1
|
Gupta N, Kanwar N, Arora A, Khatri K, Kanwal A. The interplay of rheumatoid arthritis and osteoporosis: exploring the pathogenesis and pharmacological approaches. Clin Rheumatol 2024; 43:1421-1433. [PMID: 38499817 DOI: 10.1007/s10067-024-06932-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/22/2024] [Accepted: 03/08/2024] [Indexed: 03/20/2024]
Abstract
Rheumatoid arthritis (RA) and osteoporosis are two chronic disorders that are often seen together. RA is an autoimmune disorder that causes pain and inflammation in the joints, while osteoporosis is a disorder in which the bones become weak and fragile. Risk factors for bone loss in RA include disease activity, longer disease duration, erosive disease, autoantibody positivity, and joint damage leading to impaired physical activity. Recent research has shown that there is a complex interplay between immune cells, cytokines, and bone remodeling processes in both RA and osteoporosis. The bone remodeling process is regulated by cytokines and immune system signaling pathways, with osteoclasts activated through the RANK/RANKL/OPG pathway and the Wnt/DKK1/sclerostin pathway. Understanding these mechanisms can aid in developing targeted therapies for treatment of osteoporosis in RA patients. Current pharmacological approaches include anti-osteoporotic drugs such as bisphosphonates, denosumab, teriparatide, abaloparatide, raloxifene, and romosozumab. Conventional disease-modifying antirheumatic drugs such as methotrexate and biologicals including TNF inhibitors, IL-6 inhibitors, rituximab, and abatacept lower disease activity in RA and can improve bone metabolism by reducing inflammation but have limited impact on bone mineral density. This review will shed light on the relationship between osteoporosis and rheumatoid arthritis as well as the various factors that influence the onset of osteoporosis in RA patients. We also explore several treatment approaches to effectively managing osteoporosis in RA patients.
Collapse
Affiliation(s)
- Nikhil Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, Bathinda, 151001, Punjab, India
| | - Navjot Kanwar
- Department of Pharmaceutical Sciences and Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda, 151001, Punjab, India
| | - Anchal Arora
- Department of Pharmacology, All India Institute of Medical Sciences, Bathinda, 151001, Punjab, India
| | - Kavin Khatri
- Department of Orthopedics, All India Institute of Medical Sciences, Bathinda, 151001, Punjab, India.
| | - Abhinav Kanwal
- Department of Pharmacology, All India Institute of Medical Sciences, Bathinda, 151001, Punjab, India.
| |
Collapse
|
2
|
Ng C, Qin Y, Xia Y, Hu X, Zhao B. Jagged1 Acts as an RBP-J Target and Feedback Suppresses TNF-Mediated Inflammatory Osteoclastogenesis. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2023; 211:1340-1347. [PMID: 37756541 PMCID: PMC10693321 DOI: 10.4049/jimmunol.2300317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023]
Abstract
TNF plays a crucial role in inflammation and bone resorption in various inflammatory diseases, including rheumatoid arthritis (RA). However, its direct ability to drive macrophages to differentiate into osteoclasts is limited. Although RBP-J is recognized as a key inhibitor of TNF-mediated osteoclastogenesis, the precise mechanisms that restrain TNF-induced differentiation of macrophages into osteoclasts are not fully elucidated. In this study, we identified that the Notch ligand Jagged1 is a previously unrecognized RBP-J target. The expression of Jagged1 is significantly induced by TNF mainly through RBP-J. The TNF-induced Jagged1 in turn functions as a feedback inhibitory regulator of TNF-mediated osteoclastogenesis. This feedback inhibition of osteoclastogenesis by Jagged1 does not exist in RANKL-induced mouse osteoclast differentiation, as RANKL does not induce Jagged1 expression. The Jagged1 level in peripheral blood monocytes/osteoclast precursors is decreased in RA compared with the nonerosive inflammatory disease systemic lupus erythematosus, suggesting a mechanism that contributes to increased osteoclast formation in RA. Moreover, recombinant Jagged1 suppresses human inflammatory osteoclastogenesis. Our findings identify Jagged1 as an RBP-J direct target that links TNF and Notch signaling pathways and restrains TNF-mediated osteoclastogenesis. Given that Jagged1 has no effect on TNF-induced expression of inflammatory genes, its use may present a new complementary therapeutic approach to mitigate inflammatory bone loss with little impact on the immune response in disease conditions.
Collapse
Affiliation(s)
- Courtney Ng
- Correspondence: Baohong Zhao, Ph.D. Hospital for Special Surgery, Research Institute R804, 535 East 70 Street, New York, NY 10021, 212-774-2772 (Tel), 646-714-6333 (Fax),
| | - Yongli Qin
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Yuhan Xia
- Correspondence: Baohong Zhao, Ph.D. Hospital for Special Surgery, Research Institute R804, 535 East 70 Street, New York, NY 10021, 212-774-2772 (Tel), 646-714-6333 (Fax),
| | - Xiaoyu Hu
- Institute for Immunology and School of Medicine, Tsinghua University, Beijing, China
| | - Baohong Zhao
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Graduate Program in Cell and Development Biology, Weill Cornell Graduate School of Medical Sciences, New York, New York, USA
| |
Collapse
|
3
|
Yocom A, Contino E, Kawcak C. Review of the Mechanism of Action and Use of Bisphosphonates in Horses. J Equine Vet Sci 2023:104503. [PMID: 37120118 DOI: 10.1016/j.jevs.2023.104503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 04/13/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
Bisphosphonates are a group of drugs that can reduce bone resorption by incorporating into the crystal structure of exposed hydroxyapatite where they are taken up by osteoclasts. Bisphosphonates have several other mechanisms of action including reducing pain and inflammation and altering macrophage function. There are two types of bisphosphonates - nitrogenous and non-nitrogenous, the latter of which is used in horses. This article provides a literature-based review of the proposed mechanisms of action and therapeutic uses of bisphosphonates including a brief review of bone response to disease. A review of the literature available in horses including safety data and current rules and regulations is also provided.
Collapse
Affiliation(s)
- Alicia Yocom
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523
| | - Erin Contino
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523
| | - Christopher Kawcak
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523.
| |
Collapse
|
4
|
Xia Y, Inoue K, Du Y, Baker SJ, Reddy EP, Greenblatt MB, Zhao B. TGFβ reprograms TNF stimulation of macrophages towards a non-canonical pathway driving inflammatory osteoclastogenesis. Nat Commun 2022; 13:3920. [PMID: 35798734 PMCID: PMC9263175 DOI: 10.1038/s41467-022-31475-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/20/2022] [Indexed: 01/12/2023] Open
Abstract
It is well-established that receptor activator of NF-κB ligand (RANKL) is the inducer of physiological osteoclast differentiation. However, the specific drivers and mechanisms driving inflammatory osteoclast differentiation under pathological conditions remain obscure. This is especially true given that inflammatory cytokines such as tumor necrosis factor (TNF) demonstrate little to no ability to directly drive osteoclast differentiation. Here, we found that transforming growth factor β (TGFβ) priming enables TNF to effectively induce osteoclastogenesis, independently of the canonical RANKL pathway. Lack of TGFβ signaling in macrophages suppresses inflammatory, but not basal, osteoclastogenesis and bone resorption in vivo. Mechanistically, TGFβ priming reprograms the macrophage response to TNF by remodeling chromatin accessibility and histone modifications, and enables TNF to induce a previously unrecognized non-canonical osteoclastogenic program, which includes suppression of the TNF-induced IRF1-IFNβ-IFN-stimulated-gene axis, IRF8 degradation and B-Myb induction. These mechanisms are active in rheumatoid arthritis, in which TGFβ level is elevated and correlates with osteoclast activity. Our findings identify a TGFβ/TNF-driven inflammatory osteoclastogenic program, and may lead to development of selective treatments for inflammatory osteolysis.
Collapse
Affiliation(s)
- Yuhan Xia
- Arthritis and Tissue Degeneration Program and David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kazuki Inoue
- Arthritis and Tissue Degeneration Program and David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Yong Du
- Arthritis and Tissue Degeneration Program and David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA
| | - Stacey J Baker
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E Premkumar Reddy
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew B Greenblatt
- Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
- Research Institute, Hospital for Special Surgery, New York, NY, USA
| | - Baohong Zhao
- Arthritis and Tissue Degeneration Program and David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
- Graduate Program in Cell and Development Biology, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA.
| |
Collapse
|
5
|
Lan YS, Feng YJ. The volume of brisk walking is the key determinant of BMD improvement in premenopausal women. PLoS One 2022; 17:e0265250. [PMID: 35294490 PMCID: PMC8926180 DOI: 10.1371/journal.pone.0265250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
SUMMARY Osteoporosis is an increasing health problem in postmenopausal women. Our findings indicated that long-term brisk walking with a volume greater than 16 per week is effective for improving BMD in premenopausal women. PURPOSE To examine the effects of brisk walking on bone mineral density (BMD) in premenopausal women, and further determine the effective frequency, intensity, time and volume (frequency x duration) of brisk walking for training strategy prescription. METHODS 222 healthy premenopausal women were recruited for BMD measurement. According to the survey of their physical activity level, 84 subjects (age: 46±1.8) whose physical activity index ≥40 were categorized into the brisk walking group, and 138 subjects (age: 47±2.2) whose physical activity index <40 were assigned to the sedentary group. The BMD of these two groups were statistically compared with an independent t test. Next, 35 subjects from the original sedentary group were recruited for BMD measurement after 2-year moderate brisk walking. According to the volume of physical activity per week, they were divided into the control group (n = 10, aged 49±0.9), volume 8 group (n = 4, aged 48±1.2), volume 12 group (n = 7, aged 49±1.4), volume 16 group (n = 8, aged 49±1.3), and volume 20 group (n = 6, aged 49±1.5). ANOVA was used to analyze BMD before and after brisk walking among the five groups. RESULTS The BMD in the brisk walking group (1.00±0.008 g/cm2) was significantly higher than that in the sedentary group (0.89±0.008 g/cm2) (P<0.001). Stepwise regression analysis revealed that the volume of brisk walking was significantly correlated with BMD (P<0.001). In particular, brisk walking with a volume greater than 16 (a score of duration up to 4 and a score of frequency up to 4 or 5) per week is effective for improving BMD in premenopausal women (P = 0.03, P = 0.002, respectively). CONCLUSIONS Long-term brisk walking is an efficient way to improve BMD. Taking brisk walks for 30 minutes per day 3 or more times per week (volume>16) is recommended to prevent bone loss in premenopausal women.
Collapse
Affiliation(s)
- Yong-Sheng Lan
- School of Physical Education, Changchun Normal University, Changchun, Jilin, China
- * E-mail:
| | - Yu-Juan Feng
- Shandong University of Art and Design, Jinan, Shandong, China
| |
Collapse
|
6
|
Peris P, Monegal A, Guañabens N. Bisphosphonates in inflammatory rheumatic diseases. Bone 2021; 146:115887. [PMID: 33592328 DOI: 10.1016/j.bone.2021.115887] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/12/2021] [Accepted: 02/10/2021] [Indexed: 12/25/2022]
Abstract
The main well recognized action of bisphosphonates (BPs) is their antiresorptive capacity, making them first-line drugs in the treatment of osteoporosis and other metabolic bone diseases. In this review we have compiled other possible actions of BPs, particularly in the areas of immunomodulation, anti-inflammatory capacity and in the prevention of structural joint damage in inflammatory rheumatic diseases. The immunomodulatory capacity of BPs has been focused on the mechanisms involved in the acute-phase response associated with the administration of nitrogen containing BPs (N-BPs), with the stimulus of pro-inflammatory cytokines, through the mevalonate pathway, activation of T-cells and the decrease in the cytotoxic T-lymphocyte antigen-4 (CTLA-4). In relation to their anti-inflammatory capacity, special attention has been given to their effect on preventing structural damage in inflammatory joint diseases and on the differential immune response in bone lesions of the most common and representative inflammatory rheumatic diseases, i.e. rheumatoid arthritis and spondyloarthropathies. The present data indicate that more studies are needed to improve the knowledge on the effect of BPs on inflammatory-mediated diseases and particularly on the prevention and/or treatment of the structural damage in these disorders, since these agents could be a potential useful concomitant therapy.
Collapse
Affiliation(s)
- Pilar Peris
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ana Monegal
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Núria Guañabens
- Department of Rheumatology, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
7
|
Papapoulos SE. Pamidronate: A model compound of the pharmacology of nitrogen-containing bisphosphonates; A Leiden historical perspective. Bone 2020; 134:115244. [PMID: 31958532 DOI: 10.1016/j.bone.2020.115244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
Abstract
Pamidronate [3-amino-1-hydroxypropylidene-1,1-bisphosphonate (APD)] was the first nitrogen-containing bisphosphonate (N-BP) investigated in clinical studies. In contrast to other clinically used bisphosphonates, pamidronate was discovered and its properties were initially studied in an Academic Institution. On the occasion of the 50th Anniversary of the first publications on the biological effects of bisphosphonates, I review in this article the contribution of Leiden investigators to the development of pamidronate that led to the recognition of the significance of the Nitrogen atom in the side chain of bisphosphonates for their action on bone resorption and to the formulation of principles for the use of N-BPs in the management of patients with different skeletal disorders.
Collapse
Affiliation(s)
- Socrates E Papapoulos
- Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands.
| |
Collapse
|
8
|
Andreasen CM, Jurik AG, Glerup MB, Høst C, Mahler BT, Hauge EM, Herlin T. Response to Early-onset Pamidronate Treatment in Chronic Nonbacterial Osteomyelitis: A Retrospective Single-center Study. J Rheumatol 2019; 46:1515-1523. [PMID: 30988129 DOI: 10.3899/jrheum.181254] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Chronic nonbacterial osteomyelitis (CNO) is a sterile inflammatory bone disorder with an unpredictable disease course. The objective was to assess clinical and radiological disease activity in children with CNO including response to early-onset pamidronate treatment. METHODS A single-center retrospective study was conducted of children fulfilling the Bristol Criteria for CNO. At the time of diagnosis, whole-body magnetic resonance imaging (WB-MRI) or local MRI was performed to assess radiological disease activity. Children with multifocal or spinal bone inflammation and clinical disease activity not responding to nonsteroidal antiinflammatory drugs were categorized as having extended CNO. Clinical disease activity was assessed annually. RESULTS Fifty-one children were included. Median followup time was 4 years (interquartile range 3-7). Children categorized with extended CNO (n = 32) were treated in an early-onset 2-year pamidronate regimen. In extended CNO, WB-MRI was performed at time of diagnosis, and at years 1 and 2 in 88%, 84%, and 91% of cases, respectively. During the first year, the total number of radiologically active lesions and number of spinal lesions per patient declined (p = 0.01). Clinically inactive disease was recorded in 12/32 children (38%). However, 8/12 children (67%) experienced clinical relapse. In limited CNO (n = 19), 10/19 children (53%) presented with clinically inactive disease after 1 year and did not experience clinical relapse. CONCLUSION Pamidronate might contribute to improvement in clinical and radiological disease activity in extended CNO, especially after 1 year of treatment. However, children with continuously active disease after 2 years of pamidronate treatment were seen.
Collapse
Affiliation(s)
- Caroline Marie Andreasen
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. .,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital.
| | - Anne Grethe Jurik
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital
| | - Mia B Glerup
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital
| | - Christian Høst
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital
| | - Birgitte T Mahler
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital
| | - Ellen-Margrethe Hauge
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital
| | - Troels Herlin
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital
| |
Collapse
|
9
|
Kumagai K, Harigane K, Kusayama Y, Tezuka T, Choe H, Inaba Y, Saito T. Effects of once-monthly minodronate versus risedronate in osteoporosis patients with rheumatoid arthritis: a 12-month randomized head-to-head comparison. Osteoporos Int 2018; 29:1637-1642. [PMID: 29574518 DOI: 10.1007/s00198-018-4494-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/19/2018] [Indexed: 01/01/2023]
Abstract
UNLABELLED A head-to-head comparison of once-monthly oral bisphosphonates minodronate (MIN) and risedronate (RIS) in patients with rheumatoid arthritis (RA) demonstrated that MIN has the same effect as RIS on increase in bone mineral density (BMD) and a stronger effect on inhibition of bone resorption than RIS, suggesting that MIN is a promising treatment option for osteoporosis patients with RA. INTRODUCTION To evaluate the effect of once-monthly oral MIN in patients with RA, a prospective, randomized, open-label, head-to-head comparison with once-monthly oral RIS was conducted. METHODS A total of 83 patients with RA were randomly assigned to either once-monthly oral MIN 50 mg (n = 42) or once-monthly oral RIS 75 mg (n = 41). Serial BMD and bone turnover markers were measured and compared between the treatment groups. RESULTS BMD (lumbar spine, total hip, femoral neck) increased significantly after 12 months of treatment with MIN (3.8, 2.0, and 2.2%, respectively, P < 0.05) and RIS (3.6, 1.9, and 1.9%, respectively, P < 0.05). There were no significant differences between the treatment groups. Percent changes of bone turnover markers from baseline to 12 months in the MIN group were significantly greater than those in the RIS group (TRACP-5b: - 36.3 vs - 19.3%, P < 0.05; NTX: - 27.1 vs - 17.3%, P < 0.05; BAP: -30.2 vs -19.4%, P < 0.05). CONCLUSIONS The present study of RA patients demonstrated that MIN has the same effect as RIS on increase in BMD and a stronger effect on inhibition of bone resorption than RIS. The results suggest that MIN is a promising treatment option for osteoporosis patients with RA.
Collapse
Affiliation(s)
- K Kumagai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - K Harigane
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Y Kusayama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - T Tezuka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - H Choe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Y Inaba
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - T Saito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| |
Collapse
|
10
|
Solomon DH, Kay J, Duryea J, Lu B, Bolster MB, Yood RA, Han R, Ball S, Coleman C, Lo E, Wohlfahrt A, Sury M, Yin M, Yu Z, Zak A, Gravallese EM. Effects of Teriparatide on Joint Erosions in Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Rheumatol 2017; 69:1741-1750. [PMID: 28544807 DOI: 10.1002/art.40156] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/16/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Articular erosions correlate with disability in rheumatoid arthritis (RA). Biologic agents reduce erosion progression in RA, but erosion healing occurs infrequently. This study was undertaken to assess the effects of the anabolic agent teriparatide on joint erosion volume in RA patients treated with a tumor necrosis factor inhibitor (TNFi). METHODS We conducted a randomized controlled trial in 24 patients with erosive RA, osteopenia, and disease activity controlled by TNFi treatment for at least 3 months. Half were randomized to receive teriparatide for 1 year and the others constituted a wait-list control group. Subjects and primary rheumatologists were not blinded with regard to treatment assignment, but all outcomes were assessed in a blinded manner. The primary outcome measure was change in erosion volume determined by computed tomography at 6 anatomic sites. Significance within each hand and anatomic site was based on a 2-tailed test, with P values less than 0.05 considered significant. RESULTS Baseline characteristics of the treatment groups were well balanced. After 52 weeks, the median change in erosion volume in the teriparatide group was -0.4 mm3 (interquartile range [IQR] -34.5, 29.6) and did not differ significantly from that in controls (median change +9.1 mm3 [IQR -29.6, 26.4]) (P = 0.28). No significant difference in change in erosion volume was noted at the radius, ulna, or metacarpophalangeal joints. Bone mineral density improved at the femoral neck and lumbar spine in the teriparatide group. CONCLUSION Our findings indicate that teriparatide treatment for 1 year does not significantly reduce erosion volume in the hands or wrists of patients with established RA with disease activity controlled by TNFi treatment.
Collapse
Affiliation(s)
- D H Solomon
- Brigham and Women's Hospital, Boston, Massachusetts
| | - J Kay
- University of Massachusetts Memorial Medical Center, Worcester
| | - J Duryea
- Brigham and Women's Hospital, Boston, Massachusetts
| | - B Lu
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - R A Yood
- Reliant Medical Group, Worcester, Massachusetts
| | - R Han
- Brigham and Women's Hospital, Boston, Massachusetts
| | - S Ball
- University of Massachusetts Memorial Medical Center, Worcester
| | - C Coleman
- Brigham and Women's Hospital, Boston, Massachusetts
| | - E Lo
- Brigham and Women's Hospital, Boston, Massachusetts
| | - A Wohlfahrt
- Brigham and Women's Hospital, Boston, Massachusetts
| | - M Sury
- Brigham and Women's Hospital, Boston, Massachusetts
| | - M Yin
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Z Yu
- Brigham and Women's Hospital, Boston, Massachusetts
| | - A Zak
- Brigham and Women's Hospital, Boston, Massachusetts
| | - E M Gravallese
- University of Massachusetts Memorial Medical Center, Worcester
| |
Collapse
|
11
|
Kranenburg G, Bartstra JW, Weijmans M, de Jong PA, Mali WP, Verhaar HJ, Visseren FL, Spiering W. Bisphosphonates for cardiovascular risk reduction: A systematic review and meta-analysis. Atherosclerosis 2016; 252:106-115. [DOI: 10.1016/j.atherosclerosis.2016.06.039] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/10/2016] [Accepted: 06/22/2016] [Indexed: 12/01/2022]
|
12
|
Andersson A, Bernardi AI, Stubelius A, Nurkkala-Karlsson M, Ohlsson C, Carlsten H, Islander U. Selective oestrogen receptor modulators lasofoxifene and bazedoxifene inhibit joint inflammation and osteoporosis in ovariectomised mice with collagen-induced arthritis. Rheumatology (Oxford) 2015; 55:553-63. [PMID: 26424839 PMCID: PMC4746431 DOI: 10.1093/rheumatology/kev355] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE RA predominantly affects post-menopausal women and is strongly associated with development of generalised osteoporosis. To find treatments that target both joint manifestations and osteoporosis in RA is desirable. The third generation of selective oestrogen receptor modulators (SERMs) [lasofoxifene (LAS) and bazedoxifene (BZA)] are new treatment options for post-menopausal osteoporosis. The aim of this study was to investigate the effects of LAS and BZA on arthritic disease and inflammation-associated bone loss using CIA in mice. METHODS Female DBA/1 mice were ovariectomised and subjected to CIA as a model of post-menopausal RA. Mice received treatment with LAS, BZA, 17β-estradiol (E2) as reference or vehicle. Arthritis development was assessed and BMD was determined by peripheral quantitative CT of the femurs. Serologic markers of inflammation and cartilage destruction were analysed. Immune cells in lymph nodes were studied by flow cytometry. RESULTS LAS and BZA reduced the clinical severity of arthritis as well as the grade of histologic synovitis and erosions on cartilage and bone. Moreover, SERMs protected against generalised bone loss in CIA by increasing trabecular BMD. Both SERMs decreased serum marker of cartilage destruction and LAS reduced serum IL-6 levels. SERMs did not alter Th17 cells in lymph nodes as E2 did. CONCLUSION The anti-osteoporotic drugs LAS and BZA were found to be potent inhibitors of joint inflammation and bone destruction in experimental arthritis. This study provides new important knowledge regarding the treatment regimen of post-menopausal women with RA who suffer from increased risk for osteoporosis.
Collapse
Affiliation(s)
- Annica Andersson
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research and
| | - Angelina I Bernardi
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research and
| | - Alexandra Stubelius
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research and
| | - Merja Nurkkala-Karlsson
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research and
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Carlsten
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research and
| | - Ulrika Islander
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research and
| |
Collapse
|
13
|
Abstract
BACKGROUND Osteoporosis is a bone mineralisation disorder occurring in about one third of adults with cystic fibrosis. Bisphosphonates can increase bone mineral density and decrease the risk of new fractures in post-menopausal women and people receiving long-term oral corticosteroids. OBJECTIVES To assess the effects of bisphosphonates on the frequency of fractures, bone mineral density, quality of life, adverse events, trial withdrawals, and survival in people with cystic fibrosis. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group Trials Register of references (identified from electronic database searches and handsearches of journals and abstract books) on 13 January 2014.Additional searches of PubMed were performed on 13 January 2014. SELECTION CRITERIA Randomised controlled trials of at least six months duration studying bisphosphonates in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS Two authors independently selected trials and extracted data. Trial investigators were contacted to obtain missing data. MAIN RESULTS Nine trials were identified and seven (with a total of 237 adult participants) were included.Data were combined (when available) from six included studies in participants without a lung transplant. Data showed that there was no significant reduction in fractures between treatment and control groups at 12 months, odds ratio 0.72 (95% confidence interval 0.13 to 3.80). No fractures were reported in studies with follow-up at 24 months. However, in patients taking bisphosphonates after six months the percentage change in bone mineral density increased at the lumbar spine, mean difference 4.61 (95% confidence interval 3.90 to 5.32) and at the hip or femur, mean difference 3.35 (95% confidence interval 1.63 to 5.07); but did not significantly change at the distal forearm, mean difference -0.49 (95% confidence interval -2.42 to 1.45). In patients taking bisphosphonates, at 12 months the percentage change in bone mineral density increased at the lumbar spine, mean difference 6.10 (95% confidence interval 5.10 to 7.10) and at the hip or femur, mean difference 4.35 (95% confidence interval 2.99 to 5.70). At 24 months, in patients treated with bisphosphonates the percentage change in bone mineral density also increased at the lumbar spine, mean difference 5.49 (95% confidence interval 4.38 to 6.60) and at the hip or femur, mean difference 6.05 (95% confidence interval 3.74 to 8.36). There was clinical heterogeneity between studies and not all studies reported all outcomes. Bone pain was the most common adverse event with intravenous agents. Flu-like symptoms were also increased in those taking bisphosphonates.In participants with a lung transplant (one study), intravenous pamidronate did not change the number of new fractures. At axial sites, bone mineral density increased with treatment compared to controls: percentage change in bone mineral density at lumbar spine, mean difference 6.20 (95% confidence interval 4.28 to 8.12); and femur mean difference 7.90 (95% confidence interval 5.78 to 10.02). AUTHORS' CONCLUSIONS Oral and intravenous bisphosphonates increase bone mineral density in people with cystic fibrosis. Severe bone pain and flu-like symptoms may occur with intravenous agents. Additional trials are needed to determine if bone pain is more common or severe (or both) with the more potent zoledronate and if corticosteroids ameliorate or prevent these adverse events. Additional trials are also required to further assess gastrointestinal adverse effects associated with oral bisphosphonates. Trials in larger populations are needed to determine effects on fracture rate and survival.
Collapse
Affiliation(s)
- Louise S Conwell
- Lady Cilento Children's HospitalEndocrinology and DiabetesStanley StSouth BrisbaneBrisbaneQueenslandAustralia4101
- University of QueenslandSchool of Medicine and Queensland Children's Medical Research Institute300 Herston RoadHerstonQueenslandAustralia4006
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionPO Box 41096DarwinNorthern TerritoriesAustralia0811
| | | |
Collapse
|
14
|
Bisphosphonates for the prevention and treatment of osteoporosis in patients with rheumatic diseases: a systematic review and meta-analysis. PLoS One 2013; 8:e80890. [PMID: 24324644 PMCID: PMC3855695 DOI: 10.1371/journal.pone.0080890] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 10/08/2013] [Indexed: 11/21/2022] Open
Abstract
Background While bisphosphonates (BPs) are commonly used in clinical treatment for osteoporosis, their roles on osteoporosis treatment for rheumatic patients remain unclear. We performed a meta-analysis to evaluate the efficacy of BPs on fractures prevention and bone mass preserving in rheumatic patients. Methodology/Principal Findings We searched PubMed, EmBase, and the Cochrane Central Register of Controlled Trials for relevant literatures with a time limit of Jan. 6, 2012. All randomized clinical trials of BPs for adult rheumatic patients with a follow-up of 6 months or more were included. We calculated relative risks (RRs) for fractures and weighted mean difference (WMD) for percent change of bone mineral density (BMD). Twenty trials were included for analysis. The RR in rheumatic patients treated with BPs was 0.61 (95%CI [0.44, 0.83], P = 0.002) for vertebral fractures, and 0.49 (95%CI [0.23, 1.02], P = 0.06) for non-vertebral fractures. The WMD of BMD change in the lumbar spine was 3.72% (95%CI [2.72, 4.72], P<0.001) at 6 months, 3.67% (95%CI [2.84, 4.50], P<0.001) at 12 months, 3.64% (95%CI [2.59, 4.69], P<0.001) at 24 months, and 5.87% (95%CI [4.59, 7.15], P<0.001) at 36 months in patients using BPs, as compared with those treated with calcium, vitamin D or calcitonin. In subgroup analyses, rheumatic patients using BPs for osteoporosis prevention had greater WMD than those using BPs for treating osteoporosis at 6 months (4.53% vs. 2.73%, P = 0.05) and 12 months (4.93% vs. 2.91%, P = 0.01). Conclusions/Significance In both short-term and middle-term, BPs can preserve bone mass and reduce the incidence of vertebral fractures in rheumatic patients, mainly for those who have GC consumption. The efficacy of BPs is better when using BPs to prevent rather than to treat osteoporosis in rheumatic patients.
Collapse
|
15
|
Tanaka S. Regulation of bone destruction in rheumatoid arthritis through RANKL-RANK pathways. World J Orthop 2013; 4:1-6. [PMID: 23362468 PMCID: PMC3557316 DOI: 10.5312/wjo.v4.i1.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/23/2012] [Accepted: 12/23/2012] [Indexed: 02/06/2023] Open
Abstract
Recent studies have demonstrated that osteoclasts, the primary cells responsible for bone resorption, are mainly involved in bone and joint destruction in rheumatoid arthritis (RA) patients. Recent progress in bone cell biology has revealed the molecular mechanism of osteoclast differentiation and bone resorption by mature osteoclasts. We highlight here the potential role of the receptor activator of nuclear factor κB ligand (RANKL)-RANK pathways in bone destruction in RA and review recent clinical trials treating RA by targeting RANKL.
Collapse
|
16
|
Ibáñez L, Alcaraz MJ, Maicas N, Guede D, Caeiro JR, Motterlini R, Ferrándiz ML. Downregulation of the inflammatory response by CORM-3 results in protective effects in a model of postmenopausal arthritis. Calcif Tissue Int 2012; 91:69-80. [PMID: 22644323 DOI: 10.1007/s00223-012-9612-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 05/02/2012] [Indexed: 10/28/2022]
Abstract
CO-releasing molecules (CORMs) are a new class of drugs able to release small amounts of CO in biological systems. We have shown previously that one of these molecules, CORM-3, exerts anti-inflammatory effects in animal models. The aim of this study was to assess the effects of CORM-3 on bone metabolism in a model of postmenopausal rheumatoid arthritis osteoporosis. Ovariectomy was followed by collagen-induced arthritis in female DBA-1/J mice. Animals showing arthritis on day 22 after immunization were then randomized into control and treatment groups. CORM-3 was administered at 10 mg/kg, intraperitoneally, once a day. Alendronate was administered at 100 μg/kg, orally, once a day. On days 36 and 50 after immunization, animals were killed and tissues analyzed. The arthritic score was significantly reduced by CORM-3 but not by alendronate treatment. Histopathological analyses indicated that both compounds reduced cellular infiltration and cartilage degradation. Local bone erosion and reduction in TNFα levels were seen for CORM-3 on day 50 and for alendronate on day 36. Serum levels of COMP, IL-6, MMP-3, CTX-I, alkaline phosphatase, and osteocalcin were decreased by both treatments, whereas TNFα levels were reduced by CORM-3 and TRAP-5b by alendronate. Micro-computed tomographic analysis showed protective effects on trabecular bone, which were more prominent for CORM-3 on day 36 and for alendronate on day 50. Our results suggest that CORMs represent a novel anti-inflammatory strategy to counteract joint bone erosion with partial protective effects on systemic bone loss in postmenopausal rheumatoid arthritis.
Collapse
Affiliation(s)
- Lidia Ibáñez
- Department of Pharmacology, University of Valencia, Av. Vicent Andres Estelles s/n, 46100, Burjassot, Valencia, Spain
| | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
BACKGROUND Osteoporosis is a bone mineralisation disorder occurring in about one third of adults with cystic fibrosis. Bisphosphonates can increase bone mineral density and decrease the risk of new fractures in post-menopausal women and people receiving long-term oral corticosteroids. OBJECTIVES To assess the effects of bisphosphonates on the frequency of fractures, bone mineral density, quality of life, adverse events, trial withdrawals, and survival in people with cystic fibrosis. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group Trials Register of references (identified from electronic database searches and handsearches of journals and abstract books) on 15 February 2012.Additional searches of PubMed were performed on 14 May 2011. SELECTION CRITERIA Randomised controlled trials of at least six months duration studying bisphosphonates in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS Two authors independently selected trials and extracted data. Trial investigators were contacted to obtain missing data. MAIN RESULTS Nine trials were identified and seven (with a total of 237 adult participants) were included.Data were combined (when available) from six included studies in participants without a lung transplant. Data showed that there was no significant reduction in fractures between treatment and control groups at 12 months, odds ratio 0.72 (95% confidence interval 0.13 to 3.80). No fractures were reported in studies with follow-up at 24 months. However, in patients taking bisphosphonates after six months the percentage change in bone mineral density increased at the lumbar spine, mean difference 4.61 (95% confidence interval 3.90 to 5.32) and at the hip or femur, mean difference 3.35 (95% confidence interval 1.63 to 5.07); but did not significantly change at the distal forearm, mean difference -0.49 (95% confidence interval -2.42 to 1.45). In patients taking bisphosphonates, at 12 months the percentage change in bone mineral density increased at the lumbar spine, mean difference 6.10 (95% confidence interval 5.10 to 7.10) and at the hip or femur, mean difference 4.35 (95% confidence interval 2.99 to 5.70). At 24 months, in patients treated with bisphosphonates the percentage change in bone mineral density also increased at the lumbar spine, mean difference 5.49 (95% confidence interval 4.38 to 6.60) and at the hip or femur, mean difference 6.05 (95% confidence interval 3.74 to 8.36). There was clinical heterogeneity between studies and not all studies reported all outcomes. Bone pain was the most common adverse event with intravenous agents. Flu-like symptoms were also increased in those taking bisphosphonates.In participants with a lung transplant (one study), intravenous pamidronate did not change the number of new fractures. At axial sites, bone mineral density increased with treatment compared to controls: percentage change in bone mineral density at lumbar spine, mean difference 6.20 (95% confidence interval 4.28 to 8.12); and femur mean difference 7.90 (95% confidence interval 5.78 to 10.02). AUTHORS' CONCLUSIONS Oral and intravenous bisphosphonates increase bone mineral density in people with cystic fibrosis. Severe bone pain and flu-like symptoms may occur with intravenous agents. Additional trials are needed to determine if bone pain is more common or severe (or both) with the more potent zoledronate and if corticosteroids ameliorate or prevent these adverse events. Additional trials are also required to further assess gastrointestinal adverse effects associated with oral bisphosphonates. Trials in larger populations are needed to determine effects on fracture rate and survival.
Collapse
|
18
|
Redlich K, Smolen JS. Inflammatory bone loss: pathogenesis and therapeutic intervention. Nat Rev Drug Discov 2012; 11:234-50. [PMID: 22378270 DOI: 10.1038/nrd3669] [Citation(s) in RCA: 552] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Bone is a tissue undergoing continuous building and degradation. This remodelling is a tightly regulated process that can be disturbed by many factors, particularly hormonal changes. Chronic inflammation can also perturb bone metabolism and promote increased bone loss. Inflammatory diseases can arise all over the body, including in the musculoskeletal system (for example, rheumatoid arthritis), the intestine (for example, inflammatory bowel disease), the oral cavity (for example, periodontitis) and the lung (for example, cystic fibrosis). Wherever inflammatory diseases occur, systemic effects on bone will ensue, as well as increased fracture risk. Here, we discuss the cellular and signalling pathways underlying, and strategies for therapeutically interfering with, the inflammatory loss of bone.
Collapse
Affiliation(s)
- Kurt Redlich
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | | |
Collapse
|
19
|
Redlich K, Smolen JS. Inflammatory bone loss: pathogenesis and therapeutic intervention. Nat Rev Drug Discov 2012. [DOI: 78495111110.1038/nrd3669' target='_blank'>'"<>78495111110.1038/nrd3669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [78495111110.1038/nrd3669','', '10.1002/art.1780390307')">Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
78495111110.1038/nrd3669" />
|
20
|
Abstract
Several inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, celiac disease, cystic fibrosis and chronic obstructive pulmonary disease have been associated to bone resorption. The link between osteoclast, macrophage colony stimulating factor and pro-inflammatory cytokines, especially tumor necrosis factor-alpha and interleukin-1 explain the association between inflammation and osteoporosis. These diseases are related to osteoporosis and high fracture risk independent of other risk factors common to inflammatory diseases such as reduced physical activity, poor nutritional status, hypovitaminosis D, decrease in calcium intake and glucocorticoid treatment. Erythrocyte sedimentation rate and C-reactive protein should always be performed, but the indication about when to perform the densitometry test should be analyzed for each disease. Bisphosphonates are nowadays the best choice of therapy but new medications such as denosumab, IL-1 receptor antagonist, and TNF-alpha antibody have risen as new potential treatments for osteoporosis secondary to inflammation.
Collapse
|
21
|
Sun M, Iqbal J, Singh S, Sun L, Zaidi M. The crossover of bisphosphonates to cancer therapy. Ann N Y Acad Sci 2010; 1211:107-12. [PMID: 21062299 DOI: 10.1111/j.1749-6632.2010.05812.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Bisphosphonates form a class of drugs commonly used to treat disorders of osteoclastic bone resorption, including osteoporosis, Paget's disease of the bone, rheumatoid arthritis, and bone metastases. Although long established as the therapy of choice to treat such disorders, bisphosphonates' potential in treating cancer is garnering interest. Bisphosphonates have been demonstrated to inhibit tumor growth and metastasis, induce apoptosis in tumor cells, and encourage immune reactions against tumor cells. Current applications of bisphosphonates in cancer treatment include their use to treat skeletal metastases and as an adjuvant to endocrine therapy. This review explores bisphosphonates' current clinical utility and potential as a crossover cancer therapy.
Collapse
Affiliation(s)
- Merry Sun
- The Mount Sinai Bone Program, Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | | | | | | | | |
Collapse
|
22
|
|
23
|
Le Goff B, Soltner E, Charrier C, Maugars Y, Rédini F, Heymann D, Berthelot JM. A combination of methotrexate and zoledronic acid prevents bone erosions and systemic bone mass loss in collagen induced arthritis. Arthritis Res Ther 2009; 11:R185. [PMID: 20003278 PMCID: PMC3003529 DOI: 10.1186/ar2877] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Revised: 12/03/2009] [Accepted: 12/10/2009] [Indexed: 11/10/2022] Open
Abstract
Introduction Osteoclasts play a key role in the pathogenesis of bone erosion and systemic bone mass loss during rheumatoid arthritis (RA). In this study, we aimed to determine the effect of methotrexate (MTX) and zoledronic acid (ZA), used alone or in combination, on osteoclast-mediated bone erosions and systemic bone mass loss in a rat model of collagen induced arthritis (CIA). We hypothesized that MTX and ZA could have an additive effect to prevent both bone erosion and systemic bone loss. Methods Arthritis was induced in 64 female Sprague-Dawley rats. After the clinical onset of CIA, rats were assigned to treatment with MTX (1 mg/kg/week), ZA (100 μg/kg twice weekly), both treatments at the same regimens, or vehicle. Arthritis score and paw thickness were recorded twice weekly. The rats were sacrificed on D28 and hind paws were removed for radiographic, histological and immunohistochemical analysis. The effects of treatments on osteoclastogenesis were determined by Tartrate resistant acid phosphatase (TRAP) staining. Micro-CT of the tibia was carried out for histomorphometric analysis. Bone mass density was evaluated by densitometry. Results MTX significantly decreased the severity of CIA, whereas ZA slightly exacerbated it. When these two drugs were used in combination, MTX prevented the pro-inflammatory effect of ZA. The combination of ZA with MTX was more effective than MTX alone for reducing structural joint damage with a dramatic decrease of osteoclasts' number in the eroded joints. However, MTX alone also significantly reduced the number of osteoclasts and the number of CD68+ mononuclear cells. ZA alone, or ZA with MTX, significantly increased the systemic bone mass density measured by densitometry and bone volume on histomorphometric analysis. Conclusions A combination of MTX and ZA prevented both bone erosion and systemic bone loss in a rat model of arthritis. Both treatments independently decreased the number of osteoclasts in the eroded joint. However, while MTX probably acts mainly through a decrease of inflammation, ZA has a direct effect on osteoclasts, allowing a dramatic down-regulation of these cells in inflamed joints. These two different mechanisms of action provide support for the use of a combination of these two drugs to improve the prevention of structural joint damage in RA.
Collapse
Affiliation(s)
- Benoit Le Goff
- INSERM UMR-S 957, 1 rue Gaston Veil, 44035, Nantes Cedex 1, France.
| | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
BACKGROUND Osteoporosis is a bone mineralisation disorder occurring in about one third of adults with cystic fibrosis (CF). Bisphosphonates can increase bone mineral density (BMD) and decrease the risk of new fractures in post-menopausal women and people receiving long-term oral corticosteroids. OBJECTIVES To assess the effects of bisphosphonates on the frequency of fractures, BMD, quality of life, adverse events, trial withdrawals, and survival in people with CF. SEARCH STRATEGY We searched the CF and Genetic Disorders Group Trials Register of references (identified from electronic database searches and handsearches of journals and abstract books) on 29 October 2008.Additional searches of Pubmed were performed on 01 November 2008. SELECTION CRITERIA Randomised controlled trials of at least six months duration studying bisphosphonates in people with CF. DATA COLLECTION AND ANALYSIS Two authors independently selected trials and extracted data. Trial investigators were contacted to obtain missing data. MAIN RESULTS Seven trials were identified and five (with a total of 145 adult participants) were included.Data were combined when available from four included studies in participants without a lung transplant. This showed that there was no significant reduction in fractures between groups. However, after six months, the percentage change in BMD increased in those on bisphosphonates at the lumbar spine, mean difference (MD) 4.61 (95% confidence interval (CI) 3.90 to 5.32) and at the hip, MD 3.35 (95% CI 1.63 to 5.07); but did not significantly change at the distal forearm, MD -0.49 (95% CI -2.42-1.45). There was clinical heterogeneity between studies and not all studies reported all outcomes. Bone pain was the most common adverse event with intravenous agents. Flu-like symptoms were also increased in those taking bisphosphonates.In participants with a lung transplant (one study), intravenous pamidronate did not change the number of new fractures. At axial sites, BMD increased with treatment compared to controls: percentage change in bone mineral density at lumbar spine, MD 6.20 (95% CI 4.28 to 8.12) and femur MD 7.90 (95% CI 5.78 to 10.02). AUTHORS' CONCLUSIONS Oral and intravenous bisphosphonates increase BMD in people with CF. Severe bone pain and flu-like symptoms may occur with intravenous agents. Additional trials are needed to determine if bone pain is more common or severe (or both) with the more potent zoledronate and if corticosteroids ameliorate or prevent these adverse events. Trials in larger populations are needed to determine effects on fracture rate and survival.
Collapse
Affiliation(s)
- Louise S Conwell
- Endocrinology and Diabetes, Royal Children's Hospital, Herston Road, Herston, Brisbane, Queensland, Australia, 4029
| | | |
Collapse
|
25
|
Sutherland KA, Rogers HL, Tosh D, Rogers MJ. RANKL increases the level of Mcl-1 in osteoclasts and reduces bisphosphonate-induced osteoclast apoptosis in vitro. Arthritis Res Ther 2009; 11:R58. [PMID: 19405951 PMCID: PMC2688211 DOI: 10.1186/ar2681] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 04/08/2009] [Accepted: 04/30/2009] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Bisphosphonates are the most widely used class of drug for inhibiting osteoclast-mediated bone loss, but their effectiveness at preventing joint destruction in rheumatoid arthritis has generally been disappointing. We examined whether the ability of bisphosphonates to induce osteoclast apoptosis and inhibit bone resorption in vitro is influenced by the cytokine receptor activator of nuclear factor-kappa B ligand (RANKL), an important mediator of inflammation-induced bone loss. METHODS Rabbit osteoclasts were treated with the bisphosphonates clodronate or alendronate for up to 48 hours in the absence or presence of RANKL. Changes in cell morphology and induction of apoptosis were examined by scanning electron microscopy, whilst resorptive activity was determined by measuring the area of resorption cavities. Changes in the level of anti-apoptotic proteins, including Mcl-1, Bcl-2, and Bcl-x>L, were determined in rabbit osteoclasts and in cytokine-starved mouse osteoclasts by Western blotting. RESULTS RANKL significantly attenuated the ability of both clodronate and alendronate to induce osteoclast apoptosis and inhibit bone resorption. Treatment of rabbit osteoclasts with RANKL was associated with an increase in the anti-apoptotic protein Mcl-1 but not Bcl-2. A role for Mcl-1 in osteoclast survival was suggested using osteoclasts generated from mouse bone marrow macrophages in the presence of RANKL + macrophage colony-stimulating factor (M-CSF) since cytokine deprivation of mouse osteoclasts caused a rapid loss of Mcl-1 (but not Bcl-2 or Bcl-xL), which preceded the biochemical and morphological changes associated with apoptosis. Loss of Mcl-1 from mouse osteoclasts could be prevented by factors known to promote osteoclast survival (RANKL, M-CSF, tumour necrosis factor-alpha [TNF-alpha], or lipopolysaccharide [LPS]). CONCLUSIONS RANKL protects osteoclasts from the apoptosis-inducing and anti-resorptive effects of bisphosphonates in vitro. The ability of RANKL (and other pro-inflammatory factors such as TNF-alpha and LPS) to increase the level of Mcl-1 in osteoclasts may explain the lack of effectiveness of some bisphosphonates in preventing inflammation-induced bone loss.
Collapse
Affiliation(s)
- Karen A Sutherland
- Bone & Musculoskeletal Research Programme, School of Medicine & Dentistry, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Helena L Rogers
- Bone & Musculoskeletal Research Programme, School of Medicine & Dentistry, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Denise Tosh
- Bone & Musculoskeletal Research Programme, School of Medicine & Dentistry, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Michael J Rogers
- Bone & Musculoskeletal Research Programme, School of Medicine & Dentistry, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| |
Collapse
|
26
|
Tsutsumi R, Hock C, Bechtold CD, Proulx ST, Bukata SV, Ito H, Awad H, Nakamura T, O'Keefe RJ, Schwarz EM. Differential effects of biologic versus bisphosphonate inhibition of wear debris-induced osteolysis assessed by longitudinal micro-CT. J Orthop Res 2008; 26:1340-6. [PMID: 18404739 PMCID: PMC2742224 DOI: 10.1002/jor.20620] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aseptic loosening of total joint replacements is caused by wear debris-induced osteoclastic bone resorption, for which bisphosphonates (BPs) and RANK antagonists have been developed. Although BPs are effective in preventing metabolic bone loss, they are less effective for inflammatory bone loss. Because this difference has been attributed to the antiapoptotic inflammatory signals that protect osteoclasts from BP-induced apoptosis, but not RANK antagonists, we tested the hypothesis that osteoprotegerin (OPG) is more effective in preventing wear debris-induced osteolysis than zoledronic acid (ZA) or alendronate (Aln) in the murine calvaria model using in vivo micro-CT and traditional histology. Although micro-CT proved to be incompatible with titanium (Ti) particles, we were able to demonstrate a 3.2-fold increase in osteolytic volume over 10 days induced by polyethylene (PE) particles versus sham controls (0.49 +/- 0.23 mm(3) versus 0.15 +/- 0.067 mm(3); p < 0.01). Although OPG and high-dose ZA completely inhibited this PE-induced osteolysis (p < 0.001), pharmacological doses of ZA and Aln were less effective but still reached statistical significance (p < 0.05). Traditional histomorphometry of the sagital suture area of calvaria from both Ti and PE-treated mice confirmed the remarkable suppression of resorption by OPG (p < 0.001) versus the lack of effect by physiological BPs. The differences in drug effects on osteolysis were largely explained by the significant difference in osteoclast numbers observed between OPG versus BPs in both Ti- and PE-treated calvaria; and linear regression analyses that demonstrated a highly significant correlation between osteolysis volume and sagittal suture area versus osteoclast numbers (p < 0.001).
Collapse
Affiliation(s)
- Ryosuke Tsutsumi
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York,Department of Orthopaedic Surgery, Kyoto University Medical School, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606−8507, Japan
| | - Colleen Hock
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - C. Dustin Bechtold
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Steven T. Proulx
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Susan V. Bukata
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Kyoto University Medical School, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606−8507, Japan
| | - Hani Awad
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Takashi Nakamura
- Department of Orthopaedic Surgery, Kyoto University Medical School, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606−8507, Japan
| | - Regis J. O'Keefe
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Edward M. Schwarz
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York,To whom correspondence should be addressed: Dr. Edward M. Schwarz The Center for Musculoskeletal Research University of Rochester Medical Center 601 Elmwood Avenue, Box 665, Rochester, NY 14642 Phone 585−275−3063, FAX 585−756−4727 E-mail:
| |
Collapse
|
27
|
Jin UH, Suh SJ, Park SD, Kim KS, Kwon DY, Kim CH. Inhibition of mouse osteoblast proliferation and prostaglandin E2 synthesis by Ulmus davidiana Planch (Ulmaceae). Food Chem Toxicol 2008; 46:2135-42. [DOI: 10.1016/j.fct.2008.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 01/09/2007] [Accepted: 02/08/2008] [Indexed: 11/26/2022]
|
28
|
Herman S, Krönke G, Schett G. Molecular mechanisms of inflammatory bone damage: emerging targets for therapy. Trends Mol Med 2008; 14:245-53. [PMID: 18468489 DOI: 10.1016/j.molmed.2008.04.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 03/31/2008] [Accepted: 04/04/2008] [Indexed: 01/01/2023]
Abstract
Chronic inflammatory bone diseases, such as rheumatoid arthritis (RA), ankylosing spondylitis and periodontal disease, demonstrate the major impact of chronic inflammation on both bone metabolism and bone architecture. During the past decade, scientists have gained increasing insight into the link between inflammation and bone. As a result of new discoveries about the molecular mechanisms of inflammatory bone loss, several molecules have been identified that are attractive and novel targets for the treatment of inflammatory bone loss. These novel therapeutic approaches include anti-tumor necrosis factor (TNF)-alpha blocking agents, neutralizing antibodies against certain pro-inflammatory cytokines, such as interleukin (IL)-6 and IL-17, and a set of other promising targets that still require extensive research, such as the Wnt signaling network.
Collapse
Affiliation(s)
- Sonja Herman
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany
| | | | | |
Collapse
|
29
|
Abstract
The host response to wear debris particles constitutes a major component of periprosthetic osteolysis and aseptic loosening. Thus, biologic interventions represent a logical approach to prevent this complication of total joint replacement. Several major obstacles must be overcome before a therapeutic intervention can emerge, most notably the development of a safe and effective drug, as well as the development of a quantitative outcome measure that can prove efficacy in a relatively small multicenter trial of patients with established osteolysis. Research is needed in several areas, including whether a threshold phenomenon exists for osteolytic progression, whether anabolic agents administered postoperatively can significantly increase osteointegration of the implant and reduce the potential for aseptic loosening, and whether RANKL antagonists can inhibit the progression of periprosthetic osteolysis. Imaging advancements and an osteolysis registry would significantly enhance the potential for a successful clinical trial.
Collapse
|
30
|
Katayama K, Matsuno T. Effects of Bisphosphonates on Fracture Incidence and Bone Metabolism in Rheumatoid Arthritis Patients in General Practice Taking Long-Term Corticosteroid Therapy. Clin Drug Investig 2008; 28:149-58. [DOI: 10.2165/00044011-200828030-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
31
|
Abstract
The receptor activator of nuclear factor-κB ligand (RANKL), its cognate receptor RANK, and its natural decoy receptor osteoprotegerin have been identified as the final effector molecules of osteoclastic bone resorption. This has provided an ideal target for therapeutic interventions in metabolic bone disease. As described in previous reviews in this supplement, RANKL signaling is required for osteoclast differentiation, activation, and survival. Furthermore, in vivo inhibition of RANKL leads to immediate osteoclast apoptosis, and there are no in vivo models of bone resorption that are refractory to RANKL inhibition. Thus, the only step remaining in the development of a clinical intervention is the generation of a safe, effective, and specific drug that can inhibit RANKL in humans. Here we review the clinical development of denosumab (formerly known as AMG 162), which is a fully human mAb directed against RANKL. This discussion includes the breadth of 21 human studies that have led to the current phase 3 clinical trials seeking approval for use of this agent to treat postmenopausal women with low bone mineral density (osteoporosis) and patients with metastatic lytic bone lesions (multiple myeloma, and prostate and breast cancer).
Collapse
Affiliation(s)
- Edward M Schwarz
- The Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York 14642, USA.
| | | |
Collapse
|
32
|
Shu G, Yamamoto K, Nagashima M. Differences in osteoclast formation between proximal and distal tibial osteoporosis in rats with adjuvant arthritis: inhibitory effects of bisphosphonates on osteoclasts. Mod Rheumatol 2006; 16:343-9. [PMID: 17164994 DOI: 10.1007/s10165-006-0515-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 07/19/2006] [Indexed: 10/23/2022]
Abstract
Patients with rheumatoid arthritis commonly suffer both systemic and periarticular osteoporosis. Bisphosphonates (BPs) are inhibitors of bone resorption, and several derivatives have been developed for treatment of enhanced bone resorption. We aimed to characterize osteoclast formation in two different sites, the proximal tibial and distal tibial areas, in rats with adjuvant arthritis, and to investigate the impact of amino or non-amino types of bisphosphonate. Adjuvant arthritis was initiated in rats while administering daily injections of either etidronate, a non-amino BP, or alendronate, an amino BP, for 3 weeks. On the day following the last injection, bone mineral density (BMD) was measured in the proximal tibia to assess systemic osteoporosis and in the distal tibia for periarticular osteoporosis using dual-energy X-ray absorptiometry. Subsequently, bone marrow cells from either end of the tibia were collected and incubated for 7 days before staining and counting tartrate-resistant acid phosphatase positive cells. In the rats with adjuvant arthritis, BMD of either end of the tibia was lower than in normal rats. Although etidronate prevented bone mineral loss at both ends, distal loss was significantly less than proximal. In contrast, alendronate significantly inhibited mineral loss primarily in the proximal area. Large osteoclasts, defined as having five or more nuclei, formed preferentially in the proximal tibia, while small osteoclasts with fewer than four nuclei were found mainly distally. The suppressive effect of alendronate was greater on the large osteoclasts, while etidronate had a greater effect on the small osteoclasts. These results show that the size and multinuclearity of osteoclasts and the number of osteoclasts formed are different in the distal and proximal areas of the tibia, and that alendronate and etidronate may suppress different types of osteoclasts as discriminated by the number of nuclei.
Collapse
Affiliation(s)
- Goukei Shu
- Department of Joint Disease and Rheumatism, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan,
| | | | | |
Collapse
|
33
|
Twiss IM, van den Berk AHM, de Kam ML, Bosch JJ, Cohen AF, Vermeij P, Burggraaf J. A comparison of the gastrointestinal effects of the nitrogen-containing bisphosphonates pamidronate, alendronate, and olpadronate in humans. J Clin Pharmacol 2006; 46:483-7. [PMID: 16554458 DOI: 10.1177/0091270006286781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- I M Twiss
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | | | | | | |
Collapse
|
34
|
Breuil V, Euller-Ziegler L. Bisphosphonate therapy in rheumatoid arthritis. Joint Bone Spine 2006; 73:349-54. [PMID: 16616575 DOI: 10.1016/j.jbspin.2005.10.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Accepted: 10/04/2005] [Indexed: 10/24/2022]
Abstract
Focal bone damage and generalized bone loss are features of rheumatoid arthritis (RA). The introduction of TNFalpha antagonists has radically improved the management of RA by providing a means of slowing or preventing the occurrence of focal bone damage. However, some patients with severe RA have contraindications to TNFalpha antagonist therapy and others either fail to respond or fail to tolerate TNFalpha antagonists. In addition, whether TNFalpha antagonists effectively combat generalized bone loss remains unknown. Bisphosphonates can prevent generalized bone loss. Their main target is the osteoclast, which has been identified as the culprit in focal bone damage caused by inflammatory diseases. As a result, the potential effects of bisphosphonates on focal bone damage related to RA are generating strong interest. Although results from the few studies in humans have been disappointing, new insights into the mechanisms of action of amino-bisphosphonates and recent data obtained in animals, most notably with new-generation bisphosphonates, have rekindled the hope that bisphosphonates may be beneficial in RA. We review herein the main studies of the effects of bisphosphonate therapy on focal bone damage and generalized bone loss in patients with RA.
Collapse
Affiliation(s)
- Véronique Breuil
- Rheumatology Department, Hôpital L'Archet 1, 151, route Saint-Antoine-de-Ginestière, 06202 Nice cedex 3, France.
| | | |
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW Inflammation-induced osteolysis is a problem in both inflammatory arthritis and total joint arthroplasty. New drug therapies have been shown to slow, halt, or even reverse the osteolysis associated with inflammatory arthritis. Unfortunately, similar advances in the medical treatment of periprosthetic osteolysis have not occurred. This review will update the state of periprosthetic osteolysis. RECENT FINDINGS Preliminary results with phase I and II clinical trials with AMG-162, a human IgG2 that binds receptor activator of nuclear factor kappaB (RANK) ligand, have been reported. Based on these results AMG-162 appears to be safe and to have a potent effect on osteoclast function. Based on animal studies, it is expected that regents such as AMG-162 that block RANK-ligand/RANK interaction will have activity in inflammation-induced osteolysis. Volumetric three-dimensional and magnetic resonance imaging scans for detecting and quantifying periprosthetic osteolysis have been validated in cadaver studies. Lymphocytic infiltrates and positive skin tests to cobalt have been found in patients with periprosthetic osteolysis after second generation metal-on-metal prostheses. These findings again raise the question of whether metal allergy may contribute to implant failure in these patients. A new subset of T helper cells that are neither Th1 nor Th2, but secrete a unique pattern of cytokines including IL-17, has recently been discovered. The importance of these cells in modifying particle-induced osteolysis remains to be determined. SUMMARY There have been significant advances in our understanding of periprosthetic osteolysis, imaging technology to quantify osteolysis, and drug development. The time now seems ripe to translate these advances in clinical trials.
Collapse
Affiliation(s)
- R John Looney
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, NY 1442, USA.
| | | | | | | |
Collapse
|
36
|
|
37
|
Romas E. Bone loss in inflammatory arthritis: mechanisms and therapeutic approaches with bisphosphonates. Best Pract Res Clin Rheumatol 2006; 19:1065-79. [PMID: 16301197 DOI: 10.1016/j.berh.2005.06.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The inflammatory process in rheumatoid arthritis provokes intense bone resorption, evidenced as bone erosions, juxta-articular osteopenia and generalized osteoporosis. These types of bone loss share a common pathogenesis, and the role of osteoclasts in focal bone erosion was verified in elegant animal studies. The tumour necrosis factor (TNF) family of cytokines and receptors--specifically TNF-alpha, RANKL, RANK and OPG--are dominant regulators of osteoclastic bone resorption in rheumatoid arthritis. The confirmation of the osteoclast mechanism provides new insight into the structural joint protection afforded by disease-modifying drugs and suggests innovative approaches to limit bone destruction. Emerging treatment strategies for bone disease in rheumatoid arthritis are the use of monoclonal antibodies to neutralize RANKL, and powerful bisphosphonates that target pathogenic osteoclasts.
Collapse
Affiliation(s)
- Evan Romas
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia.
| |
Collapse
|
38
|
Haugeberg G, Emery P. Value of dual-energy x-ray absorptiometry as a diagnostic and assessment tool in early rheumatoid arthritis. Rheum Dis Clin North Am 2006; 31:715-28. [PMID: 16287593 DOI: 10.1016/j.rdc.2005.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
New research has revealed common pathophysiologic and cellular mechanisms behind the development of osteoporosis and joint damage in rheumatoid arthritis (RA). Because osteoporosis is a direct consequence of the inflammatory disease process, bone mass measurements in principle could be an outcome marker of inflammation, of damage, and of response to therapeutic intervention. Several devices have been developed for quantitative bone mass assessment including dual energy x-ray absorptiometry (DXA), which is considered the reference standard. This article based on current data and understanding discusses the use of DXA as a diagnostic and assessment tool especially in early RA.
Collapse
Affiliation(s)
- Glenn Haugeberg
- Department of Rheumatology, Sørlandet Hospital, Kristiansand, Norway
| | | |
Collapse
|
39
|
Zhao H, Liu S, Huang D, Xu Q, Shuto T, Iwamoto Y. The protective effects of incadronate on inflammation and joint destruction in established rat adjuvant arthritis. Rheumatol Int 2005; 26:732-40. [PMID: 16237529 DOI: 10.1007/s00296-005-0061-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2005] [Accepted: 08/21/2005] [Indexed: 11/26/2022]
Abstract
The effects of a new generation bisphosphonate, incadronate, in established adjuvant arthritis rats were evaluated according to the arthritis index, hind paw volume, and radiological and histopathological examinations. Incadronate suppressed the radiological and histopathological changes of hind paws, as well as the joint swelling in a dose-dependent manner. In contrast, the arthritis control rats showed drastic joint inflammation, marked destruction of bone and articular cartilage. The remains of articular cartilage lost Safranin O staining, and were attached with numerous TRAP-positive multinuclear cells. Some of resorption lacunas could be seen at the cartilage matrix nearby the TRAP-positive multinuclear cells. As regards the chondroprotective effects of bisphosphonates, we speculate that it is probably concerned with the inhibition of the chondroclasts. These data indicate that bisphosphonates may be a class of effective agent that can be considered for treatment of various arthritic conditions, including human rheumatoid arthritis.
Collapse
Affiliation(s)
- Hongpu Zhao
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510120, China.
| | | | | | | | | | | |
Collapse
|
40
|
Stolina M, Adamu S, Ominsky M, Dwyer D, Asuncion F, Geng Z, Middleton S, Brown H, Pretorius J, Schett G, Bolon B, Feige U, Zack D, Kostenuik PJ. RANKL is a marker and mediator of local and systemic bone loss in two rat models of inflammatory arthritis. J Bone Miner Res 2005; 20:1756-65. [PMID: 16160733 DOI: 10.1359/jbmr.050601] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Revised: 05/16/2005] [Accepted: 06/02/2005] [Indexed: 02/05/2023]
Abstract
UNLABELLED RANKL is an essential mediator of bone erosions, but the role of RANKL in systemic bone loss had not been studied in arthritis. RANKL protein was increased in rat joint extracts and serum at the earliest stages of arthritis. Osteoprotegerin (OPG) treatment reversed local and systemic bone loss, suggesting that RANKL is both a marker and mediator of bone loss in arthritis. INTRODUCTION RANKL is well established as an essential mediator of bone erosions in inflammatory arthritis, but the role of RANKL in systemic bone loss in arthritis had not been studied. We hypothesized that serum RANKL could serve as both a mediator and as a novel biomarker for local and systemic bone loss in arthritis. We challenged this hypothesis in two established rat models of inflammatory arthritis. We sought to determine whether serum RANKL was elevated early in disease progression and whether RANKL suppression could prevent both local and systemic bone loss in these models. MATERIALS AND METHODS Detailed time-course studies were conducted in animals with collagen-induced (CIA) or adjuvant-induced (AIA) arthritis to evaluate the onset and progression of inflammation (paw swelling), bone erosions, osteoclast numbers, and RANKL protein levels in arthritic joints and in serum. Additional CIA and AIA rats (n=8/group) received placebo (PBS) or recombinant OPG (3 mg/kg three times weekly) for 10 days beginning 4 days after disease onset (first macroscopic evidence of hind paw erythema and edema) to assess the role of RANKL in local and systemic bone loss. RESULTS RANKL protein was significantly elevated in the joints and serum of CIA and AIA rats within 1-2 days of disease onset. Increased RANKL levels were associated with local (hind paw) and systemic (vertebral) osteopenia in both models. The RANKL inhibitor OPG prevented local and systemic osteopenia in both models of established disease. CONCLUSIONS RANKL protein is significantly increased both locally and systemically during the earliest stages of inflammatory arthritis in rats, suggesting that serum RANKL might have prognostic value for bone erosions and systemic osteopenia in this condition. RANKL inhibition through OPG prevented local and systemic bone loss in these arthritis models, suggesting that RANKL inhibition is a promising new approach for treating bone loss in arthritis.
Collapse
MESH Headings
- Animals
- Arthritis, Experimental/blood
- Arthritis, Experimental/complications
- Arthritis, Experimental/drug therapy
- Biomarkers/blood
- Bone Diseases, Metabolic/blood
- Bone Diseases, Metabolic/drug therapy
- Bone Diseases, Metabolic/etiology
- Carrier Proteins/blood
- Disease Models, Animal
- Female
- Glycoproteins/administration & dosage
- Inflammation/blood
- Inflammation/complications
- Inflammation/drug therapy
- Joints/metabolism
- Male
- Membrane Glycoproteins/blood
- Osteoprotegerin
- RANK Ligand
- Rats
- Rats, Inbred Lew
- Receptors, Cytoplasmic and Nuclear/administration & dosage
- Receptors, Tumor Necrosis Factor/administration & dosage
Collapse
Affiliation(s)
- Marina Stolina
- Department of Metabolic Disorders, Amgen Inc., Thousand Oaks, California 91320, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Yamamoto K, Yoshino S, Shue G, Nagashima M. Inhibitory effect of bone resorption and inflammation with etidronate therapy in patients with rheumatoid arthritis for 3 years and in vitro assay in arthritis models. Rheumatol Int 2005; 26:627-32. [PMID: 16133581 DOI: 10.1007/s00296-005-0042-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 08/06/2005] [Indexed: 11/26/2022]
Abstract
This study was conducted to identify bone resorption and anti-inflammatory effects with intermittent cyclical etidronate therapy (ICET) in patients with rheumatoid arthritis, and anti-inflammatory effect of etidronate in vitro. We compared bone mineral density (BMD), urinary deoxypyridinoline (DPD) level, bone alkaline phosphatase (BAP) level and Larsen damage scores between the ICET and the non-ICET groups for 3 years. The levels of interleukin-6 (IL-6), prostaglandin E2 (PGE2), substance P and vascular endothelial growth factor (VEGF) in synovial cells from arthritis models were measured following the addition of etidronate. In the ICET group, BMD and BAP levels increased. Urinary DPD level and the Larsen damage score were significantly lower than that in the non-ICET group. In the in vitro study, the production of IL-6, PGE2, substance P and VEGF were inhibited in a dose-dependent manner. Bone resorption and destruction inhibition effect of etidronate remained for 3 years. In vitro study showed that the production of inflammatory cytokines and an angiogenesis factor were inhibited.
Collapse
Affiliation(s)
- Kaname Yamamoto
- Department of Joint Disease and Rheumatism, Nippon Medical School, 1-1-5 Sendagi, Tokyo 113-8603, Japan
| | | | | | | |
Collapse
|
42
|
Vujasinović-Stupar N, Pilipović N, Branković S. [Cyclic intravenous pamidronate in treatment of osteoporosis]. MEDICINSKI PREGLED 2005; 57:545-50. [PMID: 16107000 DOI: 10.2298/mpns0412545v] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the efficacy and tolerability of cyclic intravenous pamidronate therapy in women with severe osteoporosis. MATERIAL AND METHODS Bone mineral density (BMD) measurement was performed by dual-energy X-ray absorptiometry using LUNAR DPX-L device. Slow intravenous infusion regimens of pamidronate (30 mg) every three months were used in treatment of 240 women, in addition to supplemental Ca and vitamin D. Bone mineral density was measured from lumbar spine 1 year later (120 mg of pamidronate) in 195 women and 2 years later (240 mg of pamidronate) in 29 women. The placebo group included 63 women treated only with calcium and vitamin D. RESULTS The average age of 240 women with severe osteoporosis was 61.2 +/- 9.5. All were postmenopausal, except for two of them. Their mean age at the onset of menopause was 46.2 +/- 5.6. Mean duration of menopause was 15.7 +/- 8.1. After 1 year of therapy, bone mineral density increased from 0.781 g/cm2 to 0.83 7 g/cm2 (p < 0.001), the mean increase bone mass was 7.2% (p < 0.0001). After 2 years, bone mineral density increased to 0.844 g/cm2, the improvement was 8.1% from baseline (p < 0.001). Bone mineral density in the placebo group, after one year, significantly increased (p = 0.046) from 0.966 g/cm2 to 1.004 g/cm2, the improvement was 3.9%. However, after two years, bone mineral density decreased to 0.973 g/cm2, and compared with baseline this change was 0.7% and not significant (p > 0.05). CONCLUSION Pamidronate prevented further decrease of BMD in our patients with severe osteoporosis and also increased BMD in these patients. This safe and efficient drug is well tolerated.
Collapse
|
43
|
Ingham E, Fisher J. The role of macrophages in osteolysis of total joint replacement. Biomaterials 2005; 26:1271-86. [PMID: 15475057 DOI: 10.1016/j.biomaterials.2004.04.035] [Citation(s) in RCA: 379] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2003] [Accepted: 04/19/2004] [Indexed: 12/12/2022]
Abstract
The osteolysis associated with conventional polyethylene on metal total joint replacements is associated with the formation of an inflamed periprosthetic membrane rich in macrophages, cytokines and implant-derived wear particles. There is a wealth of evidence to indicate that the presence and activation of macrophages in the periprosthetic tissues around joint replacements is stimulated by UHMWPE particles. Particles within the size range 0.1-1.0 microm have been shown to be the most reactive. Animal studies have provided increasing evidence that, of the milieu of cytokines produced by particle-stimulated macrophages, TNF-alpha is a key cytokine involved in osteolysis. Recent advances in the understanding of the mechanisms of osteoclastogenesis and osteoclast activation at the cellular and molecular level have indicated that bone marrow-derived macrophages may play a dual role in osteolysis associated with total joint replacement. Firstly, as the major cell in host defence responding to UHMWPE particles via the production of cytokines and secondly as precursors for the osteoclasts responsible for the ensuing bone resorption.
Collapse
Affiliation(s)
- Eileen Ingham
- School of Biochemistry and Molecular Biology, Institute of Medical and Biological Engineering, Division of Microbiology, University of Leeds, Leeds LS2 9JT, UK.
| | | |
Collapse
|
44
|
|
45
|
Kim KS, Lee SD, Kim KH, Kil SY, Chung KH, Kim CH. Suppressive effects of a water extract of Ulmus davidiana Planch (Ulmaceae) on collagen-induced arthritis in mice. JOURNAL OF ETHNOPHARMACOLOGY 2005; 97:65-71. [PMID: 15652277 DOI: 10.1016/j.jep.2004.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2004] [Revised: 10/08/2004] [Accepted: 10/13/2004] [Indexed: 05/24/2023]
Abstract
Ulmus davidiana Planch (Ulmaceae) has long been known to have anti-inflammatory and protective effects on damaged tissue, inflammation and bone resorption. Therefore, this study was undertaken to address (1) whether the water extract of the bark of Ulmus davidiana Planch (Ulmaceae) (UD) can modulate the expression of inducible inflammatory cytokines in mice; (2) in order to assess the therapeutic effects of UD in collagen-induced arthritis (CIA) in mice. DBA/1 mice were immunized with bovine type II collagen. After a second collagen immunization, mice were treated with UD orally at 100mg/kg once a day for 3 weeks. Paws were evaluated macroscopically for redness, swelling and deformities. The levels of TNF-alpha and IL-1beta in the ankle were examined. The severity of arthritis within the knee joints was evaluated by histological assessment of cartilage destruction and pannus formation. Administration of UD significantly suppressed the progression of CIA and inhibited the production of TNF-alpha and IL-1beta in the paws. The erosion of cartilage was dramatically reduced in mouse knees after treatment with UD. In the serum of UD-treated mice, the levels of IL-4 and IL-10, anti-inflammatory cytokines, were increased. From the results, it was concluded that administration of UD has therapeutic effects on CIA including protection of cartilage and RA for a potential therapy.
Collapse
Affiliation(s)
- Kap-Sung Kim
- Department of Acupuncture, Biochemistry and Molecular Biology, College of Oriental Medicine, Dongguk University and National Research Laboratory for Glycobiology, Kyungju, Kyungbuk 780-714, Korea
| | | | | | | | | | | |
Collapse
|
46
|
Tascioglu F, Colak O, Armagan O, Alatas O, Oner C. The treatment of osteoporosis in patients with rheumatoid arthritis receiving glucocorticoids: a comparison of alendronate and intranasal salmon calcitonin. Rheumatol Int 2005; 26:21-9. [PMID: 15688191 DOI: 10.1007/s00296-004-0496-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2004] [Accepted: 05/28/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the effects of alendronate and intranasal salmon calcitonin (sCT) treatments on bone mineral density and bone turnover in postmenopausal osteoporotic women with rheumatoid arthritis (RA) receiving low-dose glucocorticoids. METHODS Fifty osteoporotic postmenopausal women with RA, who had been treated with low-dose corticosteroids for at least 6 months, were randomized to receive alendronate 10 mg/day or sCT 200 IU/day for a period of 24 months. All patients received calcium supplementation 1,000 mg and vitamin D 400 IU daily. Bone mineral density (BMD) of the lumbar spine, femoral neck, and trochanter was measured annually using dual-energy X-ray absorptiometry. Bone metabolism measurements included urinary deoxypyridinoline (DPD), serum bone alkaline phosphatase (BAP), and serum osteocalcin (OC). RESULTS Over 2 years, the lumbar spine (4.34%, P < 0.001), femoral neck (2.52%, P < 0.05), and trochanteric (1.29%, P < 0.05) BMD in the alendronate group increased significantly. The sCT treatment increased lumbar spine BMD (1.75%, P < 0.05), whereas a significant bone loss occurred at the femoral neck at month 24 (-3.76%, P < 0.01). A nonsignificant decrease in the trochanteric region was observed in the sCT group (-0.81%). The difference between the groups with respect to the femoral neck and trochanteric BMD was statistically significant ( P < 0.001 and P < 0.05, respectively). The decreases in urinary DPD (-21.87%, P < 0.001), serum BAP (-10.60%, P < 0.01), and OC (-19.59%, P < 0.05) values were statistically significant in the alendronate group, whereas nonsignificant decreases were observed in the sCT group (-5.77%, -1.96%, and -4.31%, respectively). A significant difference was found in the DPD and BAP levels between the two treatment groups in favor of the alendronate group at all time points ( P = 0.001 and P < 0.05, respectively). CONCLUSION The results of this study demonstrated that alendronate treatment produced significantly greater increases in the femoral neck BMD and greater decreases in bone turnover than intranasal sCT in RA patients receiving low dose glucocorticoids.
Collapse
Affiliation(s)
- Funda Tascioglu
- Department of Physical Therapy and Rehabilitation, Osmangazi University Faculty of Medicine, 26480 Eskisehir, Turkey.
| | | | | | | | | |
Collapse
|
47
|
Kim KH, Kim KS, Choi BJ, Chung KH, Chang YC, Lee SD, Park KK, Kim HM, Kim CH. Anti-bone resorption activity of deer antler aqua-acupunture, the pilose antler of Cervus korean TEMMINCK var. mantchuricus Swinhoe (Nokyong) in adjuvant-induced arthritic rats. JOURNAL OF ETHNOPHARMACOLOGY 2005; 96:497-506. [PMID: 15619570 DOI: 10.1016/j.jep.2004.09.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2004] [Revised: 09/13/2004] [Accepted: 09/24/2004] [Indexed: 05/24/2023]
Abstract
Effect of deer antler aqua-acupunture (DAA), prepared from the pilose antler of Cervus korean TEMMINCK var. mantchuricus Swinhoe, a traditional immunosuppressive acupuncture, was evaluated to assess the reductions in bone mass, strength, and turnover in adjuvant-induced arthritic rats. For measuring the above parameters, a 20-day dosing experiment was performed using 6-week-old female Lewis rats. Arthritis was induced by injecting the adjuvant into the hind paw of the Lewis rats. The age-dependent increases in the body weight, lumbar bone mineral content and density (BMC and BMD) and compressive strength were disturbed in the arthritic rats. At 10 days, the histomorphometric parameters of bone formation (BFR/BS and BFR/BV) and the serum osteocalcin levels were significantly reduced compared with the baseline controls of Lewis rats. However, the BMC values corrected for body weight did not differ significantly between the arthritic and normal rats, and the bone minerals were not reduced when they were compared with the baseline controls. At 20 days, the parameters of bone minerals and strength of the lumbar body in the arthritic rats, both with and without correction for body weight, were significantly reduced compared with the baseline controls. The trabecular mineralizing surface remained significantly reduced and the osteoclast numbers were increased. DAA at the doses of 10, 20, 50 and 100 microg/kg, administered by Shinsu (B23) acupuncture daily from the start of the experiment, significantly prevented the development of the chronic paw edema at 20 days. The reductions in the parameters such as bone minerals, strength, and trabecular bone formation, and the increase in osteoclast number were alleviated by this DAA. Age-dependent increases in the lumbar height, disturbed by the adjuvant injection, were also maintained. These results indicated that a 20-day-period is necessary to obtain sufficient reductions in the bone mass and strength of the lumbar body concerning the model of secondary osteoarthritis in adjuvant arthritic rats. DAA was able to prevent these reductions by modulating the bone turnover in this arthritis model.
Collapse
Affiliation(s)
- Kyung-Ho Kim
- Department of Acupuncture, Biochemistry and Molecular Biology, College of Oriental Medicine, Dongguk University and National Research Laboratory for Glycobiology, Kyungju, Kyungbuk 780-714, Republic of Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Akiyama T, Mori S, Mashiba T, Miyamoto K, Komatsubara S, Cao Y, Manabe T, Norimatsu H, Dobashi H, Tokuda M. Incadronate disodium inhibits joint destruction and periarticular bone loss only in the early phase of rat adjuvant-induced arthritis. J Bone Miner Metab 2005; 23:295-301. [PMID: 15981025 DOI: 10.1007/s00774-004-0602-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Accepted: 12/22/2004] [Indexed: 10/25/2022]
Abstract
Destruction of articular cartilage and subchondral bone loss in the affected joints of rat adjuvant arthritis have never been quantified histologically. This study aimed to evaluate the effect of incadronate disodium on joint destruction and periarticular bone loss, using histomorphometric measurements. Seven-week-old female Lewis rats were injected with 0.1 mg of heat-killed Mycobacterium butyricum into the tail base. Immediately after sensitization, vehicle, or incadronate at 10 or 100 microg/kg per day, was administered subcutaneously, three times per week. Hind-paw volume was measured weekly and the animals were killed at 2, 4, 6, and 10 weeks after sensitization. After taking X-rays, decalcified sagittal sections of the ankle joint were prepared and stained with toluidine blue and tartarate-resistant acid phosphatase. Articular cartilage destruction and subchondral bone loss were evaluated histomorphometrically. At 2 weeks after sensitization, no radiographic or histologic changes were observed. However, at 4 weeks, severe articular cartilage destruction and subchondral bone loss were found in the arthritic control group, while these changes were inhibited dose-dependently by incadronate treatment. At 6 and 10 weeks, both the destructive changes and the bone loss had further progressed, and they were not inhibited by incadronate treatment. Incadronate dose-dependently inhibited articular cartilage destruction and subchondral bone loss at 4 weeks after sensitization in this adjuvant arthritis model. However, the suppressive effects of incadronate did not continue until 6 and 10 weeks.
Collapse
Affiliation(s)
- Tomoyuki Akiyama
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kagawa 761-0793, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Kameyama Y, Hagino H, Okano T, Enokida M, Fukata S, Teshima R. Bone response to mechanical loading in adult rats with collagen-induced arthritis. Bone 2004; 35:948-56. [PMID: 15454102 DOI: 10.1016/j.bone.2004.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2004] [Revised: 04/08/2004] [Accepted: 05/03/2004] [Indexed: 10/26/2022]
Abstract
To elucidate the effects of inflammation on the response of bone to mechanical stress, we performed experiments using a rat with collagen-induced arthritis (CIA) model. Six-month-old female Wistar rats were used in the experiment. Bovine type II collagen sensitization and additional sensitization after 1 week were preformed in all CIA groups. Loads were applied using a four-point bending device. The right tibia was loaded in both CIA and control (CONT) groups at 35 N (low groups), 40 N (medium groups), or 47 N (high groups) for 36 cycles at 2 Hz three times per week for 3 weeks. Histomorphometrical data were collected from the periosteal and endosteal surfaces of the tibia in all rats. The tibia periosteal surface was subdivided into lateral and medial surfaces. Formation surface (FS), mineral apposition rate (MAR) and bone formation rate (BFR) were calculated. At lateral surface of periosteal surface, all three parameters showed significant differences between the loaded and nonloaded tibiae. All these parameters were significantly lower in CIA groups than in CONT groups, and interaction was seen between applied loading and CIA. There was a significant correlation between peak strain and the right-left difference of FS in the CONT groups. At medial surface of periosteal surface, there were force-related increase in FS, MAR, and BFR on the loaded side in both CIA and CONT groups, except MAR in the CONT group. All three parameters showed significant differences between the loaded and nonloaded tibiae. At endocortical surface, force-related increase was observed only in FS on the loaded side in CONT groups, and FS was significantly higher on the loaded side than the nonloaded side. CIA lowered all three parameters significantly. We examined the response to mechanical loading on the tibia in untreated CONT rats and rats with CIA by bone histomorphometry, and found that arthritis suppressed bone formation induced by mechanical loading.
Collapse
Affiliation(s)
- Yasuhiro Kameyama
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | | | | | | | | | | |
Collapse
|
50
|
Herrak P, Görtz B, Hayer S, Redlich K, Reiter E, Gasser J, Bergmeister H, Kollias G, Smolen JS, Schett G. Zoledronic acid protects against local and systemic bone loss in tumor necrosis factor-mediated arthritis. ACTA ACUST UNITED AC 2004; 50:2327-37. [PMID: 15248234 DOI: 10.1002/art.20384] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Increased osteoclast activity is a key factor in bone loss in rheumatoid arthritis (RA). This suggests that osteoclast-targeted therapies could effectively prevent skeletal damage in patients with RA. Zoledronic acid (ZA) is one of the most potent agents for blocking osteoclast function. We therefore investigated whether ZA can inhibit the bone loss associated with chronic inflammatory conditions. METHODS Human tumor necrosis factor (TNF)-transgenic (hTNFtg) mice, which develop severe destructive arthritis as well as osteoporosis, were treated with phosphate buffered saline, single or repeated doses of ZA, calcitonin, or anti-TNF, at the onset of arthritis. RESULTS Synovial inflammation was not affected by ZA. In contrast, bone erosion was retarded by a single dose of ZA (-60%) and was almost completely blocked by repeated administration of ZA (-95%). Cartilage damage was partly inhibited, and synovial osteoclast counts were significantly reduced with ZA treatment. Systemic bone mass dramatically increased in hTNFtg mice after administration of ZA, which was attributable to an increase in trabecular number and connectivity. In addition, bone resorption parameters were significantly lowered after administration of ZA. Calcitonin had no effect on synovial inflammation, bone erosion, cartilage damage, or systemic bone mass. Anti-TNF entirely blocked synovial inflammation, bone erosion, synovial osteoclast formation, and cartilage damage but had only minor effects on systemic bone mass. CONCLUSION ZA appears to be an effective tool for protecting bone from arthritic damage. In addition to their role in antiinflammatory drug therapy, modern bisphosphonates are promising candidates for maintaining joint integrity and reversing systemic bone loss in patients with arthritis.
Collapse
|