Advancement in the Treatment of Osteoporosis and the Effects on Bone Healing

Presentation and outcome in carriers of pathogenic variants in SLC34A1 and SLC34A3 encoding sodium-phosphate transporter NPT 2a and 2c

Pathogenic variants in SLC34A1 and SLC34A3 encoding sodium-phosphate transporter 2a and 2c are rare causes of phosphate wasting. Since data on presentation and outcomes are scarce, we collected clinical, biochemical and genetic data via an online questionnaire and the support of European professional organizations. One hundred thirteen patients (86% children) from 90 families and 17 countries with pathogenic or likely pathogenic variants in SLC34A1 or SLC34A3 and a median follow-up of three years were analyzed. Biallelic SLC34A1 variant carriers showed polyuria, failure to thrive, vomiting, constipation, hypercalcemia and nephrocalcinosis in infancy, while biallelic SLC34A3 carriers presented in childhood or even adulthood with rickets/osteomalacia and/or osteopenia/osteoporosis, hypophosphatemia and, less frequently, nephrocalcinosis, while the prevalences of kidney stones were comparable. Adult biallelic SLC34A3 carriers had a six-fold increase chronic kidney disease (CKD) prevalence compared to the general population. All biallelic variant carriers shared a common biochemical pattern including elevated 1,25(OH)2D and alkaline phosphatase levels, suppressed parathyroid hormone (PTH), and hypercalciuria. Heterozygous carriers showed similar but less pronounced phenotypes. In biallelic SLC34A1 carriers, an attenuation of clinical features was observed after infancy, independent of treatment. Phosphate treatment was given in 55% of patients, median duration two years, and resulted in significant reduction, although not normalization, of alkaline phosphatase and of hypercalciuria but an increase in PTH levels, while 1,25(OH)2D levels remained elevated. Thus, our study indicates that biallelic SLC34A1 and SLC34A3 carriers show distinct, albeit overlapping phenotypes, with the latter having an increased risk of CKD in adulthood. Phosphate treatment may promote kidney phosphate loss and enhance 1,25(OH)2D synthesis via increased PTH production.

Association between vertebral bone quality score and residual back pain following percutaneous vertebroplasty for osteoporotic vertebral compression fractures

BACKGROUND

Residual back pain (RBP) is one of the complications following percutaneous vertebroplasty (PVP) in older people with osteoporotic vertebral compression fractures (OVCFs). The vertebral bone quality (VBQ) score obtained from magnetic resonance imaging (MRI) can be used to evaluate bone quality. The objective of this study aimed to explore the potential relationship between the VBQ score and RBP after PVP.

METHODS

From January 2018 to January 2022, patients with OVCFs who underwent PVP in our hospital were retrospectively reviewed. Each patient's lumbar VBQ score was recorded. The RBP was defined as a visual analog scale (VAS) score ≥ 4 for back pain postoperatively. Other variables included demographic, clinical, radiological, and surgical data. The univariate and multivariate logistic regression analyses were used to determine the independent risk factors.

RESULTS

The incidence of RBP was 8.0% among 598 patients. The results of the multivariate regression analysis showed that preoperative VBQ score (OR 3.295, P < 0.001), BMD (OR 0.545, P = 0.007), lumbodorsal fascia contusion (OR 4.297, P = 0.034), and cement distribution (OR 4.556, P = 0.006) were risk factors associated with RBP after PVP.

CONCLUSIONS

The preoperative high VBQ score was an independent risk factor associated with RBP after PVP. Moreover, other risk factors included low BMD, lumbodorsal fascia contusion, and cement distribution. The MRI-VBQ score may serve as a useful tool for assisting in evaluating patients at risk of RBP following PVP.

Association between modified dietary inflammation index score and lumbar vertebrae bone mineral density in patients with hypertension: data from NHANES-a population-based study

BACKGROUND

The modified Dietary Inflammation Index Score (M-DIS) is a scoring system used to quantify the inflammatory effects of nutrients and foods. Inflammation may affect Bone Mineral Density (BMD) and increase the risk of osteoporosis and fractures. The purpose of this study was to utilize data from the National Health and Nutrition Examination Survey (NHANES) to evaluate the relationship between M-DIS and lumbar vertebrae BMD in patients with hypertension.

METHODS

Data from 2007 to 2008, 2009-2010, 2013-2014 and 2017-2018 NHANES cycles were collected for secondary analysis. Information provided by NHANES participants included complete dietary intake interviews and BMD measurements. M-DIS was calculated based on dietary intake interviews. Dual energy X-ray absorptiometry (DXA) was used to evaluate the average BMD of lumbar vertebrae (L1-L4). As an indicator of bone health, weighted multiple logistic regression and restricted spline analysis were utilized to study the relationship between M-DIS and lumbar vertebrae BMD in American patients with hypertension.

RESULTS

A total of 3864 participants aged ≥ 20 years with complete data were included in this study. The proportion of osteopenia in the lumbar spine was 7.2%. After adjusting for confounding factors, negative correlations were observed between the BMD of each vertebral and its average BMD with M-DIS. In Model 3, the relationship between mean lumbar BMD and M-DIS was β = - 0.0103 (95% CI - 0.0160 to - 0.0046, P < 0.001). Notably, L1 showed a particularly significant negative correlation with β = - 0.0120 (95% CI - 0.0172 to - 0.0067, P < 0.001), while the proportion of osteopenia was highest in the L3 vertebra, accounting for 8.3%. Higher M-DIS was positively correlated with the incidence of osteopenia (OR 0.595, 95% CI 0.371-0.965, P = 0.041). Further analyses revealed that in hypertensive patients, elevated M-DIS in women was associated with lower lumbar BMD (P for nonlinearity = 0.093), while this trend was not significant in hypertensive men.

CONCLUSIONS

The results of this study suggest that a higher M-DIS (pro-inflammatory diet) is significantly associated with BMD in females with hypertension. These results indicate that female with hypertension who prefer a pro-inflammatory diet may be at an increased risk of osteopenia, highlighting the necessity for tailored dietary recommendations.

Thermal Changes During Clavicle Fracture Healing in Children

Introduction: Clavicle fractures are among the most common in children, typically treated conservatively, with standard radiographs used to diagnose and monitor healing. Recently, infrared thermography (IRT) has been proposed as an alternative method for fracture detection, but no study has correlated the temperature changes during callus formation. Materials and Methods: Children aged 4-18 with X-ray-diagnosed clavicle fractures were included in the study. IRT measured temperatures above the fracture and contralateral healthy side on the 1st, 4th, 8th, 15th, and 22nd day after the injury. Along with IRT, an ultrasound was used to assess callus formation. Results: The study included 27 patients with an average age of 12.4 years, mostly boys. The left side was more often affected than the right side (33%). We found a correlation between callus formation and the ∆T. A maximum temperature difference of an average of 0.7 °C was noted during the proliferative phase of callus formation. After the formation of the fibrocartilaginous callus (4th to 8th day), the temperature above the fracture declined until it was equal (22nd day) to that of the healthy side. The average temperature difference between the broken and the healthy sides was statistically significant on the 4th and 8th days (during callus formation). Conclusions: The increased skin temperature above the fracture correlates with the inflammatory phase of bone healing. After the callus is visible on ultrasound, the temperature linearly drops with no statistical difference between the injured and the healthy sides. The standard protocol for clavicle fracture treatment typically involves using X-rays to assess callus formation during follow-up. IRT has shown potential in diagnosing callus formation in children with clavicle fractures, potentially reducing the need for traditional X-rays.

Oral dehydroepiandrosterone supplementation enhances osteoporotic fracture healing in the OVX rats

Osteoporosis easily causes delayed fracture union, even non-union. It has been demonstrated that dehydroepiandrosterone (DHEA) supplementation can increase estrogen levels and improve bone mineral density (BMD) in the elderly, while the role of DHEA on fracture healing remains unknown. This study aimed to elucidate the impact of DHEA supplementation on osteoporotic fracture healing. Seventy-two female Sprague-Dawley rats were used. Forty-eight rats received ovariectomy (OVX), and the remaining rats received a sham OVX operation (sham group). A right transverse femoral osteotomy was performed in all rats at 12 weeks post-OVX. OVX rats were randomly allocated into 2 groups (n = 24 in each group): (i) ovariectomized rats (control group) and (ii) ovariectomized rats treated with DHEA (DHEA group, 5 mg/kg/day). The DHEA supplementation was initiated on the first day post-fracture for 3, 6, and 12 weeks. Fracture healing was evaluated by radiography, histology, biomechanical analysis, and dual-energy X-ray absorptiometry (DEXA). Serum biomarkers were analyzed using enzyme-linked immunosorbent assay (ELISA). At 3 and 6 weeks, radiographs revealed reduced calluses formation and lower radiographic scores in the control group than in other groups. The sham and DHEA groups showed higher BMD and bone mineral content (BMC) at the fracture site than the control group after fracture. Histological analysis revealed the fracture callus was remodeled better in the sham and DHEA groups than in the control group. At the early phase of healing, DHEA supplementation increased osteoblast number, callus area, and cartilage area than the control group. An increased bone area was observed in the DHEA group than in the control group at the late phase of healing. Additionally, improved biomechanical characteristics were observed in both the sham and DHEA groups than those in the control group post-fracture. ELISA showed higher levels of insulin-like growth factor-1 (IGF-1) and 17β-estradiol (E2) in the DHEA group than in the control group post-fracture. Furthermore, the DHEA group exhibited significantly elevated alkaline phosphatase (ALP) and osteocalcin (OC) levels compared to the control group at 6 and 12 weeks. The DHEA group and the control group did not exhibit a notable difference in TRAP-5b levels. The present study demonstrated that the DHEA treatment has a favorable impact on osteoporotic fracture healing by enhancing callus formation, consolidation, and strength in the OVX rats.

Cardiometabolic index is associated with increased bone mineral density: a population-based cross-sectional study

Background

Osteoporosis is a multifactorial bone disease in which lipid metabolism plays an important role. Bone Mineral Density (BMD) measured by Dual-energy X-ray Absorptiometry (DXA) is a critical indicator for diagnosing osteoporosis. The cardiometabolic index (CMI) is a novel metric that combines two quantitative indicators of blood lipids-triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C). This study explores the association between CMI and BMD and seeks to elucidate the role of lipid metabolism in the context of bone health.

Methods

Based on the data of the National Health and Nutrition Examination Survey (NHANES) 2017-March 2020-pre-pandemic, weighted multiple linear regression and smooth curve fitting were used to study the relationship between CMI and femoral BMD. Stratified analyses were also conducted for age, gender, BMI, ethnicity, diabetes and hypertension status. And, the saturation threshold effect of CMI was further analyzed using a two-stage linear regression model.

Result

This study enrolled a total of 1,650 participants (48.7% males), with an average age of 63.0 ± 8.6 years. After adjusting for multiple confounding factors, CMI was positively correlated with total femur BMD, trochanter BMD, and intertrochanter BMD, while the correlation with femur neck BMD was not statistically significant. In the fully adjusted model, each unit increase in CMI was associated with a 0.026 (g/cm2) increase in total femur BMD, a 0.022 (g/cm2) increase in trochanter BMD, and a 0.034 (g/cm2) increase in intertrochanter BMD. Subjects in the highest quartile of CMI had a 0.034 (g/cm2) increase in total femur BMD, a 0.035 (g/cm2) increase in trochanter BMD, and a 0.039 (g/cm2) increase in intertrochanter BMD in the fully-adjusted model compared to those in the lowest quartile. In addition, saturation was observed between CMI and total femur BMD, trochanter BMD and intertrochanter BMD, with saturation thresholds of 1.073, 1.431 and 1.073, respectively.

Conclusion

CMI is strongly associated with BMD, indicating its potential relevance in bone metabolism. However, the role of CMI in the context of bone health, especially regarding osteoporosis risk, requires further investigation in large-scale prospective studies.

Negative association between Body Roundness Index and bone mineral density: insights from NHANES

Background

Osteoporosis (OP), affecting millions around the globe, is a prevalent degenerative condition of the bones characterized by a decrease in bone mineral density (BMD) and an increase in bone fragility. A novel anthropometric measure, the Body Roundness Index (BRI), provides a more accurate assessment of body fat distribution compared to traditional metrics. Using data from the National Health and Nutrition Examination Survey (NHANES), this study aims to explore the relationship between BRI and total BMD in U.S. adults aged 20 and above.

Methods

Data from NHANES (2011-2018) were examined, encompassing 9,295 participants following exclusions. Dual-energy X-ray absorptiometry (DXA) was employed to measure BMD. BRI was calculated using waist circumference (WC) and height. The study accounted for variables such as demographic traits, physical exam results, lab test findings, and survey responses. Weighted multivariable linear regression models and smooth curve fitting methods were utilized to assess the relationship between BRI and total BMD.

Results

The research found a notable inverse relationship between BRI and total BMD. In the model with full adjustments, an increase of one unit in BRI was linked to a 0.0313 g/cm2 reduction in total BMD (P < 0.0001). Moreover, an inflection point was identified at BRI = 9.5229, where each one-unit rise in BRI beyond this threshold corresponded to a more substantial decrease in total BMD (0.0363 g/cm2). Analysis by subgroups revealed that this negative association was consistent across most demographic and health-related categories.

Conclusions

The results demonstrate a notable inverse relationship between BRI and total BMD, indicating that a higher BRI could be associated with lower BMD and a potentially greater risk of developing OP. This underscores the significance of accounting for body fat distribution in preventing OP and advocates for the use of BRI as a valuable marker for early intervention approaches.

Systematic Review and Meta-Analysis of the Effect of Osteoporosis on Fusion Rates and Complications Following Surgery for Degenerative Cervical Spine Pathology

BACKGROUND

As the elderly population grows, the increasing prevalence of osteoporosis presents a unique challenge for surgeons. Decreased bone strength and quality are associated with hardware failure and impaired bone healing, which may increase the rate of revision surgery and the development of complications. The purpose of this review is to determine the impact of osteoporosis on postoperative outcomes for patients with cervical degenerative disease or deformity.

METHODS

A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Medical Subject Headings terms involving spine surgery for cervical degenerative disease and osteoporosis were performed. This review focused on radiographic outcomes, as well as surgical and medical complications.

RESULTS

There were 16 studies included in the degenerative group and 9 in the deformity group. Across degenerative studies, lower bone mineral density was associated with increased rates of cage subsidence in osteoporotic patients undergoing operative treatment for cervical degenerative disease. Most studies reported varied results on the relationship between osteoporosis and other outcomes such as revision and readmission rates, costs, and perioperative complications. Our meta-analysis suggests that osteoporotic patients carry a greater risk of reduced fusion rates at 6 months and 1 year postoperatively. With respect to cervical deformity correction, although individual complication rates were unchanged with osteoporosis, the collective risk of incurring any complication may be increased in patients with poor bone stock.

CONCLUSIONS

Overall, the literature suggests that outcomes for osteoporotic patients after cervical spine surgery are multifactorial. Osteoporosis seems to be a significant risk factor for developing cage subsidence and pseudarthrosis postoperatively, whereas reports on medical and hospital-related metrics were inconclusive. Our findings highlight the challenges of caring for osteoporotic patients and underline the need for adequately powered studies to understand how osteoporosis changes the risk index of patients undergoing cervical spine surgery.

CLINICAL RELEVANCE

In patients undergoing cervical spine surgery for degenerative disease, osteoporosis is a significant risk factor for long-term postoperative complications-notably cage subsidence and pseudarthrosis. Given the elective nature of these procedures, interdisciplinary collaboration between providers should be routinely implemented to enable medical optimization of patients prior to cervical spine surgery.

LEVEL OF EVIDENCE: 1

A comprehensive review and advanced biomolecule-based therapies for osteoporosis

BACKGROUND

The prevalence of osteoporosis (OP) on a global scale is significantly elevated that causes life threatening issues. The potential of groundbreaking biomolecular therapeutics in the field of OP is highly encouraging. The administration of biomolecular agents has the potential to mitigate the process of bone demineralization while concurrently augmenting the regenerative capacity of bone tissue, thereby facilitating a personalized therapeutic approach. Biomolecules-based therapies showed promising results in term of bone mass protection and restoration in OP.

AIM OF REVIEW

We summarized the recent biomolecular therapies with notable progress in clinical, demonstrating the potential to transform illness management. These treatments frequently utilize different biomolecule based strategies. Biomolecular therapeutics has a targeted character, which results in heightened specificity and less off-target effects, ultimately leading to increased patient outcomes. These aspects have the capacity to greatly enhance the management of OP, thus resulting in a major enhancement in the quality of life encountered by individuals affected by this condition.

Bone Regenerative Effect of Injectable Hypoxia Preconditioned Serum-Fibrin (HPS-F) in an Ex Vivo Bone Defect Model

Biofunctionalized hydrogels are widely used in tissue engineering for bone repair. This study examines the bone regenerative effect of the blood-derived growth factor preparation of Hypoxia Preconditioned Serum (HPS) and its fibrin-hydrogel formulation (HPS-F) on drilled defects in embryonic day 19 chick femurs. Measurements of bone-related growth factors in HPS reveal significant elevations of Osteopontin, Osteoprotegerin, and soluble-RANKL compared with normal serum (NS) but no detection of BMP-2/7 or Osteocalcin. Growth factor releases from HPS-F are measurable for at least 7 days. Culturing drilled femurs organotypically on a liquid/gas interface with HPS media supplementation for 10 days demonstrates a 34.6% increase in bone volume and a 52.02% increase in bone mineral density (BMD) within the defect area, which are significantly higher than NS and a basal-media-control, as determined by microcomputed tomography. HPS-F-injected femur defects implanted on a chorioallantoic membrane (CAM) for 7 days exhibit an increase in bone mass of 123.5% and an increase in BMD of 215.2%, which are significantly higher than normal-serum-fibrin (NS-F) and no treatment. Histology reveals calcification, proteoglycan, and collagen fiber deposition in the defect area of HPS-F-treated femurs. Therefore, HPS-F may offer a promising and accessible therapeutic approach to accelerating bone regeneration by a single injection into the bone defect site.

Zinc- and Fluoride-Releasing Bioactive Glass as a Novel Bone Substitute

Bioglass 45S5, a silica-based glass, has pioneered a new field of biomaterials. Bioglass 45S5 promotes mineralization through calcium ion release and is widely used in the dental field, including toothpaste formulations. However, the use of Bioglass 45S5 for bone grafting is limited owing to the induction of inflammation, as well as reduced degradation and ion release. Phosphate-based glasses exhibit higher solubility and ion release than silica-based glass. Given that these glasses can be synthesized at low temperatures (approximately 1,000°C), they can easily be doped with various metal oxides to confer therapeutic properties. Herein, we fabricated zinc- and fluoride-doped phosphate-based glass (multicomponent phosphate [MP] bioactive glass) and further doped aluminum oxide into the MP glass (4% Al-MP glass) to overcome the striking solubility of phosphate-based glass. Increased amounts of zinc and fluoride ions were detected in water containing the MP glass. Doping of aluminum oxide into the MP glass suppressed the striking dissolution in water, with 4% Al-MP glass exhibiting the highest stability in water. Compared with Bioglass 45S5, 4% Al-MP glass in water had a notably reduced particle size, supporting the abundant ion release of 4% Al-MP glass. Compared with Bioglass 45S5, 4% Al-MP glass enhanced the osteogenesis of mouse bone marrow-derived mesenchymal stem cells. Mouse macrophages cultured with 4% Al-MP glass displayed enhanced induction of anti-inflammatory M2 macrophages and reduced proinflammatory M1 macrophages, indicating M2 polarization. Upon implanting 4% Al-MP glass or Bioglass 45S5 in a mouse calvarial defect, 4% Al-MP glass promoted significant bone regeneration when compared with Bioglass 45S5. Hence, we successfully fabricated zinc- and fluoride-releasing bioactive glasses with improved osteogenic and anti-inflammatory properties, which could serve as a promising biomaterial for bone regeneration.

Best Bisphosphonate Threshold for 10-Year Vertebral and Non-vertebral Fracture Mitigation

AIMS

This study was aimed to determine the ideal thresholds for bone mineral densities in our tested Jordanian cohort to initiate bisphosphonate pharmacotherapeutics in order to establish a national protocol for prescribing bisphosphonates that is tailored to the local population, rather than relying on global T and Z scores standards.

METHODS

This retrospective study analyzed the entire population of adult patients at Prince Rashid bin Al-Hussein Hospital Rehabilitation and Rheumatology Center between August and October 2023 for the purpose of screening, monitoring, diagnosing, and treating osteoporosis. The study included 328 clients suspected to have osteoporosis, selected based on criteria such as primary osteoporosis or potential secondary osteoporosis. The study used two fracture risk assessment tools (FRAX) dichotomized states: <3% (negative state) and ≥3% (positive state), as well as <20% (negative state) and ≥20% (positive state). Binary logistic regression analysis, receiver-operating characteristic, and sensitivity analysis tests were performed sequentially to analyze the performance of prognosticators and sensitivity indices to evaluate their sensitivity, specificity, and accuracy indexes.

RESULTS

The study involved 328 clients at a rehabilitation clinic, with 82.62% (271) females and 17.38% (57) males. The majority were aged between 60 and 69 years, with a slightly higher obesity rate in females. The study found that initiation of bisphosphonates in Jordanian cohorts with optimal bone mineral density thresholds of 0.775 g/cm2 may significantly reduce the risk of hip osteoporosis over 10 years, with sensitivity, specificity, and accuracy indexes of 78.6%, 88.46%, and 50.61%, respectively, with a performance utility of 0.896±0.026 (p-value<0.001), 95% CI (0.846-0.946).

CONCLUSION

Due to ethnicity differences, exploring regional or national specific bone mineral density thresholds for bisphosphonates initiation may be a better optional choice than adopting global T-score standards.

Association between triglyceride glucose index and total bone mineral density: a cross-sectional study from NHANES 2011-2018

The Homeostatic Model Assessment for Triglyceride Glucose Index (TyG) and its related indices, including triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-waist-to-height ratio (TyG-WHtR) and triglyceride glucose-body mass index (TyG-BMI), has emerged as a practical tool for assessing insulin resistance in metabolic disorders. However, limited studies have explored the connection between TyG, TyG-related indices and osteoporosis. This population-based study, utilizing data from the National Health and Nutrition Examination Survey 2011-2018, involved 5456 participants. Through weighted multivariate linear regression and smoothed curve fitting, a significant positive correlation was found between TyG, TyG-related indices and total bone mineral density (BMD) after adjusting for covariates [β = 0.0124, 95% CI (0.0006, 0.0242), P = 0.0390; β = 0.0004, 95% CI (0.0003, 0.0004), P < 0.0001; β = 0.0116, 95% CI (0.0076, 0.0156), P < 0.0001; β = 0.0001, 95% CI (0.0001, 0.0001), P < 0.0001]. In subgroup analysis, race stratification significantly affected the relationship between TyG and total BMD. Additionally, gender and race were both significant for TyG-related indices. Non-linear relationships and threshold effects with inflection points at 9.106, 193.9265, 4.065, and 667.5304 (TyG, TyG-BMI, TyG-WHtR, TyG-WC) were identified. Saturation phenomena were observed between TyG-BMI, TyG-WC and total BMD with saturation thresholds at 314.177 and 1022.0428. These findings contributed to understanding the association between TyG, TyG-related indices and total BMD, offering insights for osteoporosis prevention and treatment.

Icariin promotes bone marrow mesenchymal stem cells osteogenic differentiation via the mTOR/autophagy pathway to improve ketogenic diet-associated osteoporosis

BACKGROUND

Icariin, a traditional Chinese medicine, has demonstrated anti-osteoporotic properties in ovariectomized mice. However, its effectiveness in preventing bone loss induced by ketogenic diet (KD), which mimics osteoporosis in human, remains unexplored. This study aims to investigate icariin's impact on KD-induced bone loss in mice.

METHODS

Thirty mice were divided into: sham, KD, and KD + icariin groups. Post a 12-week intervention, evaluation including bone microstructures, serum concentrations of tartrate-resistant acid phosphatase (TRAP) and bone-specific alkaline phosphatase (ALP), and femoral tissue expression levels of osteocalcin (OCN) and TRAP. The expression levels of mammalian target of rapamycin (mTOR), ALP, peroxisome proliferator-activated receptor gamma (PPAR-γ), phosphorylated mTOR (p-mTOR), and the autophagy adaptor protein (p62) were also analyzed. Alizarin granule deposition and cellular ALP levels were measured following the induction of bone marrow mesenchymal stem cells (BMSCs) into osteogenesis.

RESULTS

The study found that KD significantly impaired BMSCs' osteogenic differentiation, leading to bone loss. Icariin notably increased bone mass, stimulated osteogenesis, and reduced cancellous bone loss. In the KD + icariin group, measures such as bone tissue density (TMD), bone volume fraction (BV/TV), trabecular number (Tb.N), and trabecular thickness (Tb.Th) were significantly higher than in the KD group. Additionally, bone trabecular separation (Tb.Sp) was markedly lower in the KD + icariin group. Moreover, icariin increased OCN and ALP levels while suppressing PPAR-γ, TRAP, p62, and p-mTOR. In cellular studies, icariin encouraged osteogenic development in BMSCs under KD conditions.

CONCLUSIONS

Icariin effectively counteracts bone thinning and improves bone microstructure. Its mechanism likely involves stimulating BMSCs osteogenic differentiation and inhibiting bone resorption, potentially through mTOR downregulation. These findings suggest icariin's potential as an alternative treatment for KD-induced bone loss.

The association between dietary inflammation index and bone mineral density: results from the United States National Health and nutrition examination surveys

OBJECTIVE

To investigate the associations of dietary inflammation index (DII) with bone density and osteoporosis in different femoral areas.

METHODS

The study population was selected from the National Health and Nutrition Examination Survey (NHANES) with the exclusion criteria of age 18, pregnancy, or missing information on DII, femoral bone marrow density (BMD), estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (UACR), or had diseases which may influence systemic inflammation. DII was calculated based on the questionnaire interview of dietary recall within 24 h. Subjects' baseline characteristics were collected. The associations between DII and different femoral areas were analyzed.

RESULTS

After applying exclusion criteria, 10,312 participants were included in the study. Significant differences among DII tertiles were found in BMD or T scores (p < .001) of the femoral neck, the trochanter, the intertrochanter, and the total femur. High DII was associated with low BMDs and T scores in all the femoral areas (all p < .01). Compared to low DII (tertile1, DII < 0.380 as reference), in the femoral neck, the intertrochanter, and the total femur, increased DII is independently associated with increased the possibility of the presence of osteoporosis (OR, 95% CI: 1.88, 1.11-3.20; 2.10, 1.05-4.20; 1.94, 1.02-3.69, respectively). However, this positive association was only observed in the trochanteric area of the non-Hispanic White population after full adjustment (OR, 95% CI: 3.22 (1.18, 8.79)). No significant difference in the association of DII and the presence of osteoporosis were found in subjects with or without impaired kidney function (eGFR < 60 ml/min/1.73 m²).

CONCLUSION

High DII is independently related to declined femoral BMD of femoral areas.

Cellular senescence in skeletal disease: mechanisms and treatment

The musculoskeletal system supports the movement of the entire body and provides blood production while acting as an endocrine organ. With aging, the balance of bone homeostasis is disrupted, leading to bone loss and degenerative diseases, such as osteoporosis, osteoarthritis, and intervertebral disc degeneration. Skeletal diseases have a profound impact on the motor and cognitive abilities of the elderly, thus creating a major challenge for both global health and the economy. Cellular senescence is caused by various genotoxic stressors and results in permanent cell cycle arrest, which is considered to be the underlying mechanism of aging. During aging, senescent cells (SnCs) tend to aggregate in the bone and trigger chronic inflammation by releasing senescence-associated secretory phenotypic factors. Multiple signalling pathways are involved in regulating cellular senescence in bone and bone marrow microenvironments. Targeted SnCs alleviate age-related degenerative diseases. However, the association between senescence and age-related diseases remains unclear. This review summarises the fundamental role of senescence in age-related skeletal diseases, highlights the signalling pathways that mediate senescence, and discusses potential therapeutic strategies for targeting SnCs.

Advances in the interaction between endoplasmic reticulum stress and osteoporosis

The endoplasmic reticulum (ER) is the main site for protein synthesis, folding, and secretion, and accumulation of the unfolded/misfolded proteins in the ER may induce ER stress. ER stress is an important participant in various intracellular signaling pathways. Prolonged- or high-intensity ER stress may induce cell apoptosis. Osteoporosis, characterized by imbalanced bone remodeling, is a global disease caused by many factors, such as ER stress. ER stress stimulates osteoblast apoptosis, increases bone loss, and promotes osteoporosis development. Many factors, such as the drug's adverse effects, metabolic disorders, calcium ion imbalance, bad habits, and aging, have been reported to activate ER stress, resulting in the pathological development of osteoporosis. Increasing evidence shows that ER stress regulates osteogenic differentiation, osteoblast activity, and osteoclast formation and function. Various therapeutic agents have been developed to counteract ER stress and thereby suppress osteoporosis development. Thus, inhibition of ER stress has become a potential target for the therapeutic management of osteoporosis. However, the in-depth understanding of ER stress in the pathogenesis of osteoporosis still needs more effort.

A Recombinant Parathyroid Hormone-Related Peptide Locally Applied in Osteoporotic Bone Defect

The local application of drug-loaded bioactive scaffold materials is one of the important directions to solve the clinical problem of osteoporotic (OP) bone defects. This study retains the advantages of drug loading and mechanical properties of natural 3D bioactive scaffolds. The scaffolds are functionally modified through chemical and self-assembly approaches with application of polydopamine (PDA) nanoparticles and parathyroid hormone-related peptide-1 (PTHrP-1) for efficient local drug loading. This study investigates the effects of the novel bioactive scaffolds on ossification, osteoclastogenesis, and macrophage polarization. This work elucidates the effects of the scaffolds in regulating osteoclastic activity and new bone formation in vitro. Further studies on the establishment and repair of OP bone defects in small animals are conducted, and the potential of natural bioactive porous scaffold materials to promote the repair of OP bone defects is initially verified. The preparation of safe and economical anti-OP bone repair material provides a theoretical basis for clinical translational applications.

BMI, socioeconomic status, and bone mineral density in U.S. adults: Mediation analysis in the NHANES

Introduction

The mechanism by which socioeconomic status (SES) affects bone mineral density (BMD) remains unknown, and body mass index (BMI) may be a potential mediator. The purpose of this study was to investigate whether BMI mediates the relationship between SES [education level and poverty income ratio (PIR)] and lumbar BMD and the proportion it mediates.

Methods

This study included a total of 11,075 adults from the National Health and Nutrition Examination Survey (NHANES). Lumbar BMD was measured at the lumbar spine by dual-energy X-ray absorptiometry (DXA). Multivariate linear regression and smoothing curve fitting were used to investigate the relationship between SES and lumbar BMD. Mediator analysis was used to investigate the proportion of BMI mediating the association between SES and BMD.

Results

In the fully adjusted model, there was a positive correlation between SES and BMD (education level: β = 0.025, 95% CI: 0.005, 0.045; PIR: β = 0.007, 95% CI: 0.002, 0.011). Mediation analysis showed that BMI mediated the relationship between PIR, education level, and lumbar BMD with a range of mediation proportions from 13.33 to 18.20%.

Conclusion

BMI partially mediated the positive association between SES and BMD, and this association may be largely mediated by factors other than BMI.