed that physical and pharmacological therapies differentially regulate the osteocyte lacunar network through distinct perilacunar adaptations across functional microenvironments. While BIS stabilizes local lacunar architecture, PTH drives asymmetrical lacunar expansion (increased volume with reduced sphericity) through perilacunar remodeling that supersedes any added ML effects. Crucially, estrogen loss disrupts the natural spatial maturation gradient by inducing rounding of lacunae in newly formed bone. Therapies counteract this disruption, restoring the healthy gradients in lacunar morphometry between spatially distinct microenvironments. Additionally, despite restoring tissue-level bone volume, physical and pharmacological osteoporosis therapies do not fully recover persistent lacunar density deficits. The overall lacunar morphological spatial signatures confirm active osteocytic tuning to endocrine, physical and matrix cues.

The pace of fracture repair declines with age, increasing the risk of delayed union and nonunion. Delayed union and nonunion are associated with significant morbidity and even mortality with few effective non-surgical interventions. Here, we identify cathelicidin antimicrobial peptide (CAMP) as an age-dependent regulator of bone repair. Single-cell RNA sequencing and immunohistochemistry demonstrated higher CAMP expression during fracture healing in young compared with aged mice. Global or myeloid lineage-depletion of Camp delayed fracture repair in young mice, whereas Camp depletion in aged mice increased callus bone formation. Heterochronic bone marrow transplantation using the conditional genetic knockout further implicated hematopoietic-lineage derived cells in these effects and demonstrated that myeloid-specific Camp expression is important in the rejuvenation of the pace of fracture healing. CAMP promotes osteogenic differentiation through P2X7 receptor (P2X7R)-dependent signaling, influencing the downstream regulation of NLRP3 expression. NLRP3 expression is also correlated with osteogenesis following Camp modulation in both young and old mice, supporting CAMP-P2X7R-NLRP3 signaling as a regulator of osteogenesis. Together, these findings identify CAMP as a hematopoietic-derived regulator of bone repair whose function is age-dependent, promoting fracture healing in young animals while constraining it in aged animals.

Background: Giant cell tumor of bone (GCTB) is an intermediate osteolytic neoplasm characterized by a high rate of local recurrence. The tumor comprises two main cell populations: neoplastic stromal cells and osteoclast-like giant cells. Current adjuvant therapies primarily target osteoclast-like giant cells but have limited activity against the neoplastic stromal cells that drive tumor growth and recurrence. Here, we sought to identify actionable vulnerabilities in GCTB stromal cells by profiling druggable receptor tyrosine kinases (RTKs) and associated signaling pathways and evaluating their pharmacological inhibition in patient-derived in vitro models. Methods: RTK activation and downstream signaling were assessed using phospho-protein arrays and western blotting in therapy-naive and denosumab-treated GCTB patient samples and in patient-derived GCTB cell lines, representing clinically relevant models of the neoplastic component. Tyrosine kinase inhibitors (TKIs) targeting activated pathways were evaluated in patient-derived GCTB cell lines cultured under both two-dimensional (2D) and three-dimensional (3D) conditions. Effects on cell viability, proliferation, cell cycle distribution, and cell death were assessed using MTT and XTT assays, flow cytometry, live-cell imaging, and confocal microscopy. Results: Several activated RTKs, including EGFR, IGF-IR, InsR, PDGFR, and PDGFR{beta}, together with downstream signaling proteins MEK1/2 and ERK1/2, were identified as potential therapeutic targets. Among the inhibitors tested, trametinib, a MEK1/2 inhibitor, and axitinib, a multi-target inhibitor of VEGFR1-3, PDGFR{beta}, and c-Kit, demonstrated the strongest antiproliferative and cytotoxic effects, markedly reducing cell viability and proliferation while promoting cell death in vitro. Importantly, trametinib showed selective activity against GCTB stromal cells compared with healthy controls, suggesting a potential therapeutic window. Conclusions: This study identifies trametinib and axitinib as promising therapeutic candidates for targeting the neoplastic component of GCTB. Our findings provide a rationale for further preclinical and clinical evaluation of RTK-directed therapies to complement current treatments and specifically target the neoplastic GCTB stromal cells underlying tumor persistence and recurrence.

Purpose: To determine whether a cobalt-chrome genetic reactivity (CoGR) score - originally developed to identify patients at greater risk of developing adverse reaction to metal-on-metal hips - is associated with poorer patient-reported outcomes after knee arthroplasty (KA). Methods: In a prospective multicentre study, patients at a minimum two years post all cobalt-chrome KA were invited to research clinics. Participants provided samples for blood metal ion measurements and DNA sequencing and completed Forgotten Joint Scores (FJS). Component alignment was assessed on AP and lateral plain radiographs. The association between CoGR and FJS was assessed using regression adjusted for time since surgery, age, gender, BMI and tested for modification by blood cobalt. In a case-control analysis, CoGR scores of revised patients with histologically confirmed adverse reactions to metal debris (and specifically aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL)) were compared with controls (revised patients with no signs of ARMD and unrevised patients with FJS of 75 or more) using Firth logistic regression. Results: 376 patients were included: 312 unrevised patients and 64 patients who underwent revision. Each one-unit increase in CoGR score was associated with a 9.8 point lower FJS (95% confidence interval (CI) 4.2 to 15.4 points; p < 0.001). This increased to a 17.5 (9.4 to 25.5) point reduction per CoGR score unit in patients with blood cobalt above the median level. Comparing 28 ARMD cases (12 with ALVAL) with 177 controls, each one-unit CoGR increase was associated with odds ratios of 1.90 (CI 1.34 to 2.75) for ARMD and 3.05 (CI 1.89 to 5.34) for ALVAL. Conclusions: A higher CoGR score was associated with worse patient-reported outcome and higher odds of histologically confirmed adverse reaction to metal debris at revision. Adverse immune responses may be a more significant factor in unexplained pain after KA than is generally recognised.

To correct lower limb length discrepancies, orthopedic surgeons often perform limb lengthening procedures. These procedures involve directly lengthening a primary bone (e.g., femur), which also stretches the muscles and tendons spanning the elongation site. Limb lengthening procedures improve lower-limb length symmetry, often at the expense of chronic joint-level decrements. For example, knee joint range of motion and strength does not always return to pre-surgery values following femur lengthening. These joint-level decrements governed by altered muscle force-length characteristics, but it is unestablished how human muscles remodel during surgical limb lengthening. Here, we characterized bilateral human vastus lateralis fascicle force-length profiles following femur lengthening. At 2.2 {+/-} 1.7 years (Avg {+/-} SE) post-initial surgery, the lengthened limb's vastus lateralis fascicles were longer, effectively stiffer, and weaker than the contralateral limb. The lengthened limb's vastus lateralis fascicles were 38 mm longer (Avg) than that of the contralateral limb, even though the lengthened limb's femur was only 31 mm longer (Avg). The onset of vastus lateralis fascicle passive force production began at 22% shorter (Avg) operating lengths in lengthened versus contralateral limb muscles. Additionally, vastus lateralis peak active force production was 34% less (Avg) in the lengthened versus contralateral limbs, and in-series quadriceps tendon stiffness was not stiffer in lengthened limbs. These data suggest that active muscle tissues lengthen more than passive muscle tissues following limb lengthening, effectively creating stiffer muscles. Years after limb lengthening, patient muscles exhibit numerous differences in their force-length properties versus that of natural growth, likely contributing to impaired joint-function.

At physiological levels glucocorticoid (GC) signalling within the osteoblast lineage has been proposed to be required for skeletal homeostasis, whereas supraphysiological activation supresses bone formation and causes bone loss. While these observations suggest that GC exert dose- and context-dependent effects, the molecular mechanisms underlying these opposing actions remain unresolved. Here we systematically dissected the receptor-, lineage-, and concentration-dependent effects of GC signalling on human bone marrow stromal cell (BMSC) differentiation using integrated transcriptional, epigenomic, and functional analyses. Our findings suggest that GC opposing effects are not simply due to a GR dose-response but instead reflect distinct context- and concentration-dependent modes of action. During early BMSC differentiation, the cellular context induced GR-dependent licensing of lineage-specific gene and enhancer programs. The adverse effects of high-dose GC developed over time and could not be predicted from the early transcriptional response. We found that high-dose GC caused osteoblast maturation arrest, accompanied with a cellular stress response sustained by myeloid zinc finger 1 (MZF1) also identified as an endogenous inhibitor of osteoblast differentiation.

Even though osteoarthritis is considered a disease of the whole joint, integrated analysis of articular calcified cartilage (ACC) behaviour with adjacent tissues remains a persistent limitation. Herein, we performed synchrotron X-ray computed tomography in intact loaded joints and coupled anatomical analysis with digital volume correlation to examine whether microarchitectural ACC features serve as predictive mechano-biomarkers of osteoarthritis. We reveal that male osteoarthritis-prone STR/Ort mice have thicker yet more porous ACC that contains larger but less spherical chondrocyte lacunae than their healthy parental-control CBA mice. This was linked to asymmetrical distribution of tensile and compressive strains generated under physiological loads in the ACC and underlying subchondral bone in tibial epiphyses of STR/Ort mice. Together these data suggest that murine ACC microarchitecture has a mechano-predictive role in age-related osteoarthritis.

Current treatment of orthopedic ligament injury relies principally on non-regenerative materials and surgical repair rather than strategies that promote intrinsic tissue regeneration. This study evaluated whether biologic augmentation with XWRAP, a human amniotic membrane allograft, combined with a cryopreserved amniotic-fluid-derived biologic containing micronized human amnion membrane, promotes regeneration of ligament architecture in a rabbit medial collateral ligament (MCL) gap-defect model. Standardized 4-mm mid-substance MCL gap defects were created in New Zealand White rabbits (n=3) and either treated with the amniotic membrane/amniotic-fluid biologic combination or left untreated, with intact contralateral or adjacent MCL serving as native controls; ligaments were evaluated by transmission electron microscopy at 2 and 6 weeks post-procedure, with collagen fibril diameter quantified from calibrated high-magnification micrographs. Treated defects developed significantly larger mean collagen fibril diameters than untreated defects at both time points (75 vs. 50 nm at 2 weeks and 88 vs. 62 nm at 6 weeks; p<0.0001 for each comparison), reaching approximately 90% of native, uninjured ligament fibril diameter (98 nm) by 6 weeks. Treated defects also developed a broader, bimodal fibril-diameter distribution resembling native ligament architecture, whereas untreated defects remained characterized by a narrow, unimodal population of small-diameter fibrils typical of scar-associated repair. These findings indicate that biologic augmentation with XWRAP combined with an amniotic-fluid-derived biologic promotes a regenerative, rather than purely reparative, healing response following ligament injury, progressively restoring collagen fibril architecture toward that of native tissue in this preclinical model.

Infection following high-energy open fractures remains a major challenge. Open fractures are exposed to environmental and skin pathogens, which, along with traumatized tissue and implanted hardware, create a favorable environment for infection. 24-83% of open fractures yield positive culture results. Despite culture-positive wounds being at higher risk for infection, culture data are rarely used in clinical decision-making. Culture-positivity in open fractures is believed to indicate higher wound bioburden, but this hypothesis remains unconfirmed. This study aimed to correlate culture positivity and quantitative wound bioburden using next-generation sequencing (NGS) and to characterize patterns of bioburden and bacterial diversity amongst patients with open fracture and Fracture Related Infection. We hypothesized that higher wound bioburden would be associated with culture positivity. This secondary analysis of the METRC Bioburden Study included 78 patients with severe open tibia fractures who underwent standardized tissue sampling at definitive wound closure and at later fracture site revision surgery. DNA extracted from intraoperative tissue was analyzed via 16S rRNA gene amplicon sequencing. Quantitative bioburden metrics included bacterial read percentage and bacteria-to-human read ratio (BHR). Associations between sequencing-based bioburden, culture results, and clinical infection (CDC-defined) were evaluated using Mann-Whitney U tests, McNemars chi-squared tests, and unsupervised clustering analyses. Culture-positive samples exhibited significantly higher bacterial read percentages and higher log(BHR) values than culture-negative samples. Optimal thresholds yielded high sensitivity and specificity for both bacterial reads and BHR for predicting culture positivity. Neither baseline culture nor NGS positivity predicted later infection. However, follow-up samples from patients with established infection showed significantly higher bioburden and distinct microbiome structures. Clustering analyses identified two infection-associated microbial profiles: one with high bioburden and high diversity (polymicrobial infection) and one with low bioburden and low diversity (single-dominant pathogen). Culture positivity in open fractures correlates strongly with increased bacterial bioburden, indicating that positive cultures may primarily reflect microbial load rather than specific pathogens. Quantitative NGS-based measures, including bacterial read proportion and BHR, may offer a biologically grounded approach to assess wound contamination and may inform infection risk. Distinct bioburden-diversity patterns suggest heterogeneous infection phenotypes that may require tailored surgical and antimicrobial strategies.

Computed tomography (CT) interpretation requires recognition of the anatomical level of each slice. Classification may facilitate preprocessing and AI-assisted fracture diagnosis. We developed deep learning models to classify craniofacial CT slices into six anatomical categories. A total of 11,769 images were collected from a multicenter database involving 10 Japanese university hospitals and the public Head-Neck-Radiomics-HN1 dataset. Patients were divided into training (70%) and evaluation (30%) sets. Five CNN architectures were trained from scratch, and hard- and soft-voting ensembles were evaluated. Individual-model accuracy ranged from 94.72% to 96.09%; the hard-voting ensemble achieved 96.46% accuracy (Cohen's k = 0.954). Although performance differed among individual models (Cochran's Q = 99.29, p < 0.001), the ensemble did not significantly outperform EfficientNetV2B1 (McNemar's p = 0.163). Errors occurred mainly between adjacent anatomical regions. Deep learning can classify craniofacial CT slices accurately and may support automated dataset organization and AI-assisted fracture diagnosis. External validation is needed.

Objective: To determine how fibronectin fragment (Fn-f), a matrikine that induces an osteoarthritis (OA)-like phenotype, reshapes chondrocyte states and transcriptional programs at single-cell resolution. Design: Primary human ankle chondrocytes from two cadaveric donors without OA were treated with PBS or purified recombinant Fn-f for 18 hours and profiled by single-cell RNA sequencing. Transcriptional states were characterized by marker genes and functional enrichment, compared with classifications used for OA chondrocytes, and evaluated for Fn-f-dependent changes in abundance and transcriptional programs. Results: Five transcriptionally distinct populations were identified with features that matched previous classifications of effector, inflammatory, pre-hypertrophic/fibrochondrocyte, reparative, and homeostatic chondrocytes. Fn-f markedly redistributed cells among these states, enriching inflammatory chondrocytes while reducing effector and reparative populations. Within transcriptional states, Fn-f differentially altered matrix/cartilage, inflammatory, and stress/immediate-early programs. These responses did not uniformly correspond to assigned subtype identities, demonstrating that transcriptional programs can be dynamically deployed across chondrocyte states. Conclusions: Controlled perturbations of healthy chondrocytes complement observational OA atlases by resolving stimulus-dependent changes in chondrocyte state abundance and transcriptional programs. Discordance between subtype annotations and dynamic functional programs further highlights the need for harmonized definitions of chondrocytes across phenotypic states.

Prostate cancer (PC) bone metastases (PCBM) are a debilitating disease morbidity that primarily affects the axial skeleton. PCBM are predominantly osteosclerotic with mixed osteosclerotic/osteolytic features, including irregular bone deposition, loss of collagen alignment and increased porosity that mimic features of woven bone formed during development and repair. We hypothesize that progression of PCBM is driven by interactions between tumor cells and the bone microenvironment and is associated with changes in the stromal compartment. We performed tandem mass tag mass spectrometry proteomics on lumbar vertebral specimens from 32 cadaveric PCBM specimens and 3 age-matched controls. Unsupervised clustering segregated specimens into three clusters associated with benign, mixed, and osteosclerotic lesion states, characterized by distinct immune-, tumor-, and osteogenic-associated protein signatures. Histological analysis showed tumor infiltration was accompanied by marrow fibrosis and increased collagen III deposition. We identified a marker signature associated with osteosclerotic remodeling and mapped this signature to independent metastatic PC transcriptomic datasets. The proteomics-derived markers reproduced similar molecular groupings at RNA level, and robustly segregated bone PCBMs from soft tissue metastases PC in RNA data. Together, these findings define molecularly distinct states of tumor-driven changes in PCBM that extend beyond histological classification and may inform biomarker development and therapeutic stratification.

Individuals with fibrodysplasia ossificans progressiva (FOP), a rare genetic disorder caused by mutations in the bone morphogenetic protein receptor ACVR1 (also known as ALK2), experience progressive and severely debilitating endochondral heterotopic ossification (HO). Previous studies have identified fibro-adipogenic progenitors (FAPs) as a major cellular source of HO in FOP mouse models. Here, we used mRNA sequencing of FAPs isolated from injured muscle of FOP mice to capture the earliest gene expression changes associated with the transformation of muscle tissues into bone. Whereas the transcriptomes of mutant and wild-type FAPs were indistinguishable prior to injury and at 1 day post injury, dramatic dysregulation of gene expression was observed at 3 and 5 days after injury. Surprisingly, gene expression changes suggested early specification of osteochondral lineages by 3 days post injury, approximately 3 to 4 days before the appearance of histologically identifiable cartilage. We identified dysregulation of genes encoding components of major signaling pathways, cell cycle regulators, extracellular matrix components, and hypoxia response mediators, and showed that these gene expression changes are temporally associated with abnormal population growth of mutant FAPs. We further demonstrated that treatment of FOP mice with either an anti-activin A monoclonal antibody or the ACVR1 kinase inhibitor BLU-782 (IPN60130; fidrisertib) normalized the expression of the majority of dysregulated FAP genes. However, the relative efficacy of the drugs differed, and distinct sets of overlapping genes were normalized by the treatments. The substantial transcriptional changes caused by these drugs in FAPs from normally regenerating muscle were also enumerated and described. These findings define early transcriptional events associated with pathogenic FAP reprogramming and provide a molecular framework for understanding the shared and distinct effects of activin A and ACVR1 inhibition.

Bone loss and metabolic dysregulation often coexist in older adults, yet the relationship between age-related changes in bone cell metabolism and bone-forming activity remains unclear. By modeling both conditions in aged mice and using in vivo stable-isotope tracing, we demonstrated that age-related decline in bone formation was coupled with an intrinsic impairment of glycolysis within bone tissue. Impaired glycolysis was associated with reduced protein levels of key glycolysis enzymes, and transcriptomics analyses revealed compensatory upregulation of glycolysis genes in aged bone. Metabolic intervention through long-term caloric restriction prevented age-related trabecular bone loss. Furthermore, osteoblast-specific genetic enhancement of glycolysis, via overexpression of HIF1 or the rate-limiting enzyme PFKFB3, significantly improved osteoblast function and increased bone mass in aged mice. Together, the study identifies glycolytic decline as a cell-autonomous driver of osteoblast deficiency and provides proof of principle that reactivating glycolysis can promote bone accrual in aging.

Paraspinal muscles support and move the spine, and reduced size and density of these muscles is associated with increased risk of vertebral fracture and back pain. We test the hypothesis that subsistence-oriented forager-horticulturalists (Bolivian Tsimane) have larger and denser paraspinal muscles, and smaller age-related differences in paraspinal muscle size and density, than more sedentary post-industrialized suburbanites (Framingham Heart Study [FHS]). We measured cross-sectional area (CSA) and density of trunk extensors and psoas major at L3 from computed tomography scans of 411 FHS and 330 Tsimane (50% women, aged 50-90 years). Sex-stratified linear regressions determined associations of muscle CSA and density with age and cohort (Tsimane or FHS [ref.]), with and without an age-cohort interaction term. Covariates were height and weight. After adjusting for covariates, Tsimane women had 11-14% larger and denser extensors, and 17-26% smaller and less-dense psoas major, than FHS women. Tsimane men had 8-21% smaller and less-dense psoas major than FHS men. The age-related difference in extensors density was 41% smaller for Tsimane men than for FHS men. There were no other significant age-related cohort differences in muscle CSA or density. We observed a different balance in the size and density of trunk extensors versus psoas major between Tsimane and FHS. A possible explanation for this observation is cohort differences in the amount and types of physical activity, although future work is required to determine the influence of lifestyle and environmental factors on paraspinal muscle size and density.

Leisure time physical activity (LTPA) in mid-life may have beneficial effects on risk factors for hip fracture in later life. Conversely, physical activity may increase fracture risk through risk of injury, and the optimal amount of physical activity for reducing hip fracture risk remains unclear. We explored the associations between volume and intensity of LTPA in mid-life, and subsequent risk of hip fracture ascertained from linked health data. This prospective observational study used middle aged adults aged 40- 65 years from UK Biobank. LTPA volume (LTPAv) was derived from self-reported walking, moderate and vigorous activity at baseline (2006- 2010). Cox proportional hazard and Fine-Gray sub-distribution models were used to estimate the association between activity and hip fracture, which was sex-stratified. From 324,284 participants with complete data 53% were female and mean age at baseline was 54.5 (SD 7.3). Across 16 years of follow-up there were 2,674 hip fractures. In terms of LTPA volume, the lowest risk of hip fracture occurred in quintile 3 for women (HR 0.78, 95% CI 0.67-0.91), and men (HR 0.74, 95% CI 0.60- 0.90), relating to approximately one hour/day of leisure time physical activity. When activity intensities were examined separately, the lowest estimated hazards were observed for vigorous activity, at quintile 4 in women (HR 0.65, 95% CI 0.55 - 0.76) and quintile 3 in men (HR 0.64, 95% CI 0.52- 0.79), corresponding to approximately 60- 90 minutes of vigorous activity per week. In conclusion, moderately high volumes of mid-life physical activity, particularly vigorous activity, were related to lower risk of subsequent hip fracture, but these relationships appear to attenuate at higher volumes.