Muhammad Nabeel Akram

Introduction: Osteoporosis is a disorder in which bone mineral density, bone strength, and bone durability are all diminished, and the patients’ BMD T-score is less than 2.5 standard deviations.¹ Worldwide, osteoporosis causes more than 8.9 million fractures annually, which results in an osteoporotic fracture every 3 seconds.² Clinicians routinely evaluate bone health during annual wellness visits, specifically for women and men (not as prevalent) aged at least 50 years and upon presentation of a fracture.³ Screening for osteoporosis (e.g., fracture risk assessment) can be conducted to determine if an individual is at-risk for the condition.³ Bisphosphonates are effective therapies for established osteoporosis. Bisphosphonates should not be used for more than 10 years, and the usage of these medications can lead to GI symptoms and an increased risk of atypical subtrochanteric fractures.^2,4 The primary non-pharmacological approach involves exercise and diet evaluation.^2,4 Osteoporosis and its associated complications are common causes of morbidity and mortality in older adults.² Individuals with osteoporosis are offered pharmacologic therapy, which can provide some form of treatment, but it does have its side effects and cannot be used in the long-term.² 3D metal printing can assist by personalizing osteoporosis treatment and predicting fracture risk.⁵ Methods: Groups are studying the potential of integrating metals into different biocompatible scaffolds. In all the studies reviewed, groups created a scaffold (PLGA, PLA, or others) and then integrated the metal particles prior to experimentation.^5,6,7,8,9 The scaffolds were tested in vivo and in vitro to compare the effectiveness of the scaffolds. Results: One of the scaffolds tested was a 3 Mg/PCL scaffold that demonstrated good comprehensive properties (bone formation and vascularization) when placed in in vitro and in vivo environments.⁵ Furthermore, Micro-CT images reflected that a thicker layer of new bone tissue was created in the experimental group at 8- and 12-weeks post-surgery. Bone volume fraction at 12 weeks for the experimental was almost equivalent to that of a normal bone.⁵ A PLGA/TCP scaffold was also tested. PT15M scaffolds demonstrated the best osteoconductivity, mechanical strength, osteogenesis, and angiogenesis. Biosafety is a concern with the usage of Mg ion so the immune response will need to be monitored.⁶ Conclusions: Research has shown promising results with regards to osteointegration, cell differentiation, angiogenesis, and other related factors. Current results do support the hypothesis that 3D printing of metals can assist in treating osteoporosis. However, further work needs to be conducted prior to any future human clinical trials.

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5. Dong Q, Zhang M, Zhou X, et al. 3D-printed Mg-incorporated PCL-based scaffolds: A promising approach for bone healing. Materials Science and Engineering: C. 2021;130:112372. doi: 10.1016/j.msec.2021.112372
6. Lai Y, Li Y, Cao H, et al. Osteogenic magnesium incorporated into PLGA/TCP porous scaffold by 3D printing for repairing challenging bone defect. Biomaterials. 2019; 197:207-219.  doi:10.1016/j.biomaterials.2019.01.013
7. Ma L, Wang X, Zhao N, et al. Integrating 3D Printing and Biomimetic Mineralization for Personalized Enhanced Osteogenesis, Angiogenesis, and Osteointegration. ACS Applied Materials & Interfaces. 2018;10(49):42146-42154. doi:10.1021/acsami.8b17495
8. Ye M, Liu W, Yan L, Cheng S, Li X, Qiao S. 3D‑printed Ti6Al4V scaffolds combined with pulse electromagnetic fields enhance osseointegration in osteoporosis. Molecular Medicine Reports. 2021;23(6). doi:10.3892/mmr.2021.12049
9. Dang W, Ma B, Li B, et al. 3D printing of metal-organic framework nanosheets-structured scaffolds with tumor therapy and bone construction. Biofabrication. 2020;12(2):025005. doi:10.1088/1758-5090/ab5ae3