Effects of short-term use of ibuprofen or acetaminophen on bone resorption in healthy men: a double-blind, placebo-controlled pilot study

Dose-dependent roles of aspirin and other non-steroidal anti-inflammatory drugs in abnormal bone remodeling and skeletal regeneration

The failure of remodeling process that constantly regenerates effete, aged bone is highly associated with bone nonunion and degenerative bone diseases. Numerous studies have demonstrated that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) activate cytokines and mediators on osteoclasts, osteoblasts and their constituent progenitor cells located around the remodeling area. These cells contribute to a complex metabolic scenario, resulting in degradative or synthetic functions for bone mineral tissues. The spatiotemporal effects of aspirin and NSAIDs in the bone remodeling are controversial according the specific therapeutic doses used for different clinical conditions. Herein, we review in vitro, in vivo, and clinical studies on the dose-dependent roles of aspirin and NSAIDs in bone remodeling. Our results show that low-dose aspirin (< 100 μg/mL), which is widely recommended for prevention of thrombosis, is very likely to be benefit for maintaining bone mass and qualities by activation of osteoblastic bone formation and inhibition of osteoclast activities via cyclooxygenase-independent manner. While, the roles of high-dose aspirin (150-300 μg/mL) and other NSAIDs in bone self-regeneration and fracture-healing process are difficult to elucidate owing to their dual effects on osteoclast activity and bone formation of osteoblast. In conclusion, this study highlighted the potential clinical applications of low-dose aspirin in abnormal bone remodeling as well as the risks of high-dose aspirin and other NSAIDs for relieving pain and anti-inflammation in fractures and orthopedic operations.

Effects of short-term combined treatment with alendronate and elcatonin on bone mineral density and bone turnover in postmenopausal women with osteoporosis

The antiresorptive drug elcatonin (ECT) is known to relieve pain in postmenopausal women with osteoporosis. A prospective open-labeled trial was conducted to compare the effects of short-term combined treatment with alendronate (ALN) and ECT on bone mineral density (BMD) and bone turnover with those of single treatment with ALN in postmenopausal women with osteoporosis. Two hundred and five postmenopausal osteoporotic women (mean age: 70 years) were recruited in our outpatient clinic. Forty-six women with back pain were treated with ALN and ECT (intramuscular, 20 units a week), and 159 women without obvious back pain were treated with ALN alone. The lumbar BMD, urinary levels of cross-linked N-terminal telopeptides of type I collagen (NTX), and serum levels of alkaline phosphatase (ALP) were measured during the six-month treatment period. The baseline characteristics, except for age, body weight and number of patients with prevalent vertebral fractures, were not significantly different between the two groups. The mean increase rate in the lumbar BMD at six months was similar in the ALN (+4.41%) and ALN+ECT (+5.15%) groups, following similar reduction rates in urinary NTX levels (-40.2% and -43.0%, respectively, at three months) and serum ALP levels (-19.0% and -19.7%, respectively, at six months). These results were consistent even after adjustments for age, body weight, and number of patients with prevalent vertebral fractures. The present study in postmenopausal osteoporotic women confirmed that the effects of short-term combined treatment with ALN and ECT on lumbar BMD and bone turnover in patients with back pain appeared to be comparable to those of single treatment with ALN in patients without obvious back pain.

Prostaglandin E2 strongly inhibits human osteoclast formation

Prostaglandin E(2) (PGE(2)) enhances osteoclast formation in mouse macrophage cultures treated with receptor activator of nuclear factor-kappaB ligand (RANKL). The effects of PGE(2) on human osteoclast formation were examined in cultures of CD14(+) cells prepared from human peripheral blood mononuclear cells. CD14(+) cells differentiated into osteoclasts in the presence of RANKL and macrophage colony-stimulating factor. CD14(+) cells expressed EP2 and EP4, but not EP1 or EP3, whereas CD14(+) cell-derived osteoclasts expressed none of the PGE(2) receptors. PGE(2) and PGE(1) alcohol (an EP2/4 agonist) stimulated cAMP production in CD14(+) cells. In contrast to mouse macrophage cultures, PGE(2) and PGE(1) alcohol inhibited RANKL-induced human osteoclast formation in CD14(+) cell cultures. H-89 blocked the inhibitory effect of PGE(2) on human osteoclast formation. These results suggest that the inhibitory effect of PGE(2) on human osteoclast formation is mediated by EP2/EP4 signals. SaOS4/3 cells have been shown to support human osteoclast formation in cocultures with human peripheral blood mononuclear cells in response to PTH. PGE(2) inhibited PTH-induced osteoclast formation in cocultures of SaOS4/3 cells and CD14(+) cells. Conversely, NS398 (a cyclooxygenase 2 inhibitor) enhanced osteoclast formation induced by PTH in the cocultures. The conditioned medium of CD14(+) cells pretreated with PGE(2) inhibited RANKL-induced osteoclast formation not only in human CD14(+) cell cultures, but also in mouse macrophage cultures. These results suggest that PGE(2) inhibits human osteoclast formation through the production of an inhibitory factor(s) for osteoclastogenesis of osteoclast precursors.

Análise clínica e biomecânica do efeito do diclofenaco sódico na consolidação da fratura da tíbia no rato

Os AINH (Antiinflamatórios não hormonais) são agentes utilizados na prática clínica que interferem no processo inflamatório pela inibição da síntese de prostaglandinas e tromboxanos. Alguns trabalhos experimentais investigaram sua ação no processo de consolidação de fraturas, por meio de estudos clínicos e histológicos, sendo escassas as análises biomecânicas. Nesse estudo foram utilizados 20 ratos da linhagem Wistar, divididos aleatoriamente em dois grupos iguais: grupo A (controle) e grupo B (tratado com diclofenaco sódico). Em ambos os grupos foram realizadas fraturas abertas, após perfuração, na tíbia direita. A administração da droga foi via intramuscular, dose única diária, por 28 dias. Os animais foram pesados semanalmente. Após o sacrifício as tíbias foram dissecadas, pesadas e submetidas a ensaio biomecânico de flexão analisando-se carga máxima, deformação e coeficiente de rigidez. Observou-se que no grupo tratado com AINH não houve aumento do peso corpóreo a partir da segunda semana e as tíbias fraturadas foram mais pesadas. Neste grupo o calo ósseo suportou menor carga máxima, apresentando maior deformação e menor coeficiente de rigidez. Nos animais tratados, o osso não fraturado também se mostrou menos rígido. Concluiu-se, nas condições estudadas, que o DS alterou o processo de consolidação e o metabolismo ósseo, levando a retardo na maturação do calo e menor rigidez do osso intacto, respectivamente.