Cell Count in Osteoporotic Bone Proves Cell Death as a Cause for the Disruption of Bone Architecture and Cause for the Osteoporotic Disease
Authors: Tellez Duarte Agustin 
Published: May 2015

Introduction Osteoporosis is a pandemic class disease, it has been up until today the main cause for fractures in the elderly, and perhaps the main cause of disability and loss of life quality in older people. It also represents a cause for the loss of billions of dollars worldwide attending its complications. It has been managed until today performing tests looking for bone density for its diagnosis and treatment, with very poor success rates. The bone cell “osteocyte” is the functional unit of the bone, and even though its function has not been well studied, osteoclasts and osteoblasts have been extensively studied. It is my belief that the cause for this disease has a closer relationship to this cell than to osteoblast–osteoclast activity. We will evaluate the number of osteocytes found in the lacunae of the bone and its relationship with the trabecular patterns. The hypothesis for this study is that osteocyte death decreases the number per square millimeter of its population so bone architecture suffers and this causes bone to be more fragile. Material and Methods A total of eight human live bone samples obtained from patients with low-force fractures, one human live bone sample obtained from an otherwise healthy patient, one manual trocar for sample obtention, one optic microscope, hematoxylin eosin tincture kit, one microtome, and one microcamera. In the operating room, under sterile technic, an orthopedic surgeon takes a bone sample from the calcar region with a manual trocar in low-force fractured patients, the sample is put in formaldehyde solution 10%, then it is taken to the pathology laboratory where the sample is cut, run through hematoxylin eosin tincture process, microtomed, and put in a glass slide, then observed in the optic microscope in ×10, ×60, and ×100 objectives, microphotographs are taken and analyzed by three different observers, a pathologist, an orthopedic surgeon, and an orthopedic resident, cells are counted and results analyzed in a spread sheet to obtain a t test, using Kappa to analyze interobserver differences. Results A total of three subjects were excluded from the study during the trial because of errors during the sample management, six subjects were analyzed obtaining a mean empty lacuna lacunae per square millimeter of 6,400 Pearson correlation test of 0.95, p = 0.05, tT = 1.943, tc = 6.598, lacuna lacunae with cells count of 2,200 cells per square millimeter r =  − 0.148, tT = 1.476, tC = 0.299, p = 0.10. Interobserver difference Kappa index of 1. Trabecular patterns were also analyzed observing a loss of parallel pattern in places where no osteocytes are found. Conclusion In the analyzed samples, the number of lacuna lacunae with osteocytes was less than half compared with the lacuna lacunae without osteocyte in its interior; the interobserver rate Kappa 1 demonstrates visual analyses of this information performed through microphotographs. In addition, the architecture of the trabeculae observed in zones where lacuna lacunae are empty is lost, observing trabeculae with irregular patterns; irregularity increases as lacuna lacunae appear empty. These demonstrates that osteoporotic bone becomes fragile not because of the calcic density, but because trabecular organization and architecture depends directly correlational to the number of osteocytes in the region. Bone density and cell population are two different patterns; cell absence in bone is probably the cause of fragile bone because of the trabecular architectural pattern loss.