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Lopes MBG, Araújo LHDC, Lustosa LM, Alencar Neto JBD, Felipe MRDB. Atypical Tibial Fracture Treated with Osteosynthesis Associated with Total Knee Arthroplasty: Case Report. Rev Bras Ortop 2023; 58:e964-e967. [PMID: 38077765 PMCID: PMC10708969 DOI: 10.1055/s-0041-1739301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 08/13/2021] [Indexed: 08/03/2024] Open
Abstract
Bisphosphonates are widely used in the treatment of osteoporosis but predispose the patient to the appearance of atypical fractures. The femoral subtrochanteric region is usually affected, but other bones can be as well. Atypical tibia fractures in patients with severe gonarthrosis is a therapeutic challenge. The present work reports the case of an elderly patient with advanced gonarthrosis who presented atypical tibial fracture. The patient made prolonged use of bisphosphonates for osteoporosis, presenting with pain and functional limitation resulting from gonarthrosis, which progressed to sudden pain in the right tibial metaphysis, preventing ambulation. The radiographs showed bilateral severe arthrosis; marked varism; tibial and femoral medial erosion; and fracture in the proximal third of the right tibial diaphysis. The fracture and arthrosis on the right side were treated by osteosynthesis with blocked plaque and total knee arthroplasty with posterior stabilization and fixed base. After physical rehabilitation, significant improvement of pain and function was reported, independent gait was reacquired and a range of motion of 0 to 100° was reached. After one year, the radiographs showed fracture consolidation and satisfactory alignment of the lower limbs' axes. The coexistence of severe arthrosis and atypical fracture made treatment difficult. However, the result was satisfactory and the approach with simultaneous osteosynthesis and arthroplasty proved to be adequate.
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Affiliation(s)
| | | | | | | | - Marcos Rainier de Brito Felipe
- Residente do Departamento de Ortopedia, Hospital Walter Cantídio da Universidade Federal do Ceará, Fortaleza, CE, Brasil
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Song S, Guo Y, Yang Y, Fu D. Advances in pathogenesis and therapeutic strategies for osteoporosis. Pharmacol Ther 2022; 237:108168. [PMID: 35283172 DOI: 10.1016/j.pharmthera.2022.108168] [Citation(s) in RCA: 126] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 02/07/2023]
Abstract
Osteoporosis, is the most common bone disorder worldwide characterized by low bone mineral density, leaving affected bones vulnerable to fracture. Bone homeostasis depends on the precise balance between bone resorption by osteoclasts and bone matrix formation by mesenchymal lineage osteoblasts, and involves a series of complex and highly regulated steps. Bone homeostasis will be disrupted when the speed of bone resorption is faster than bone formation. Based on various regulatory mechanisms of bone homeostasis, a series of drugs targeting osteoporosis have emerged in clinical practice, including bisphosphonates, selective estrogen receptor modulators, calcitonin, molecular-targeted drugs and so on. However, many drugs have major adverse effects or are unsuitable for long-term use. Therefore, it is very urgent to find more effective therapeutic drugs based on the new pathogenesis of osteoporosis. In this review, we summarize novel mechanisms involved in the pathological process of osteoporosis, including the roles of gut microbiome, autophagy, iron balance and cellular senescence. Based on the above pathological mechanism, we found promising drugs for osteoporosis treatment, such as: probiotics, alpha-ketoglutarate, senolytics and hydrogen sulfide. This new finding may provide an important basis for elucidating the complex pathological mechanisms of osteoporosis and provide promising drugs for clinical osteoporosis treatment.
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Affiliation(s)
- Shasha Song
- College of Pharmacy, Shenzhen Technology University, Shenzhen 518118, PR China
| | - Yuanyuan Guo
- Department of Pharmacy, Liyuan Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei 430077, PR China
| | - Yuehua Yang
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, PR China
| | - Dehao Fu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, PR China.
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Twelve years of GWAS discoveries for osteoporosis and related traits: advances, challenges and applications. Bone Res 2021; 9:23. [PMID: 33927194 PMCID: PMC8085014 DOI: 10.1038/s41413-021-00143-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/21/2020] [Indexed: 02/03/2023] Open
Abstract
Osteoporosis is a common skeletal disease, affecting ~200 million people around the world. As a complex disease, osteoporosis is influenced by many factors, including diet (e.g. calcium and protein intake), physical activity, endocrine status, coexisting diseases and genetic factors. In this review, we first summarize the discovery from genome-wide association studies (GWASs) in the bone field in the last 12 years. To date, GWASs and meta-analyses have discovered hundreds of loci that are associated with bone mineral density (BMD), osteoporosis, and osteoporotic fractures. However, the GWAS approach has sometimes been criticized because of the small effect size of the discovered variants and the mystery of missing heritability, these two questions could be partially explained by the newly raised conceptual models, such as omnigenic model and natural selection. Finally, we introduce the clinical use of GWAS findings in the bone field, such as the identification of causal clinical risk factors, the development of drug targets and disease prediction. Despite the fruitful GWAS discoveries in the bone field, most of these GWAS participants were of European descent, and more genetic studies should be carried out in other ethnic populations to benefit disease prediction in the corresponding population.
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Abstract
Romosozumab (Evenity®), a humanized monoclonal antibody, promotes bone formation and inhibits bone resorption by inhibiting sclerostin, a protein involved in the regulation of bone formation. Subcutaneous romosozumab is approved in several countries, including those of the EU for treating severe osteoporosis as well as in the USA for osteoporosis in postmenopausal women at high risk of fracture. In pivotal phase III trials (FRAME and ARCH), 12 months' once-monthly romosozumab 210 mg significantly reduced vertebral and clinical fracture risk versus placebo and oral alendronate in postmenopausal women with osteoporosis. After patients transitioned from romosozumab to 12-24 months of subcutaneous denosumab or oral alendronate, fracture risks were significantly improved versus placebo-to-denosumab and alendronate-only treatment. In these trials and a phase IIIb trial, romosozumab significantly increased bone mineral density (BMD) relative to placebo, alendronate and subcutaneous teriparatide at 12 months, with these benefits maintained 12-24 months after patients transitioned from romosozumab to alendronate or denosumab in pivotal trials. Romosozumab had a generally manageable tolerability profile. While further clinical experience is needed to more definitively establish its efficacy and safety, including its CV safety, romosozumab extends the treatment options in postmenopausal women with osteoporosis who have a high risk of fracture and in those who have failed or are intolerant to other available osteoporosis therapy.
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Affiliation(s)
- Julia Paik
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
| | - Lesley J Scott
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand
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Tsartsalis AN, Lambrou GI, Tsartsalis DN, Papassotiriou I, Vlachou E, Terpos E, Chrousos GP, Kanaka-Gantenbein C, Kattamis A. Bone Metabolism Markers in Thalassemia Major-Induced Osteoporosis: Results from a Cross-Sectional Observational Study. Curr Mol Med 2019; 19:335-341. [PMID: 30868952 DOI: 10.2174/1566524019666190314114447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Thalassemia major (TM) patients eventually face many new health conditions, including endocrinopathies and low bone mineral density, usually observed in the aging general population. OBJECTIVE The aim of the current study was to evaluate the biomarkers of bone remodeling in TM patients and to compare them with both osteoporotic and healthy population, in order to investigate the new therapeutic paths. METHODS Sixty-four patients with TM (32 men and 32 women) participated in the study. The patients were evaluated with dual-energy X-ray absorptiometry (DXA) of the lumbar spine and femoral neck and with markers of bone remodeling including receptor activator of nuclear factor kappa-Β ligand (RANKL), osteoprotegerin (OPG), C-terminal telopeptide (CTX), and sclerostin. Results were compared with those from 12 postmenopausal women with osteoporosis and 12 women with normal bone mineral density. RESULTS The statistical analysis of the biochemical markers of bone metabolism revealed overall significant differences between the three groups only for RANKL and OPG/RANKL (p=0.049 and p=0.009). RANKL was higher and OPG/RANKL was lower in TM patients compared to osteoporosis group. CONCLUSION Patients with TM do not have a higher probability of suffering from osteoporosis from the general population. However, some markers of osteoclast activity differ between patients with TM and osteoporosis, indicating the possible differences in terms of anti-osteoporotic treatment. The lack of significant differences among the three groups in regards to the levels of CTX and sclerostin may indicate the potential efficacy of the current osteoporotic treatment also for TM patients.
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Affiliation(s)
- Athanasios N Tsartsalis
- Naval Hospital of Athens, Department of Endocrinology Diabetes and Metabolism, Dinokratous 70, 11521, Athens, Greece
| | - George I Lambrou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory, Thivon & Levadeias 8, 11527, Goudi, Athens, Greece.,Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, 11527, Goudi, Athens, Greece
| | - Dimitrios N Tsartsalis
- Department of Clinical Physiology, Linkoping University, Linkoping, SE-58183 Linkoping, Sweden
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Thivon, 115 27 Athens, Greece
| | - Eugenia Vlachou
- Department of Nursing, School of Health and Caring Professions, University of West Attica, Ag. Spydironos 28, 12243, Aigaleo, Athens, Greece
| | - Evaggelos Terpos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, "Alexandra" General Hospital, Lourou 12, 11527, Athens, Greece
| | - George P Chrousos
- First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory, Thivon & Levadeias 8, 11527, Goudi, Athens, Greece.,Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, 11527, Goudi, Athens, Greece.,Division of Endocrinology Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, 11527, Goudi, Athens, Greece
| | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, National and Kapodistrian University of Athens, Choremeio Research Laboratory, Thivon & Levadeias 8, 11527, Goudi, Athens, Greece.,Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, 11527, Goudi, Athens, Greece.,Division of Endocrinology Diabetes and Metabolism, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, 11527, Goudi, Athens, Greece
| | - Antonis Kattamis
- Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias, 11527, Goudi, Athens, Greece
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Romualdo PC, Cunha NBFF, Leoni GB, Sousa-Neto MD, Consolaro A, de Queiroz AM, da Silva RAB, da Silva LAB, Nelson-Filho P. The effect of ovariectomy and 2 antiresorptive therapeutic agents on bone response in rats: A 3-dimensional imaging analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:218-225. [PMID: 29748038 DOI: 10.1016/j.oooo.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/14/2018] [Accepted: 04/06/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate bone mineral density (BMD) and microarchitecture in femurs and maxillary bones of ovariectomized (OVX) rats treated or not treated with alendronate (ALD) or odanacatib (ODN). STUDY DESIGN Twenty rats were divided into groups: SHAM, OVX, OVX/ALD, and OVX/ODN. After 12 weeks, the femurs and maxillae were removed and subjected to 3-dimensional analysis by micro-computed tomography. Results were analyzed with 1-way analysis of variance and Tukey's post hoc test (α = 0.05). RESULTS OVX decreased maxillary and femoral BMD and altered femoral microarchitecture (P < .05). The drugs increased BMD of both types of bones, but only ALD maintained the phenotype similar to the SHAM group. The action of ALD was limited to the femoral trabecular separation (Tb.Sp). OVX and the drugs had no effect on the microarchitecture of the maxilla (P > .05). CONCLUSIONS ALD and ODN therapy increased BMD in both bones after ovariectomy. ALD was more successful than ODN in preserving the morphology of bone similar to the SHAM group. ALD maintained the phenotype for Tb.Sp in the femur, but ODN did not. In the maxillae, neither ovariectomy nor the 2 antiresorptive drugs had significant effects on microarchitecture.
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Affiliation(s)
- Priscilla Coutinho Romualdo
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | | | - Graziela Bianchi Leoni
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Manoel Damião Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Alberto Consolaro
- Department of Oral Pathology, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
| | - Alexandra Mussolino de Queiroz
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Raquel Assed Bezerra da Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Lea Assed Bezerra da Silva
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Cheng L, Zhou S, Zhao Y, Sun Y, Xu Z, Yuan B, Chen X. Tanshinone IIA attenuates osteoclastogenesis in ovariectomized mice by inactivating NF-kB and Akt signaling pathways. Am J Transl Res 2018; 10:1457-1468. [PMID: 29887959 PMCID: PMC5992540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 04/06/2018] [Indexed: 06/08/2023]
Abstract
Osteoporosis is a common disease associated with age and menopausal status. Postmenopausal osteoporosis is the most common type of primary osteoporosis and is accompanied by increased risk of osteoporotic fracture. Natural and herbal compounds have long been used to prevent and treat many human diseases. Here, we demonstrated that tanshinone IIA prevented ovariectomy-induced bone loss in an in vivo mouse model that closely mimics osteoporosis. In addition, we found that tanshinone IIA inhibited the receptor activator of nuclear factor NF-κB ligand (RANKL)-induced osteoclast differentiation and osteoclastogenesis in vitro. Tanshinone IIA treatment also abrogated RANKL-induced activation of the NF-κB pathway, PI3-kinase/Akt signaling, and the mitogen-activated protein kinase (MAPK) pathways, including nuclear translocation of NF-κB p65 and phosphorylation of IκB, extracellular signal-regulated kinase (ERK), p38, and Akt. Inactivation of these pathways resulted in deceased expression of osteoclastogenesis-related markers. These results suggest that tanshinone IIA, a natural drug, has the potential to treat and prevent bone loss diseases, including postmenopausal osteoporosis.
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Affiliation(s)
- Li Cheng
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical UniversityShanghai 200003, China
- Department of Orthopaedics, Cixi People’s Hospital, Wenzhou Medical UniversityCixi 315300, Zhejiang, China
| | - Shengyuan Zhou
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical UniversityShanghai 200003, China
| | - Yin Zhao
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical UniversityShanghai 200003, China
| | - Yanqing Sun
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical UniversityShanghai 200003, China
| | - Zheng Xu
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical UniversityShanghai 200003, China
| | - Bo Yuan
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical UniversityShanghai 200003, China
| | - Xiongsheng Chen
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical UniversityShanghai 200003, China
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8
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Zhang JL, Qiu XM, Zhang N, Tang W, Gober HJ, Li DJ, Wang L. Bu‑Shen‑Ning‑Xin decoction suppresses osteoclastogenesis by modulating RANKL/OPG imbalance in the CD4+ T lymphocytes of ovariectomized mice. Int J Mol Med 2018; 42:299-308. [PMID: 29717766 PMCID: PMC5979942 DOI: 10.3892/ijmm.2018.3645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 03/22/2018] [Indexed: 02/05/2023] Open
Abstract
Postmenopausal osteoporosis (PMO) has been recognized as an inflammatory condition. CD4+ T cells serve a key role in the interaction between bone metabolism and the immune system. Bu-Shen-Ning-Xin decoction (BSNXD), a traditional Chinese medicine, has been ultilized as a remedy for PMO. In the present study, the aim was to investigate the immune modulatory effects of BSNXD on CD4+ T cells, receptor activation of nuclear factor κB ligand (RANKL)/osteoprotegerin (OPG) imbalance, skeletal parameters and osteoclastogenesis. Ovariectomized (OVX) mice were treated with a series of concentrations of BSNXD and then autopsied. The bone phenotype was analyzed by micro computed tomography. CD4+ T cells were isolated and their percentage was measured using flow cytometry (FCM). RANKL and OPG expression by the CD4+ T cells at the transcriptional and translational levels were quantified by reverse transcription-quantitative polymerase chain reaction, ELISA and FCM. CD4+ T cells were cultured with blood serum derived from BSNXD-treated OVX mice (BSNXD-derived serum) and the apoptosis rate was quantified by FCM. CD4+ T cells were co-cultured with bone marrow-derived macrophages and exposed to BSNXD-derived serum to whether CD4+ T cells are involved in BSNXD-modulated osteoclastogenesis and the results were quantified via tartrate-resistant acid phosphatase staining. The results revealed that BSNXD ameliorated OVX-induced bone loss, prevented the expansion of CD4+ T cells and restored the RANKL/OPG imbalance in the CD4+ T cells of OVX mice. In vitro, BSNXD-derived serum promoted the apoptosis of CD4+ T cells. The co-culture system demonstrated that CD4+ T cells from OVX mice increase osteoclastogenesis, while this effect was suppressed by BSNXD administration. The findings of the study collectively suggest that BSNXD exerts an immunoprotective effect on the bone phenotype of OVX mice by ameliorating RANKL/OPG imbalance in CD4+ T cells and attenuating osteoclastogenesis.
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Affiliation(s)
- Jia-Li Zhang
- Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, IBS, Fudan University Shanghai Medical College, Shanghai 200011, P.R. China
| | - Xue-Min Qiu
- Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, IBS, Fudan University Shanghai Medical College, Shanghai 200011, P.R. China
| | - Na Zhang
- Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, IBS, Fudan University Shanghai Medical College, Shanghai 200011, P.R. China
| | - Wei Tang
- Hepato‑Biliary‑Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo 113‑8655, Japan
| | - Hans-Jürgen Gober
- Department of Pharmacy, Neuromed Campus, Johannes Kepler University, 4020 Linz, Austria
| | - Da-Jin Li
- Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, IBS, Fudan University Shanghai Medical College, Shanghai 200011, P.R. China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Hospital and Institute of Obstetrics and Gynecology, IBS, Fudan University Shanghai Medical College, Shanghai 200011, P.R. China
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9
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Dried and free flowing granules of Spinacia oleracea accelerate bone regeneration and alleviate postmenopausal osteoporosis. Menopause 2018; 24:686-698. [PMID: 28118295 DOI: 10.1097/gme.0000000000000809] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study was to demonstrate the efficacy of extract derived from Spinacia oleracea extract (SOE) in reversing bone loss induced by ovariectomy and bone healing properties in a drill-hole fracture model in rats. METHODS SOE was administered orally for 12 weeks in adult ovariectomized Sprague Dawley rats after inducing osteopenic condition. Bone micro-architecture, expressions of osteogenic and resorptive gene markers, biomechanical strength, new bone formation, and bone turnover markers were studied. Uterine histomorphometry was used to assess estrogenicity. Bone regeneration potential of SOE was assessed in a drill-hole fracture model. Fracture healing was assessed by calcein intensity and micro-CT analysis of callus at fracture region. RESULTS SOE prevented ovariectomy-induced bone loss as evident from 122% increase in bone volume/tissue volume (BV/TV) and 29% decline in Tb.Sp in femoral trabecular micro-architecture. This was corroborated by the more than twofold stimulation in the expression of osteogenic genes runt-related transcription factor 2, osterix, osteocalcin, bone morphogenetic protein 2, collagen-1. Furthermore in the fracture healing model, we observed a 25% increase in BV/TV and enhancement in calcein intensity at the fractured site. The extract when converted into dried deliverable Spinaceae oleracea granule (SOG) form accelerated bone regeneration at fracture site, which was more efficient as evident by a 39% increase in BV/TV. Transforming SOE into dried granules facilitated prolonged systemic availability, thus providing enhanced activity for a period of 14 days. CONCLUSIONS SOE treatment effectively prevents ovariectomy-induced bone loss and stimulated fracture healing in adult rats. The dried granular form of the extract of Spinaceae oleracea was effective in fracture healing at the same dose.
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Abstract
INTRODUCTION Sclerostin, a glycoprotein produced primarily by osteocytes, blocks the canonical Wnt signaling bone formation pathway. Romosozumab is a humanized monoclonal antibody to sclerostin that binds to sclerostin, permitting the engagement of Wnt ligands with their co-receptors, resulting in an increase in bone formation and bone mineral density (BMD). Clinical studies with romosozumab have shown dramatic improvements in BMD at the spine and hip. Romosozumab is associated with improvement in bone strength through mechanisms that include increases in bone formation and, different from classical osteoanabolic agents, suppression of bone resorption. Areas covered: Herein, the authors highlight the available data on romosozumab for the treatment of osteoporosis. This includes the latest data on the efficacy, pharmacokinetics and pharmacodynamics as well as safety and tolerability data. Expert opinion: Monthly subcutaneous dosing of romosozumab reduces the risk of vertebral and clinical fractures in women with postmenopausal osteoporosis, with a favorable balance of benefits and risks. Romosozumab is a promising emerging anabolic agent with a novel mechanism of action that may expand the options for treating osteoporotic patients at high risk of fracture.
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Affiliation(s)
- Leonardo Bandeira
- a Department of Medicine , College of Physicians and Surgeons, Columbia University Medical Center , New York , NY , USA
| | - E Michael Lewiecki
- b New Mexico Clinical Research & Osteoporosis Center , Albuquerque , NM , USA
| | - John P Bilezikian
- a Department of Medicine , College of Physicians and Surgeons, Columbia University Medical Center , New York , NY , USA
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11
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Capozzi A, Scambia G, Pedicelli A, Evangelista M, Sorge R, Lello S. Clinical management of osteoporotic vertebral fracture treated with percutaneous vertebroplasty. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2017; 14:161-166. [PMID: 29263726 PMCID: PMC5726202 DOI: 10.11138/ccmbm/2017.14.1.161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Our study demonstrated percutaneous vertebroplasty (PVP) is an effective procedure to rapidly reduce back pain in patients affected by acute osteoporotic vertebral compression fractures (OVCFs) assessed by MRI. We confirmed in our sample, femoral bone density impacts more deeply than vertebral T-score and/or BMD on bone strenght, as it is less affected by any interferences. We interestingly found the presence of previous osteoporotic fragility fractures and chronic glucocorticoids therapy should especially negatively influence bone health of our patients. On the other hand, even if both FRAX scores for major osteoporotic fractures and for femoral fractures seemed to globally define a population at major risk for fragility fractures, our analysis is retrospectively done. We choose and suggest a multidisciplinary medical management of these patients, considering OP is a multifactorial disease and OVCFs usually produce lots of different important consequences on general health.
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Affiliation(s)
- Anna Capozzi
- Department of Women and Child Health, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Women and Child Health, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro Pedicelli
- Department of Interventional Radiology, Institute of Radiology, Catholic University of Sacred Heart, Rome, Italy
| | - Maurizio Evangelista
- Department of Emergency, Institute of Anesthesia, Resuscitation and Pain Medicine, Catholic University of Sacred Heart, Rome, Italy
| | - Roberto Sorge
- Laboratory of Biometry, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Stefano Lello
- Department of Women and Child Health, Catholic University of Sacred Heart, Rome, Italy
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12
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Lim SY, Bolster MB. Profile of romosozumab and its potential in the management of osteoporosis. Drug Des Devel Ther 2017; 11:1221-1231. [PMID: 28458516 PMCID: PMC5402913 DOI: 10.2147/dddt.s127568] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Increased understanding of bone biology has led to the discovery of several unique signaling pathways that regulate bone formation and resorption. The Wnt signaling pathway plays a significant role in skeletal development, adult skeletal homeostasis, and bone remodeling. Sclerostin is an inhibitor of the Wnt signaling pathway. Romosozumab, a humanized monoclonal antibody that binds to sclerostin, prevents sclerostin from exerting this inhibitory effect. Therefore, in the presence of romosozumab, the Wnt signaling pathway is activated leading to bone formation and bone mineral density gain. Clinical studies of romosozumab have shown that this agent is one of the most potent bone anabolic agents in development to date. Romosozumab does not act solely as an anabolic agent, but rather, it has effects on increasing bone formation as well as reducing bone resorption. In the clinical studies, patients tolerated romosozumab well with no major safety signals reported. In a Phase III study, romosozumab as compared to placebo has been shown to reduce vertebral fractures by 73% after 1 year of treatment. Sequential therapy with romosozumab for 1 year followed by denosumab in the second year reduced vertebral fractures by 75% as compared to the group that received placebo for 1 year and denosumab in the second year. Romosozumab holds significant potential, by a novel mechanism of action, to expand our ability to treat osteoporosis. More studies are needed to determine the ideal setting in which romosozumab may be used to optimize osteoporosis treatment.
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Affiliation(s)
- Sian Yik Lim
- Straub Bone & Joint Center, Straub Medical Center, Honolulu, HI
| | - Marcy B Bolster
- Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Luo H, Gao H, Liu F, Qiu B. Regulation of Runx2 by microRNA-9 and microRNA-10 modulates the osteogenic differentiation of mesenchymal stem cells. Int J Mol Med 2017; 39:1046-1052. [DOI: 10.3892/ijmm.2017.2918] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 01/24/2017] [Indexed: 11/05/2022] Open
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14
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Moreira-Marconi E, Dionello CF, Morel DS, Sá-Caputo DC, Souza-Gonçalves CR, Paineiras-Domingos LL, Guedes-Aguiar EO, Marin PJ, Cruz BDP, Bernardo-Filho M. Could whole body vibration exercises influence the risk factors for fractures in women with osteoporosis? Osteoporos Sarcopenia 2016; 2:214-220. [PMID: 30775489 PMCID: PMC6372741 DOI: 10.1016/j.afos.2016.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/19/2016] [Accepted: 09/25/2016] [Indexed: 02/09/2023] Open
Abstract
Objective The aim of this study was to review the literature about the relevance of the whole body vibration (WBV) in decreasing the number of fractures in osteoporotic women. Methods Searches were performed by three independent researchers through the PubMed and PEDro databases. Results Only 0.1% of the publications with "Fracture and osteoporosis" have a relation with WBV exercise. The achievements have revealed a positive effect of this exercise in patients with risk factors for fractures like osteoporosis. Protocols were performed two to three times a week, from 6 up to 18 months, and with 12.6 up to 40 Hz as frequencies. Different tools were used to evaluate the effects of the WBV exercise in conditions that could cause fractures in postmenopausal women. Conclusions Although the paucity of research regarding direct effects of WBV in decreasing fractures, WBV could be a feasible and effective way to modify well-recognized risk factors for falls and fractures, improvements in some aspects of neuromuscular function and balance. More studies have to be performed establish protocols with well controlled parameters.
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Affiliation(s)
- Eloá Moreira-Marconi
- Programa de Pós-graduação em Fisiopatologia Clínica e Experimental, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares - LAVIMPIC, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Carla F Dionello
- Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares - LAVIMPIC, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Programa de Pós-graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Danielle S Morel
- Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares - LAVIMPIC, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Programa de Pós-graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Danubia C Sá-Caputo
- Programa de Pós-graduação em Fisiopatologia Clínica e Experimental, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares - LAVIMPIC, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Cintia R Souza-Gonçalves
- Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares - LAVIMPIC, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Programa de Pós-graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laisa L Paineiras-Domingos
- Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares - LAVIMPIC, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Programa de Pós-graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eliane O Guedes-Aguiar
- Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares - LAVIMPIC, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Programa de Pós-graduação em Ciências da Saúde, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | | | - Mario Bernardo-Filho
- Laboratório de Vibrações Mecânicas e Práticas Integrativas e Complementares - LAVIMPIC, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Individualisierte Therapie der Osteoporose. Internist (Berl) 2016; 57:638-45. [DOI: 10.1007/s00108-016-0074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Bandeira L, Lewiecki EM, Bilezikian JP. Pharmacodynamics and pharmacokinetics of oral salmon calcitonin in the treatment of osteoporosis. Expert Opin Drug Metab Toxicol 2016; 12:681-9. [DOI: 10.1080/17425255.2016.1175436] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Leonardo Bandeira
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - John P. Bilezikian
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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