Micro-Arc Oxidized Titanium-Cerium Alloy Enhances Osseointegration Under Osteoporosis

To address the issue of poor bone-implant combination ratio (BIC%) among osteoporotic patients, this study aimed to develop a micro-arc oxidized titanium-cerium alloy and investigate its regulatory effects on bone marrow mesenchymal stem cells (BMSCs) and mitochondrial function under oxidative stress conditions. The Ti-xCe (x=0-5 wt.%) gradient alloys were fabricated by vacuum arc melting, with subsequent microstructural characterization by metallographic analysis and mechanical property evaluation to determine the optimal cerium concentration. The selected composition was subjected to micro-arc oxidation (MAO) treatment (TiCeMAO group). Surface morphology was characterized by SEM. Antibacterial performance was systematically assessed. For biological evaluation, rBMSCs were cultured on material surfaces, where cell viability, cytotoxicity, and adhesion behavior were examined. Osteogenic differentiation capacity was quantified through qPCR, Western blot, ALP and alizarin red staining with quantitative analysis. The material's effects on mitochondrial function during oxidative stress were investigated by intracellular ROS detection, JC-1 assay, and quantification of electron transport chain complex expression. Ti-xCe (x=0-5 wt.%) alloys were successfully fabricated, with Ti-3Ce exhibiting optimal grain refinement and strength. TiCeMAO group demonstrated potent antibacterial effects, enhanced rBMSCs viability, extension and osteogenesis (P<0.01), and improved mitochondrial function as well as reduced ROS expression under oxidative stress (P<0.01). The TiCeMAO surface developed herein uniquely combines antibacterial activity, osteoinduction, and mitochondrial function modulation, offering a promising implant surface strategy for osteoporosis applications.