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Williams LJ, Agustini B, Stuart AL, Pasco JA, Hodge JM, Samarasinghe RM, Bjerkeset O, Quirk SE, Koivumaa-Honkanen H, Honkanen R, Heikkinen J, Berk M. Lithium use and bone health in women with bipolar disorder: A cross-sectional study. Acta Psychiatr Scand 2024; 149:332-339. [PMID: 38240178 DOI: 10.1111/acps.13660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/06/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Several psychiatric disorders and medications used to treat them appear to be independently associated with skeletal deficits. As there is increasing evidence that lithium possesses skeletal protective properties, we aimed to investigate the association between lithium use and bone health in a group of women with bipolar disorder. METHOD Women with bipolar disorder (n = 117, 20+ years) were recruited from south-eastern Australia. Bipolar disorder was confirmed using a clinical interview (SCID-I/NP). Bone mineral density (BMD; g/cm2 ) was measured at the spine, hip and total body using dual-energy x-ray absorptiometry and low bone mass determined by BMD T-score of <-1.0. Weight and height were measured, socioeconomic status (SES) determined and information on medication use and lifestyle factors self-reported. Linear and logistic regression were used to test associations between lithium and (i) BMD and (ii) low bone mass, respectively. RESULTS Thirty-five (29.9%) women reported current lithium use. Lithium users and non-users differed in regard to SES and BMD; otherwise, groups were similar. After adjustments, mean BMD among lithium users was 5.1% greater at the spine (1.275 [95% CI 1.229-1.321] vs. 1.214 [1.183-1.244] g/cm2 , p = 0.03), 4.2% greater at the total hip (0.979 [0.942-1.016] vs. 0.938 [0.910-0.966] g/cm2 , p = 0.03) and 2.2% greater at the total body (1.176 [1.148-1.205] vs. 1.150 [1.129-1.171] g/cm2 , p = 0.08) compared to participants not receiving lithium. Lithium users were also less likely to have low bone mass (22.9% vs. 43.9%, p = 0.031). Associations persisted after adjustment for confounders. CONCLUSION These data suggest lithium is associated with greater BMD and reduced risk of low bone mass in women with bipolar disorder. Research into the underlying mechanisms is warranted.
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Affiliation(s)
- Lana J Williams
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Bruno Agustini
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Amanda L Stuart
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Julie A Pasco
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason M Hodge
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - Rasika M Samarasinghe
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Shae E Quirk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Risto Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Jeremi Heikkinen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Institute of Clinical Medicine, Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Michael Berk
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
- Orygen, National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
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Azimi Manavi B, Stuart AL, Pasco JA, Hodge JM, Weerasinghe DK, Samarasinghe RM, Williams LJ. Antipsychotic medication use and fracture: a case-control study. Sci Rep 2023; 13:13709. [PMID: 37608079 PMCID: PMC10444797 DOI: 10.1038/s41598-023-40762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 08/16/2023] [Indexed: 08/24/2023] Open
Abstract
It has been reported that antipsychotic use is associated with lower bone mineral density and bone quality. We aimed to determine whether antipsychotic use is associated with fracture risk in a population-based sample of adults living in the Barwon Statistical Division, south-eastern Australia. In this case-control study, 1458 participants (51.8% women) with radiologically confirmed fracture between June 1st 2012 and May 31st 2013 (cases) were compared with 1795 participants (46.5% women) without fracture (controls) for the same time period. Medication use, medical history and lifestyle factors were documented by self-report. Multivariable binary logistic regression was used to explore associations between antipsychotic use and fracture following adjustment for possible confounders. In women, antipsychotic use was identified for 20 of 755 (2.6%) cases and 10 of 834 (1.2%) controls (p = 0.034) and in men, antipsychotic use was identified for 13 of 703 (1.8%) cases and 5 of 961 (0.5%) controls (p = 0.010). Following adjustments, antipsychotic use was associated with a 3.0-fold increased risk of fracture in men and a 2.3-fold increased risk of fracture in women. Patterns persisted after exclusion of participants with non-fragility fractures and self-reported schizophrenia. While future research exploring underlying mechanisms is needed, regular monitoring of bone health in antipsychotic users is suggested.
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Affiliation(s)
- Behnaz Azimi Manavi
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, 3220, Australia.
| | - Amanda L Stuart
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, 3220, Australia
| | - Julie A Pasco
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, 3220, Australia
- Barwon Health, Geelong, 3220, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, 3021, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, 3004, Australia
| | - Jason M Hodge
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, 3220, Australia
- Barwon Health, Geelong, 3220, Australia
| | - D Kavindi Weerasinghe
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, 3220, Australia
| | - Rasika M Samarasinghe
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, 3220, Australia
| | - Lana J Williams
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, 3220, Australia
- Barwon Health, Geelong, 3220, Australia
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Rifai A, Weerasinghe DK, Tilaye GA, Nisbet D, Hodge JM, Pasco JA, Williams LJ, Samarasinghe RM, Williams RJ. Biofabrication of functional bone tissue: defining tissue-engineered scaffolds from nature. Front Bioeng Biotechnol 2023; 11:1185841. [PMID: 37614632 PMCID: PMC10444209 DOI: 10.3389/fbioe.2023.1185841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Damage to bone leads to pain and loss of movement in the musculoskeletal system. Although bone can regenerate, sometimes it is damaged beyond its innate capacity. Research interest is increasingly turning to tissue engineering (TE) processes to provide a clinical solution for bone defects. Despite the increasing biomimicry of tissue-engineered scaffolds, significant gaps remain in creating the complex bone substitutes, which include the biochemical and physical conditions required to recapitulate bone cells' natural growth, differentiation and maturation. Combining advanced biomaterials with new additive manufacturing technologies allows the development of 3D tissue, capable of forming cell aggregates and organoids based on natural and stimulated cues. Here, we provide an overview of the structure and mechanical properties of natural bone, the role of bone cells, the remodelling process, cytokines and signalling pathways, causes of bone defects and typical treatments and new TE strategies. We highlight processes of selecting biomaterials, cells and growth factors. Finally, we discuss innovative tissue-engineered models that have physiological and anatomical relevance for cancer treatments, injectable stimuli gels, and other therapeutic drug delivery systems. We also review current challenges and prospects of bone TE. Overall, this review serves as guide to understand and develop better tissue-engineered bone designs.
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Affiliation(s)
- Aaqil Rifai
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - D. Kavindi Weerasinghe
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Gebreselassie Addisu Tilaye
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - David Nisbet
- The Graeme Clark Institute, The University of Melbourne, Melbourne, VIC, Australia
- Department of Biomedical Engineering, Faculty of Engineering and Information Technology, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Melbourne, VIC, Australia
- Laboratory of Advanced Biomaterials, John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
- Aikenhead Centre for Medical Discovery, St. Vincent’s Hospital, Melbourne, VIC, Australia
| | - Jason M. Hodge
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Julie A. Pasco
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
| | - Lana J. Williams
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Rasika M. Samarasinghe
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Richard J. Williams
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
- The Graeme Clark Institute, The University of Melbourne, Melbourne, VIC, Australia
- Aikenhead Centre for Medical Discovery, St. Vincent’s Hospital, Melbourne, VIC, Australia
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Azimi Manavi B, Mohebbi M, Stuart AL, Pasco JA, Hodge JM, Weerasinghe DK, Samarasinghe RM, Williams LJ. Antipsychotic medication use in association with quantitative heel ultrasound (QUS). Bone Rep 2023; 18:101694. [PMID: 37333887 PMCID: PMC10276211 DOI: 10.1016/j.bonr.2023.101694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
Purpose Antipsychotic medication use has been associated with decreased bone mineral density; however, less is known whether antipsychotics affect other parameters of bone health. Therefore, the aim of this study was to investigate the association between antipsychotic medication use and quantitative heel ultrasound (QUS) in a population based sample of men and women. Methods Thirty-one antipsychotic users and 155 non-users matched for age and sex were drawn from the Geelong Osteoporosis Study. QUS was undertaken and included the parameters: Broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness index (SI). Current medication use, lifestyle factors, anthropometry and socio-economic status were collected. Generalized Estimation Equation models were conducted to determine associations between antipsychotic medication use and each of the QUS parameters, adjusting for covariates. Results Antipsychotic users were less active, consumed less alcohol, were more likely to smoke and take antidepressants; otherwise, the groups were similar. After adjusting for age, sex and weight, antipsychotic users had a 7.7 % lower mean BUA [108.70 (95 % CI 104.26-113.14) vs. 116.42 (95 % CI 115.48-117.37) dB/MHz, p = 0.005] and 7.4 % lower mean SI [89.92 (95 % CI 86.89-92.95) vs. 97.30 (95 % CI 96.48-98.12) %, p < 0.001] compared to non-users. Differences in mean SOS between antipsychotic users and non-users failed to reach statistical significance (p = 0.07). Conclusion Antipsychotic use was associated with lower QUS parameters. The risk of bone deterioration should be considered when antipsychotics are prescribed.
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Affiliation(s)
- Behnaz Azimi Manavi
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
| | - Mohammadreza Mohebbi
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
| | - Amanda L. Stuart
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
| | - Julie A. Pasco
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
- Barwon Health, Geelong 3220, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans 3021, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Jason M. Hodge
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
- Barwon Health, Geelong 3220, Australia
| | - D. Kavindi Weerasinghe
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
| | - Rasika M. Samarasinghe
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
| | - Lana J. Williams
- Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong 3220, Australia
- Barwon Health, Geelong 3220, Australia
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Weerasinghe DK, Hodge JM, Pasco JA, Samarasinghe RM, Azimi Manavi B, Williams LJ. Antipsychotic-induced bone loss: the role of dopamine, serotonin and adrenergic receptor signalling. Front Cell Dev Biol 2023; 11:1184550. [PMID: 37305679 PMCID: PMC10248006 DOI: 10.3389/fcell.2023.1184550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Antipsychotics are commonly used in treating psychiatric disorders. These medications primarily target dopamine the serotonin receptors, they have some affinity to adrenergic, histamine, glutamate and muscarinic receptors. There is clinical evidence that antipsychotic use decreases BMD and increases fracture risk, with dopamine, serotonin and adrenergic receptor-signalling becoming an increasing area of focus where the presence of these receptors in osteoclasts and osteoblasts have been demonstrated. Osteoclasts and osteoblasts are the most important cells in the bone remodelling and the bone regeneration process where the activity of these cells determine the bone resorption and formation process in order to maintain healthy bone. However, an imbalance in osteoclast and osteoblast activity can lead to decreased BMD and increased fracture risk, which is also believed to be exacerbated by antipsychotics use. Therefore, the aim of this review is to provide an overview of the mechanisms of action of first, second and third generation antipsychotics and the expression profiles of dopamine, serotonin and adrenergic receptors during osteoclastogenesis and osteoblastogenesis.
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Affiliation(s)
- D. Kavindi Weerasinghe
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Jason M. Hodge
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Julie A. Pasco
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine—Western Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rasika M. Samarasinghe
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Behnaz Azimi Manavi
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Lana J. Williams
- IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
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Cleminson JR, Pasco JA, Bortolasci CC, Holloway-Kew KL, Hodge JM, Anderson KB, Kotowicz MA, Samarasinghe RM, Williams LJ. Lipopolysaccharide-binding protein and bone health: data from a population-based sample of men. Osteoporos Int 2023; 34:309-317. [PMID: 36409359 DOI: 10.1007/s00198-022-06602-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022]
Abstract
UNLABELLED We aimed to investigate the association between serum lipopolysaccharide-binding protein (LBP) and bone health in men. LBP was associated with lower bone density at the mid-forearm and the quantitative heel ultrasound measure, broadband ultrasound attenuation, for heavier participants. Data do not support clear associations between serum LBP and bone health. INTRODUCTION The objective of this study was to investigate the association between serum lipopolysaccharide-binding protein (LBP) and potential downstream effects on skeletal density, quality, and turnover in a population-based sample of men. METHODS This cross-sectional study utilised data from 1149 men (aged 20-96 year) enrolled in the Geelong Osteoporosis Study. Blood samples were obtained and lipopolysaccharide-binding protein (LBP), bone resorption marker, C-telopeptide (CTx), and formation marker, type 1 procollagen amino-terminal-propeptide (P1NP), were measured. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Stiffness Index (SI), broadband ultrasound attenuation (BUA), and speed of sound (SOS) were derived from quantitative heel ultrasound (QUS). Linear regression models were developed to test associations between log-transformed LBP (ln-LBP), BMD, QUS, and bone turnover, after adjusting for potential covariates. RESULTS Serum LBP ranged from 1.07-208.53 ng/mL (median 16.53 ng/mL). Those with higher levels were older, less mobile, and had lower BMD at the mid-forearm, otherwise, groups were similar. Before and after adjustment for age, ln-LBP was associated with lower BMD at the spine, total body, and mid-forearm. Further adjustment for weight attenuated associations at the spine and total body, yet the relationship at the mid-forearm was sustained (β - 0.014 ± 0.004, p = 0.001). SOS and SI were not associated with ln-LBP either before or after adjustment for age; however, weight was identified as an effect modifier in the relationship between ln-LBP and BUA. An association was observed for those weighing greater than 82.7 kg (β 3.366 ± 0.929, p < 0.001), after adjustment for potential covariates. Neither bone turnover marker was associated with ln-LBP. CONCLUSION Our data do not support a clear association between serum LBP and measures of bone health in this sample of men.
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Affiliation(s)
- Jasmine R Cleminson
- Deakin University, School of Medicine, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), PO Box 281, Geelong, Victoria, 3220, Australia.
| | - Julie A Pasco
- Deakin University, School of Medicine, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), PO Box 281, Geelong, Victoria, 3220, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Barwon Health, University Hospital, Geelong, VIC, Australia
| | - Chiara C Bortolasci
- Deakin University, School of Medicine, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), PO Box 281, Geelong, Victoria, 3220, Australia
| | - Kara L Holloway-Kew
- Deakin University, School of Medicine, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), PO Box 281, Geelong, Victoria, 3220, Australia
| | - Jason M Hodge
- Deakin University, School of Medicine, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), PO Box 281, Geelong, Victoria, 3220, Australia
- Barwon Health, University Hospital, Geelong, VIC, Australia
- Geelong Centre for Emerging Infectious Diseases, Geelong, VIC, 3220, Australia
| | - Kara B Anderson
- Deakin University, School of Medicine, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), PO Box 281, Geelong, Victoria, 3220, Australia
| | - Mark A Kotowicz
- Deakin University, School of Medicine, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), PO Box 281, Geelong, Victoria, 3220, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Victoria, Australia
- Barwon Health, University Hospital, Geelong, VIC, Australia
| | - Rasika M Samarasinghe
- Deakin University, School of Medicine, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), PO Box 281, Geelong, Victoria, 3220, Australia
| | - Lana J Williams
- Deakin University, School of Medicine, The Institute for Mental and Physical Health and Clinical Translation (IMPACT), PO Box 281, Geelong, Victoria, 3220, Australia
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Azimi Manavi B, Stuart AL, Pasco JA, Hodge JM, Samarasinghe RM, Weerasinghe DK, Williams LJ. Use of antipsychotic medication and its relationship with bone mineral density: A population-based study of men and women. Front Psychiatry 2023; 13:1004366. [PMID: 36684026 PMCID: PMC9849889 DOI: 10.3389/fpsyt.2022.1004366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/21/2022] [Indexed: 01/07/2023] Open
Abstract
Background Schizophrenia has been shown to be associated with reduced bone mineral density (BMD) and higher fracture risk. However, less is known whether antipsychotic treatment is associated with reduced BMD. Thus, we aimed to examine associations between antipsychotic use and BMD among men and women drawn from the general population. Methods This cross-sectional study involved 793 women and 587 men enrolled in the Geelong Osteoporosis Study (GOS). BMD was determined using dual-energy X-ray absorptiometry at the spine and hip. Information regarding socio-economic status (SES), current medication and/or supplementation use, lifestyle factors, and anthropometry was collected. Association between antipsychotic use and BMD was determined using linear regression after adjusting for potential confounders. Results Of the group, 33 women (4.2%) and 16 men (2.7%) currently used antipsychotics. Age was identified as an effect modifier in the association between antipsychotic use and BMD for women. Amongst women aged < 60 years, adjusted mean BMD was 11.1% lower at the spine [1.139 (95%CI 1.063-1.216) vs. 1.250 (95%CI 1.223-1.277) g/cm2, p = 0.005] for antipsychotic users compared to non-users. At the hip, age, weight, and smoking adjusted mean BMD was 9.9% lower [0.893 (95%CI 0.837-0.950) vs. 0.992 (95%CI 0.976-1.007) g/cm2, p < 0.001] for antipsychotic users in comparison with non-users. The pattern persisted following further adjustments. There was no association detected between antipsychotic use and BMD for women aged 60 years and over and for men. Conclusion Our data suggest that antipsychotic medication use is associated with reduced BMD in younger women but not older women or men.
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Affiliation(s)
- Behnaz Azimi Manavi
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Amanda L. Stuart
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Julie A. Pasco
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jason M. Hodge
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Geelong Centre for Emerging Infectious Diseases, Geelong, VIC, Australia
| | - Rasika M. Samarasinghe
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - D. Kavindi Weerasinghe
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Lana J. Williams
- School of Medicine, IMPACT—The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
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Williams LJ, Stuart AL, Berk M, Brennan-Olsen SL, Hodge JM, Quirk SE, Koivumaa-Honkanen H, Honkanen R, Heikkinen J, Chandrasekaran V, Cleminson JR, Pasco JA. Bipolar disorder and bone health: A case-control study. J Affect Disord 2022; 308:39-43. [PMID: 35398110 DOI: 10.1016/j.jad.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with significant psychological and physical comorbidity. Yet little is known about the bone health of individuals with BD. Thus, we aimed to investigate the association between BD and bone health in a population-based sample of women. METHODS Women with a history of BD (cases; n = 117) were recruited from public and private health care settings and controls, without BD, were drawn from the Geelong Osteoporosis Study (n = 909). BD was identified using a semi-structured clinical interview (SCID-I/NP). Bone mineral density (BMD) was measured at the spine, femoral neck and total body using dual energy x-ray absorptiometry, and bone quality by quantitative heel ultrasound and included the following parameters: Speed of Sound (SOS), Broadband Ultrasound Attenuation (BUA) and Stiffness Index (SI). Weight and height were measured and information on medication use and lifestyle was obtained. RESULTS Adjusted mean BMD among the cases was 4.3% lower at the hip and 1.6% lower at the total body compared to controls. Age was an effect modifier at the spine. Among women <50 years, mean spine BMD for cases was 3.5% lower than controls. No differences in spine BMD for those ≥50 years were detected. Cases also had a 1.0%, 3.2% and 7.8% lower adjusted mean SOS, BUA and SI compared to controls, respectively. LIMITATIONS Course, chronicity and recovery of BD were not explored in relation to bone health. CONCLUSION These data suggest BD is associated with low bone quantity and quality in women. Replication and research into underlying mechanisms is warranted.
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Affiliation(s)
- Lana J Williams
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia.
| | - Amanda L Stuart
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Parkville, Victoria, Australia
| | - Sharon L Brennan-Olsen
- Deakin University, Institute for Health Transformation, Geelong, Victoria, Australia; Deakin University, School of Health and Social Development, Geelong, Victoria, Australia; The University of Melbourne, Department of Medicine-Western Health, St Albans, Victoria, Australia; University of Melbourne and Western Health, Australian Institute for Musculoskeletal Science, St Albans, Victoria, Australia
| | - Jason M Hodge
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia; Geelong Centre for Emerging Infectious Diseases, Geelong, Victoria, Australia
| | - Shae E Quirk
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; University of Eastern Finland, Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; University of Eastern Finland, Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland; Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; University of Eastern Finland, Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland
| | - Jeremi Heikkinen
- University of Eastern Finland, Institute of Clinical Medicine, Kuopio, Finland; University of Eastern Finland, Kuopio Musculoskeletal Research Unit (KMRU), Kuopio, Finland; Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Vinoomika Chandrasekaran
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia
| | - Jasmine R Cleminson
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia
| | - Julie A Pasco
- Deakin University, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Geelong, Victoria, Australia; Barwon Health, Geelong, Victoria, Australia; The University of Melbourne, Department of Medicine-Western Health, St Albans, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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9
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Chandrasekaran V, Pasco JA, Stuart AL, Brennan-Olsen SL, Berk M, Hodge JM, Samarasinghe RM, Williams LJ. Anticonvulsant use and bone health in a population-based study of men and women: cross-sectional data from the Geelong Osteoporosis Study. BMC Musculoskelet Disord 2021; 22:172. [PMID: 33573610 PMCID: PMC7879513 DOI: 10.1186/s12891-021-04042-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/03/2021] [Indexed: 01/10/2023] Open
Abstract
Background Anticonvulsant use has been linked to bone deficits in specific patient populations. We studied the association between anticonvulsant use and bone health in a population-based sample of men and women. Methods Data from 926 men (24-73 yr) and 1070 women (21-94 yr) participating in the Geelong Osteoporosis Study were included. Bone mineral density (BMD, g/cm2) of the PA-spine and total hip was measured using dual-energy X-ray absorptiometry (Lunar). Bone quality was determined using quantitative heel ultrasound (QUS). Anthropometry was conducted and socioeconomic status was determined. Medication and lifestyle information was obtained via questionnaire. Linear regression was used to test associations between anticonvulsant use and bone health before and after adjustment for potential confounders. Results Seventeen (1.8%) men and 20 (1.9%) women reported anticonvulsant use. In men, anticonvulsant users had 9.1% lower adjusted mean BMD at the spine and hip compared to non-users. Body mass index was an effect modifier at the spine. Anticonvulsant users also had 1.8% lower speed of sound (SOS), 10.6% lower broadband ultrasound attenuation (BUA) and 13.7% lower stiffness index (SI) compared to non-users. In women, BMD tended to be lower at the hip compared to non-users as with the bone quality measure, BUA. No significant associations were observed at the spine or the other bone quality measures, SOS and SI. Conclusion Our data suggest that bone quantity and quality, assessed using BMD and QUS, are lower for men and possibly women who use anticonvulsants. While further exploration into potential mechanisms is needed, our findings suggest that monitoring bone health among users of anticonvulsants is warranted.
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Affiliation(s)
- Vinoomika Chandrasekaran
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia.
| | - Julie A Pasco
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia.,Barwon Health, University Hospital, Geelong, Australia.,Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia
| | - Amanda L Stuart
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia.,Deakin University, School of Health and Social Development, Geelong, Waterfront, Australia.,Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Michael Berk
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia.,Barwon Health, University Hospital, Geelong, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Jason M Hodge
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia.,Barwon Health, University Hospital, Geelong, Australia.,Geelong Centre for Emerging Infectious Diseases, Geelong, Australia
| | - Rasika M Samarasinghe
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia
| | - Lana J Williams
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, PO Box 281, Barwon Health, Geelong, Vic, 3220, Australia
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10
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Chandrasekaran V, Stuart AL, Pasco JA, Brennan-Olsen SL, Berk M, Hodge JM, Samarasinghe RM, Williams LJ. Anticonvulsant use and fracture: a case-control study. J Musculoskelet Neuronal Interact 2021; 21:422-428. [PMID: 34465682 PMCID: PMC8426646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We aimed to investigate fracture risk associated with anticonvulsant use in a population-based sample of men and women. METHODS Data from 1,458 participants (51.8% women) with a radiologically confirmed incident fracture (cases) were compared to 1,796 participants (46.5% women) without fracture (controls). Lifestyle factors, medication use and medical history were self-reported. Associations between anticonvulsant use and fracture were explored using binary logistic regression following adjustment for confounders. RESULTS In men, fracture cases and controls differed in age, smoking history, education, alcohol use, and gonadal hormone supplementation. In women, fracture cases and controls differed by previous fracture history, alcohol use, physical activity levels and use of anti-fracture agents. After adjustment for age, pooled anticonvulsant use was associated with a 3.4-fold higher risk of fracture in men and a 1.8-fold higher risk in women. Following further adjustments for confounders these patterns persisted; a 2.8-fold higher fracture risk in men and a 1.8-fold higher fracture risk in women. CONCLUSIONS Anticonvulsant use was associated with increased fracture risk, independent of demographic, lifestyle, medical and medication related factors. While further studies exploring potential underlying mechanisms are warranted, regular monitoring of bone health in anticonvulsant users with risk factors may be useful.
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Affiliation(s)
- Vinoomika Chandrasekaran
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia,Corresponding author: Vinoomika Chandrasekaran, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University Kitchener House, PO Box 281 (Barwon Health) Geelong, VIC 3220, Australia E-mail:
| | - Amanda L. Stuart
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Julie A. Pasco
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia,Barwon Health, University Hospital, Geelong, Australia,Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sharon L. Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia,Deakin University, School of Health and Social Development, Geelong Waterfront, Australia,Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Michael Berk
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia,Barwon Health, University Hospital, Geelong, Australia,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia,Department of Psychiatry, University of Melbourne, Parkville, Australia,Florey Institute of Neuroscience and Mental Health, Parkville, Australia,Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Jason M. Hodge
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia,Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Australia,Geelong Centre for Emerging Infectious Diseases, Geelong, Australia
| | - Rasika M. Samarasinghe
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Lana J. Williams
- Deakin University, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
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11
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Azimi Manavi B, Stuart AL, Pasco JA, Hodge JM, Corney K, Berk M, Williams LJ. Study protocol for the systematic review and meta-analyses of the association between schizophrenia and bone fragility. BMJ Open 2020; 10:e041859. [PMID: 33310808 PMCID: PMC7735127 DOI: 10.1136/bmjopen-2020-041859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Individuals with schizophrenia are known to be at higher risk of comorbid conditions, both physical and psychological. Osteoporosis is possibly one of these, leading to public health concerns due to higher rates of associated mortality and morbidity. We aim to systematically search all available evidence across electronic databases regarding the relationship between schizophrenia and bone fragility. METHODS AND ANALYSIS A systematic search of the research databases CINAHL, MEDLINE Complete, Embase and PsycINFO will be conducted and identified papers reviewed for eligibility, with a second reviewer confirming inclusions. Searches will be run from database inception to 1 October 2020 and supplemented by the hand checking of references of identified articles. A previously published scoring system will be used for assessing the methodological quality and risk of bias. A meta-analysis is planned. ETHICS AND DISSEMINATION Due to including published literature only, ethical permission will not be necessary. Results of this study will be published in a relevant scientific journal and presented at a conference in the field of interest. PROSPERO REGISTRATION NUMBER CRD42020171959.
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Affiliation(s)
- Behnaz Azimi Manavi
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Amanda L Stuart
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Julie A Pasco
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- Clinical and Biomedical Sciences: Barwon Health, University of Melbourne School of BioSciences, Melbourne, Victoria, Australia
| | - Jason M Hodge
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- Geelong Centre for Emerging Infectious Diseases (GCEID), Barwon Health, Geelong, Victoria, Australia
| | - Kayla Corney
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, RoyalMelbourne Hospital, Parkville, Victoria, Australia
- Centre of Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Lana J Williams
- Deakin University, IMPACT - Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
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12
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Cleminson JR, Stuart AL, Pasco JA, Hodge JM, Berk M, Samarasinghe RM, Williams LJ. Dietary tryptophan and bone health: a cross-sectional, population-based study. Arch Osteoporos 2020; 15:167. [PMID: 33083938 DOI: 10.1007/s11657-020-00838-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/05/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Tryptophan metabolites influence bone. We aimed to investigate the relationship between dietary tryptophan and bone health in a population-based sample of men and women. Following adjustment for age, dietary tryptophan was not associated with bone quantity or quality, suggesting a non-critical role of superfluous tryptophan on the skeleton. PURPOSE Tryptophan metabolites, such as serotonin, influence bone. We sought to determine the relationship between dietary intake of tryptophan and bone health in a population-based study of men and women. METHODS Participants (1033 women and 900 men, aged 20-98 years) enrolled in the Geelong Osteoporosis Study (GOS) were investigated. Dietary information was collected using a validated questionnaire. Tryptophan levels were calculated (mg/day) in accordance with Food Standards Australia and New Zealand and dichotomised according to the median. Bone mineral density (BMD; g/cm2) was measured at the spine (postero-anterior projection) and total hip using dual-energy X-ray absorptiometry. Stiffness index (SI), broadband ultrasound attenuation (BUA) and speed of sound (SOS) were derived from quantitative heel ultrasound. Linear regression models were used to test associations between dietary tryptophan and bone health, after adjustment for potential confounders. RESULTS Tryptophan intakes ranged from 112 to 3796 mg/day (median 1035) in men and 115-2869 mg/day (median 885) in women. In men older than 45 years and women, a high tryptophan intake was associated with greater hip BMD compared to participants with a low tryptophan intake (p = 0.002 and p = 0.04, respectively); however, these relationships were attenuated by age (all p > 0.05). Participants with high tryptophan intake had greater BUA and SI compared to participants with low tryptophan intake (men; BUA, p = 0.02 and SI, p = 0.02, and women; BUA, p = 0.03 and SI, p = 0.08), yet also attenuated by age (all p > 0.05). CONCLUSION No association was found between tryptophan intake and bone health in this population, which suggests a non-critical role of superfluous tryptophan consumption on the skeleton.
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Affiliation(s)
- Jasmine R Cleminson
- School of Medicine, IMPACT, Institute for Innovation in Physical and Mental Health and Clinical Translation, Deakin University, University Hospital Geelong, 285 Ryrie Street, Geelong, Victoria, 3220, Australia.
| | - Amanda L Stuart
- School of Medicine, IMPACT, Institute for Innovation in Physical and Mental Health and Clinical Translation, Deakin University, University Hospital Geelong, 285 Ryrie Street, Geelong, Victoria, 3220, Australia
| | - Julie A Pasco
- School of Medicine, IMPACT, Institute for Innovation in Physical and Mental Health and Clinical Translation, Deakin University, University Hospital Geelong, 285 Ryrie Street, Geelong, Victoria, 3220, Australia.,Department of Medicine-Western Health, Western Centre for Health Research & Education (WCHRE) Building, The University of Melbourne, Level 3/176 Furlong Road, St Albans, Victoria, 3021, Australia.,Barwon Health, University Hospital Geelong, 285 Ryrie Street, Geelong, Victoria, 3220, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Jason M Hodge
- School of Medicine, IMPACT, Institute for Innovation in Physical and Mental Health and Clinical Translation, Deakin University, University Hospital Geelong, 285 Ryrie Street, Geelong, Victoria, 3220, Australia.,Barwon Health, University Hospital Geelong, 285 Ryrie Street, Geelong, Victoria, 3220, Australia.,Geelong Centre for Emerging Infectious Diseases, University Hospital Geelong, 285 Ryrie Street, Geelong, Victoria, 3220, Australia
| | - Michael Berk
- School of Medicine, IMPACT, Institute for Innovation in Physical and Mental Health and Clinical Translation, Deakin University, University Hospital Geelong, 285 Ryrie Street, Geelong, Victoria, 3220, Australia.,Barwon Health, University Hospital Geelong, 285 Ryrie Street, Geelong, Victoria, 3220, Australia.,Department of Psychiatry, The Florey Institute for Neuroscience and Mental Health, The National Centre of Excellence in Youth Mental Health, Royal Melbourne Hospital, University of Melbourne, Royal Parade, Parkville, Victoria, 3052, Australia.,Orygen, 35 Poplar Rd, Parkville, Victoria, 3052, Australia
| | - Rasika M Samarasinghe
- School of Medicine, IMPACT, Institute for Innovation in Physical and Mental Health and Clinical Translation, Deakin University, University Hospital Geelong, 285 Ryrie Street, Geelong, Victoria, 3220, Australia
| | - Lana J Williams
- School of Medicine, IMPACT, Institute for Innovation in Physical and Mental Health and Clinical Translation, Deakin University, University Hospital Geelong, 285 Ryrie Street, Geelong, Victoria, 3220, Australia.,Barwon Health, University Hospital Geelong, 285 Ryrie Street, Geelong, Victoria, 3220, Australia
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13
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Williams LJ, Stuart AL, Berk M, Brennan-Olsen SL, Hodge JM, Cowdery S, Chandrasekaran V, Pasco JA. Bone health in bipolar disorder: a study protocol for a case-control study in Australia. BMJ Open 2020; 10:e032821. [PMID: 32051309 PMCID: PMC7044863 DOI: 10.1136/bmjopen-2019-032821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Little is known about the bone health of adults with bipolar disorder, aside from evidence purporting bone deficits among individuals with other mental illnesses, or those taking medications commonly used in bipolar disorder. In this paper, we present the methodology of a case-control study which aims to examine the role of bipolar disorder as a risk factor for bone fragility. METHODS AND ANALYSIS Men and women with bipolar disorder (~200 cases) will be recruited and compared with participants with no history of bipolar disorder (~1500 controls) from the Geelong Osteoporosis Study. Both cases and controls will be drawn from the Barwon Statistical Division, south-eastern Australia. The Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition is the primary diagnostic instrument, and psychiatric symptomatology will be assessed using validated rating scales. Demographic information and detailed lifestyle data and medical history will be collected via comprehensive questionnaires. Participants will undergo dual energy X-ray absorptiometry scans and other clinical measures to determine bone and body composition. Blood samples will be provided after an overnight fast and stored for batch analysis. ETHICS AND DISSEMINATION Ethics approval has been granted from Barwon Health Research Ethics Committee. Participation in the study is voluntary. The study findings will be disseminated via peer-reviewed publications, conference presentations and reports to the funding body.
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Affiliation(s)
- Lana J Williams
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
| | - Amanda L Stuart
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Michael Berk
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Parkville, Victoria, Australia
| | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - Jason M Hodge
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Geelong Centre for Emerging Infectious Diseases, Geelong, Victoria, Australia
| | | | | | - Julie A Pasco
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Victoria, Australia
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14
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Chandrasekaran V, Brennan-Olsen SL, Stuart AL, Pasco JA, Berk M, Hodge JM, Williams LJ. Bipolar disorder and bone health: A systematic review. J Affect Disord 2019; 249:262-269. [PMID: 30784723 DOI: 10.1016/j.jad.2019.02.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/24/2019] [Accepted: 02/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bipolar disorder is a chronic, episodic mental illness, affecting around 2.4% of the population worldwide. Psychological and/or physiological comorbidities are a common consequence, and osteoporosis is one such possible comorbidity. Thus, this systematic review aimed to collate, evaluate, and discuss the literature examining the link between bipolar disorder and bone health. METHODS We conducted an e-search of PubMed/OVID/MEDLINE, PsychINFO and CINAHL to identify studies that investigated associations between bipolar disorder and bone in adults aged ≥18. Two reviewers determined eligibility according to pre-determined criteria, and methodological quality was assessed using a previously published methodological scoring system. Due to heterogeneity, a best-evidence synthesis was performed. RESULTS Our search yielded 1409 articles, of which three (all cohorts) met predetermined criteria. The studies from Taiwan and the United States of America analysed administrative data, albeit spanning different years, and comprised a total of 344,497 participants. No studies investigating bone quantity or quality were identified. Bipolar disorder was associated with an increased risk of fracture (range 20-80%); and fracture-free survival time for those with bipolar disorder decreased substantially with advancing age, and for women (10-30% shorter than men). Fracture incidence per 1000 person years (py) was 21.4 and 10.8 in those with and without bipolar disorder, respectively. LIMITATIONS Limited data and marked methodological heterogeneity prevented the pooling of these data for a numerical synthesis. CONCLUSIONS Increased fracture risk was observed in individuals with bipolar disorder, independent of older age, sex, comorbidities and medication use. The operative mechanisms, risk and treatment factors warrant further enquiry.
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Affiliation(s)
- Vinoomika Chandrasekaran
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, PO Box 281, Geelong, 3220 Australia.
| | - Sharon L Brennan-Olsen
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia..
| | - Amanda L Stuart
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, PO Box 281, Geelong, 3220 Australia.
| | - Julie A Pasco
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, PO Box 281, Geelong, 3220 Australia; Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia.; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Barwon Health University Hospital, Geelong, Australia.
| | - Michael Berk
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, PO Box 281, Geelong, 3220 Australia; Department of Psychiatry, University of Melbourne, Parkville, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Australia; Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Australia.
| | - Jason M Hodge
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, PO Box 281, Geelong, 3220 Australia; Barwon Health University Hospital, Geelong, Australia; Geelong Centre for Emerging Infectious Diseases, Geelong, Australia.
| | - Lana J Williams
- Deakin University, School of Medicine, IMPACT Strategic Research Centre, PO Box 281, Geelong, 3220 Australia.
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15
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Williams LJ, Berk M, Hodge JM, Kotowicz MA, Stuart AL, Chandrasekaran V, Cleminson J, Pasco JA. Selective Serotonin Reuptake Inhibitors (SSRIs) and Markers of Bone Turnover in Men. Calcif Tissue Int 2018; 103:125-130. [PMID: 29441424 DOI: 10.1007/s00223-018-0398-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/29/2018] [Indexed: 10/18/2022]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) have been shown to have a clinically significant impact on bone metabolism. To explore this further, we aimed to determine whether these agents are associated with serum markers of bone turnover utilising a population-based sample of men (n = 1138; 20-96 year) participating in the Geelong Osteoporosis Study. Blood samples were obtained and the bone resorption marker, C-telopeptide (CTx) and formation marker, type 1 procollagen amino-terminal-propeptide (PINP) were measured. Anthropometry and socio-economic status (SES) were determined and information on medication use and lifestyle was obtained via questionnaire. Lifetime mood disorders were assessed using semi-structured clinical interviews. Thirty-seven (3.3%) men reported using SSRIs. Age was an effect modifier in the association between SSRIs and markers of bone turnover. Among younger men (20-60 year; n = 557), adjusted mean CTx and PINP values were 12.4% [16.7 (95% CI 14.6-18.8) vs 19.1 (95% CI 18.7-19.4) pg/ml, p = 0.03] and 13.6% [5.6 (95% CI 4.9-6.3) vs 6.4 (95% CI 6.3-6.6) pg/ml, p = 0.02] lower among SSRI users compared to non-users, respectively. No differences in SSRI use and markers of bone turnover were detected among older men (61-94 year; all p > 0.05). These patterns persisted after further adjustment for activity, alcohol, smoking, SES, depression, bone active medications and other antidepressants. Our data suggest that SSRI use is associated with alterations in bone turnover markers among younger men. The observed decreases in both CTx and PINP are likely to contribute to a low bone turnover state and increased skeletal fragility with this potential imbalance between formation and resorption resulting in subsequent bone loss.
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Affiliation(s)
- Lana J Williams
- Deakin University, Geelong, Australia.
- Barwon Health, Geelong, Australia.
| | - Michael Berk
- Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Australia
- Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Jason M Hodge
- Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
- Geelong Centre for Emerging Infectious Diseases, Geelong, Australia
| | - Mark A Kotowicz
- Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
- Melbourne Medical School-Western Precinct, The University of Melbourne, St Albans, Australia
| | | | | | | | - Julie A Pasco
- Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
- Melbourne Medical School-Western Precinct, The University of Melbourne, St Albans, Australia
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Chandrasekaran V, Brennan-Olsen SL, Stuart AL, Pasco JA, Berk M, Hodge JM, Williams LJ. Association between bipolar spectrum disorder and bone health: a meta-analysis and systematic review protocol. BMJ Open 2017; 7:e013981. [PMID: 28246138 PMCID: PMC5337658 DOI: 10.1136/bmjopen-2016-013981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Bipolar spectrum disorder is a chronic, episodic illness, associated with significant personal, social and economic burden. It is estimated to affect ∼2.4% of the population worldwide and is commonly associated with psychological and/or physiological comorbidities. Osteoporosis is one such comorbidity, a disease of bone that is asymptomatic until a fracture occurs. This systematic review attempts to capture, collate, assess and discuss the literature investigating the association between bipolar spectrum disorder and bone health. METHODS AND ANALYSIS We aim to identify articles that investigate the association between bipolar spectrum disorder and bone health in adults by systematically searching the MEDLINE, PubMed, OVID and CINAHL databases. Two independent reviewers will determine eligibility of studies according to predetermined criteria, and methodological quality will be assessed using a previously published scoring system. A meta-analysis will be conducted, and statistical methods will be used to identify and control for heterogeneity, if possible. If numerical syntheses are prevented due to statistical heterogeneity, a best evidence synthesis will be conducted to assess the level of evidence for associations between bipolar spectrum disorder and bone health. ETHICS AND DISSEMINATION Ethical permission will not be required for this systematic review since only published data will be used. This protocol will be registered with PROSPERO. Findings of the review will be published in a peer-reviewed scientific journal, and will be presented to clinical and population health audiences at national and international conferences.
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Affiliation(s)
| | - Sharon L Brennan-Olsen
- Deakin University, Geelong, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia
- Department of Medicine, The University of Melbourne-Western Precinct, St Albans, Australia
- Institute for Health and Ageing, Australian Catholic University, Melbourne, Victoria, Australia
| | | | - Julie A Pasco
- Deakin University, Geelong, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Australia
| | - Michael Berk
- Deakin University, Geelong, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
- Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Barwon Health University Hospital, Geelong, Australia
| | - Jason M Hodge
- Deakin University, Geelong, Victoria, Australia
- Barwon Health University Hospital, Geelong, Australia
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Affiliation(s)
- Lana J Williams
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Julie A Pasco
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia Melbourne Medical School - Western Campus, The University of Melbourne, St Albans, VIC, Australia
| | - Jason M Hodge
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia Barwon Health, University Hospital Geelong, Geelong, VIC, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
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Fernandes BS, Hodge JM, Pasco JA, Berk M, Williams LJ. Effects of Depression and Serotonergic Antidepressants on Bone: Mechanisms and Implications for the Treatment of Depression. Drugs Aging 2016; 33:21-5. [PMID: 26547857 DOI: 10.1007/s40266-015-0323-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Osteoporosis is a chronic skeletal disease marked by microarchitectural deterioration of the bone matrix and depletion of bone mineral density (BMD), with a consequent increased risk for fragility fractures. It has been frequently associated with depression, which is also a chronic and debilitating disorder with high prevalence. Selective serotonin reuptake inhibitors (SSRIs), first-line agents in the pharmacological treatment of mood and anxiety disorders, have also been shown to negatively affect bone metabolism. SSRIs are the most prescribed antidepressants worldwide and a large number of persons at risk of developing osteoporosis, including older patients, will receive these antidepressants. Therefore, a proper musculoskeletal evaluation of individuals who are being targeted for or using SSRIs is a priority. The aim of this article is to review the evidence regarding the effects of depression and serotonergic antidepressants on bone and its implications for clinical care.
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Affiliation(s)
- Brisa S Fernandes
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.,Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Jason M Hodge
- Barwon Biomedical Research, Barwon Health University Hospital, Geelong, VIC, Australia.,MMR Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Julie A Pasco
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.,Department of Medicine, The University of Melbourne, St Albans, VIC, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.,Florey Institute for Neuroscience and Mental Health, Department of Psychiatry and Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Lana J Williams
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
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19
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Fraher D, Hodge JM, Collier FM, McMillan JS, Kennedy RL, Ellis M, Nicholson GC, Walder K, Dodd S, Berk M, Pasco JA, Williams LJ, Gibert Y. Citalopram and sertraline exposure compromises embryonic bone development. Mol Psychiatry 2016; 21:656-64. [PMID: 26347317 DOI: 10.1038/mp.2015.135] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 05/15/2015] [Accepted: 07/14/2015] [Indexed: 12/13/2022]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed treatments for depression and, as a class of drugs, are among the most used medications in the world. Concern regarding possible effects of SSRI treatment on fetal development has arisen recently as studies have suggested a link between maternal SSRI use and an increase in birth defects such as persistent pulmonary hypertension, seizures and craniosynostosis. Furthermore, SSRI exposure in adults is associated with decreased bone mineral density and increased fracture risk, and serotonin receptors are expressed in human osteoblasts and osteoclasts. To determine possible effects of SSRI exposure on developing bone, we treated both zebrafish, during embryonic development, and human mesenchymal stem cells (MSCs), during differentiation into osteoblasts, with the two most prescribed SSRIs, citalopram and sertraline. SSRI treatment in zebrafish decreased bone mineralization, visualized by alizarin red staining and decreased the expression of mature osteoblast-specific markers during embryogenesis. Furthermore, we showed that this inhibition was not associated with increased apoptosis. In differentiating human MSCs, we observed a decrease in osteoblast activity that was associated with a decrease in expression of the osteoblast-specific genes Runx2, Sparc and Spp1, measured with quantitative real-time PCR (qRT-PCR). Similar to the developing zebrafish, no increase in expression of the apoptotic marker Caspase 3 was observed. Therefore, we propose that SSRIs inhibit bone development by affecting osteoblast maturation during embryonic development and MSC differentiation. These results highlight the need to further investigate the risks of SSRI use during pregnancy in exposing unborn babies to potential skeletal abnormalities.
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Affiliation(s)
- D Fraher
- Metabolic Genetic Diseases Laboratory, Metabolic Research Unit, School of Medicine, Deakin University, Geelong, VIC, Australia.,IMPACT and MMR Strategic Research Centres, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - J M Hodge
- IMPACT and MMR Strategic Research Centres, School of Medicine, Deakin University, Geelong, VIC, Australia.,Barwon Biomedical Research, University Hospital, Geelong, VIC, Australia
| | - F M Collier
- IMPACT and MMR Strategic Research Centres, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - J S McMillan
- Barwon Biomedical Research, University Hospital, Geelong, VIC, Australia
| | - R L Kennedy
- Barwon Biomedical Research, University Hospital, Geelong, VIC, Australia
| | - M Ellis
- Metabolic Genetic Diseases Laboratory, Metabolic Research Unit, School of Medicine, Deakin University, Geelong, VIC, Australia.,IMPACT and MMR Strategic Research Centres, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - G C Nicholson
- Barwon Biomedical Research, University Hospital, Geelong, VIC, Australia
| | - K Walder
- Metabolic Genetic Diseases Laboratory, Metabolic Research Unit, School of Medicine, Deakin University, Geelong, VIC, Australia.,IMPACT and MMR Strategic Research Centres, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - S Dodd
- IMPACT and MMR Strategic Research Centres, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - M Berk
- IMPACT and MMR Strategic Research Centres, School of Medicine, Deakin University, Geelong, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, Department of Psychiatry, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - J A Pasco
- IMPACT and MMR Strategic Research Centres, School of Medicine, Deakin University, Geelong, VIC, Australia.,Department of Medicine, Northwest Academic Centre, The University of Melbourne, St Albans, VIC, Australia
| | - L J Williams
- IMPACT and MMR Strategic Research Centres, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Y Gibert
- Metabolic Genetic Diseases Laboratory, Metabolic Research Unit, School of Medicine, Deakin University, Geelong, VIC, Australia.,IMPACT and MMR Strategic Research Centres, School of Medicine, Deakin University, Geelong, VIC, Australia
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20
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Fraher D, Hodge JM, Collier FM, McMillan JS, Kennedy RL, Ellis M, Nicholson GC, Walder K, Dodd S, Berk M, Pasco JA, Williams LJ, Gibert Y. Citalopram and sertraline exposure compromises embryonic bone development. Mol Psychiatry 2016; 21:722. [PMID: 26619812 DOI: 10.1038/mp.2015.155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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21
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Brennan-Olsen SL, Page RS, Berk M, Riancho JA, Leslie WD, Wilson SG, Saban KL, Janusek L, Pasco JA, Hodge JM, Quirk SE, Hyde NK, Hosking SM, Williams LJ. DNA methylation and the social gradient of osteoporotic fracture: A conceptual model. Bone 2016; 84:204-212. [PMID: 26723576 DOI: 10.1016/j.bone.2015.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/19/2015] [Accepted: 12/21/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Although there is a documented social gradient for osteoporosis, the underlying mechanism(s) for that gradient remain unknown. We propose a conceptual model based upon the allostatic load theory, to suggest how DNA methylation (DNAm) might underpin the social gradient in osteoporosis and fracture. We hypothesise that social disadvantage is associated with priming of inflammatory pathways mediated by epigenetic modification that leads to an enhanced state of inflammatory reactivity and oxidative stress, and thus places socially disadvantaged individuals at greater risk of osteoporotic fracture. METHODS/RESULTS Based on a review of the literature, we present a conceptual model in which social disadvantage increases stress throughout the lifespan, and engenders a proinflammatory epigenetic signature, leading to a heightened inflammatory state that increases risk for osteoporotic fracture in disadvantaged groups that are chronically stressed. CONCLUSIONS Our model proposes that, in addition to the direct biological effects exerted on bone by factors such as physical activity and nutrition, the recognised socially patterned risk factors for osteoporosis also act via epigenetic-mediated dysregulation of inflammation. DNAm is a dynamic modulator of gene expression with considerable relevance to the field of osteoporosis. Elucidating the extent to which this epigenetic mechanism transduces the psycho-social environment to increase the risk of osteoporotic fracture may yield novel entry points for intervention that can be used to reduce individual and population-wide risks for osteoporotic fracture. Specifically, an epigenetic evidence-base may strengthen the importance of lifestyle modification and stress reduction programs, and help to reduce health inequities across social groups. MINI ABSTRACT Our conceptual model proposes how DNA methylation might underpin the social gradient in osteoporotic fracture. We suggest that social disadvantage is associated with priming of inflammatory signalling pathways, which is mediated by epigenetic modifications, leading to a chronically heightened inflammatory state that places disadvantaged individuals at greater risk of osteoporosis.
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Affiliation(s)
- Sharon L Brennan-Olsen
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia; Australian Institute for Musculoskeletal Sciences, The University of Melbourne, C/- Sunshine Hospital, Furlong Road, Melbourne, 3021, VIC, Australia; Institute for Health and Ageing, Australian Catholic University, Melbourne, 3000, VIC, Australia.
| | - Richard S Page
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia; Barwon Orthopaedic Research Unit, Barwon Health, Geelong, 3220, VIC, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
| | - José A Riancho
- Department of Internal Medicine, Valdecilla Research Institute (IDIVAL), University of Cantabria, Santander, Spain
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott G Wilson
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia; School of Medicine and Pharmacology, The University of Western Australia, Nedlands, 6009, WA, Australia; Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Karen L Saban
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA; Centre of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Linda Janusek
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Julie A Pasco
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
| | - Jason M Hodge
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
| | - Shae E Quirk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
| | - Natalie K Hyde
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
| | - Sarah M Hosking
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
| | - Lana J Williams
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/- Barwon Health, Ryrie Street, Geelong, 3220, VIC, Australia
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Rauma PH, Pasco JA, Berk M, Stuart AL, Koivumaa-Honkanen H, Honkanen RJ, Hodge JM, Williams LJ. The association between use of antidepressants and bone quality using quantitative heel ultrasound. Aust N Z J Psychiatry 2015; 49:437-43. [PMID: 25586753 DOI: 10.1177/0004867414565475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Osteoporosis and depression are major public health problems worldwide. Studies have reported an association between antidepressant use, mainly selective serotonin reuptake inhibitors (SSRIs), and bone mineral density (BMD), but the issue remains unclear. METHODS This study examined data collected from 849 Australian men (aged 24-98 years) participating in the Geelong Osteoporosis Study (GOS). Bone quality was determined using quantitative ultrasound (QUS) and included the following parameters: Broadband Ultrasound Attenuation (BUA), Speed of Sound (SOS) and Stiffness Index (SI). Anthropometry, socio-economic status (SES), medication use and lifestyle factors were determined. The cross-sectional associations between bone quality and use of antidepressants were studied using multivariate linear regression adjusted for potential confounders. RESULTS At the time of assessment, 61 (7.2%) men were using antidepressants, of which 44 (72.1%) used SSRIs. Antidepressant use was associated with lower SI (p = .002), SOS (p = .010) and BUA (p = .053). However, body weight was identified as an effect modifier; QUS values were lower for antidepressant users with lower weight (< 90 kg) only. CONCLUSIONS Use of antidepressants was associated with lower QUS values for men with low body weights. Thus, the risk of osteoporosis should be taken into account when prescribing antidepressants, in particular among men who are in this weight category.
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Affiliation(s)
- Päivi H Rauma
- Social Pharmacy, School of Pharmacy, University of Eastern Finland (UEF), Kuopio, Finland Bone and Cartilage Research Unit, Institute of Clinical Medicine, UEF, Kuopio, Finland
| | - Julie A Pasco
- School of Medicine, Deakin University, Geelong, Australia North West Academic Centre, Department of Medicine, The University of Melbourne, St Albans, Australia
| | - Michael Berk
- School of Medicine, Deakin University, Geelong, Australia The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
| | | | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, UEF, Kuopio, Finland Departments of Psychiatry, Kuopio University Hospital, South-Savonia Hospital District, Mikkeli; North Karelia Central Hospital, Joensuu; SOSTERI, Savonlinna; SOTE, Iisalmi; Lapland Hospital District, Rovaniemi, Finland
| | - Risto J Honkanen
- Bone and Cartilage Research Unit, Institute of Clinical Medicine, UEF, Kuopio, Finland
| | - Jason M Hodge
- School of Medicine, Deakin University, Geelong, Australia Barwon Biomedical Research, The Geelong Hospital, Geelong, Australia
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Eeles DG, Hodge JM, Singh PP, Schuijers JA, Grills BL, Gillespie MT, Myers DE, Quinn JMW. Osteoclast formation elicited by interleukin-33 stimulation is dependent upon the type of osteoclast progenitor. Mol Cell Endocrinol 2015; 399:259-66. [PMID: 25458701 DOI: 10.1016/j.mce.2014.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/03/2014] [Accepted: 10/14/2014] [Indexed: 10/24/2022]
Abstract
Osteoclasts are bone resorbing multinucleated cells (MNCs) derived from macrophage progenitors. IL-33 has been reported to drive osteoclastogenesis independently of receptor activator of NFκB ligand (RANKL) but this remains controversial as later studies did not confirm this. We found IL-33 clearly elicited functional dentine-resorbing osteoclast formation from human adult monocytes. However, monocytes from only 3 of 12 donors responded this way, while all responded to RANKL. Human cord blood-derived progenitors and murine bone marrow macrophages lacked an osteoclastogenic response to IL-33. In RAW264.7 cells, IL-33 elicited NFκB and p38 responses but not NFATc1 signals (suggesting poor osteoclastogenic responses) and formed only mononuclear tartrate-resistant acid phosphatase positive (TRAP(+)) cells. Since TGFβ boosts osteoclastogenesis in RAW264.7 cells we employed an IL-33/TGFβ co-treatment, which resulted in small numbers of MNCs expressing key osteoclast markers TRAP and calcitonin receptors. Thus, IL-33 possesses weak osteoclastogenic activity suggesting pathological significance and, perhaps, explaining previous conflicting reports.
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Affiliation(s)
- Damien G Eeles
- MIMR-PHI Institute of Medical Research, Clayton, VIC, Australia; Department of Human Biosciences, La Trobe University, Bundoora, VIC, Australia
| | - Jason M Hodge
- Barwon Biomedical Research, Department of Medicine, The Geelong Hospital, Geelong, VIC, Australia; School of Medicine, Deakin University, Geelong, VIC, Australia
| | | | | | - Brian L Grills
- Department of Human Biosciences, La Trobe University, Bundoora, VIC, Australia
| | - Matthew T Gillespie
- MIMR-PHI Institute of Medical Research, Clayton, VIC, Australia; Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, Australia
| | - Damian E Myers
- Department of Orthopaedics, St Vincent's Hospital, Fitzroy, VIC, Australia; Department of Surgery, St Vincent's Hospital, Fitzroy, VIC, Australia
| | - Julian M W Quinn
- MIMR-PHI Institute of Medical Research, Clayton, VIC, Australia; Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, Australia.
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Fernandes TJ, Hodge JM, Singh PP, Eeles DG, Collier FM, Holten I, Ebeling PR, Nicholson GC, Quinn JMW. Cord blood-derived macrophage-lineage cells rapidly stimulate osteoblastic maturation in mesenchymal stem cells in a glycoprotein-130 dependent manner. PLoS One 2013; 8:e73266. [PMID: 24069182 PMCID: PMC3772005 DOI: 10.1371/journal.pone.0073266] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 07/22/2013] [Indexed: 11/18/2022] Open
Abstract
In bone, depletion of osteoclasts reduces bone formation in vivo, as does osteal macrophage depletion. How osteoclasts and macrophages promote the action of bone forming osteoblasts is, however, unclear. Since recruitment and differentiation of multi-potential stromal cells/mesenchymal stem cells (MSC) generates new active osteoblasts, we investigated whether human osteoclasts and macrophages (generated from cord blood-derived hematopoietic progenitors) induce osteoblastic maturation in adipose tissue-derived MSC. When treated with an osteogenic stimulus (ascorbate, dexamethasone and β-glycerophosphate) these MSC form matrix-mineralising, alkaline phosphatase-expressing osteoblastic cells. Cord blood-derived progenitors were treated with macrophage colony stimulating factor (M-CSF) to form immature proliferating macrophages, or with M-CSF plus receptor activator of NFκB ligand (RANKL) to form osteoclasts; culture medium was conditioned for 3 days by these cells to study their production of osteoblastic factors. Both osteoclast- and macrophage-conditioned medium (CM) greatly enhanced MSC osteoblastic differentiation in both the presence and absence of osteogenic medium, evident by increased alkaline phosphatase levels within 4 days and increased mineralisation within 14 days. These CM effects were completely ablated by antibodies blocking gp130 or oncostatin M (OSM), and OSM was detectable in both CM. Recombinant OSM very potently stimulated osteoblastic maturation of these MSC and enhanced bone morphogenetic protein-2 (BMP-2) actions on MSC. To determine the influence of macrophage activation on this OSM-dependent activity, CM was collected from macrophage populations treated with M-CSF plus IL-4 (to induce alternative activation) or with GM-CSF, IFNγ and LPS to cause classical activation. CM from IL-4 treated macrophages stimulated osteoblastic maturation in MSC, while CM from classically-activated macrophages did not. Thus, macrophage-lineage cells, including osteoclasts but not classically activated macrophages, can strongly drive MSC-osteoblastic commitment in OSM-dependent manner. This supports the notion that eliciting gp130-dependent signals in human MSC would be a useful approach to increase bone formation.
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Affiliation(s)
- Tania J. Fernandes
- Northwest Academic Centre, Department of Medicine, The University of Melbourne, Victoria, Australia
- Barwon Biomedical Research, The Geelong Hospital, Geelong, Victoria, Australia
| | - Jason M. Hodge
- Northwest Academic Centre, Department of Medicine, The University of Melbourne, Victoria, Australia
- Barwon Biomedical Research, The Geelong Hospital, Geelong, Victoria, Australia
- School of Medicine, Deakin University: Barwon Health, Geelong, Victoria, Australia
| | | | - Damien G. Eeles
- Prince Henry's Institute of Medical Research, Clayton, Victoria, Australia
- Department of Human Biosciences, La Trobe University, Bundoora, Victoria, Australia
| | - Fiona M. Collier
- Barwon Biomedical Research, The Geelong Hospital, Geelong, Victoria, Australia
- School of Medicine, Deakin University: Barwon Health, Geelong, Victoria, Australia
| | - Ian Holten
- Department of Plastic Surgery, Barwon Health, Geelong, Victoria, Australia
| | - Peter R. Ebeling
- Northwest Academic Centre, Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Geoffrey C. Nicholson
- Northwest Academic Centre, Department of Medicine, The University of Melbourne, Victoria, Australia
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - Julian M. W. Quinn
- Prince Henry's Institute of Medical Research, Clayton, Victoria, Australia
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
- * E-mail:
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Hodge JM, Wang Y, Berk M, Collier FM, Fernandes TJ, Constable MJ, Pasco JA, Dodd S, Nicholson GC, Kennedy RL, Williams LJ. Selective serotonin reuptake inhibitors inhibit human osteoclast and osteoblast formation and function. Biol Psychiatry 2013; 74:32-9. [PMID: 23260229 DOI: 10.1016/j.biopsych.2012.11.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 10/08/2012] [Accepted: 11/06/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are widely used antidepressants and one of the most commonly used medications. There is growing concern that SSRIs, which sequester in bone marrow at higher concentrations than brain or blood, increase bone fragility and fracture risk. However, their mechanism of action on human osteoclasts (OC) and osteoblasts (OB) differentiation remains unclear. METHODS Expression of serotonin receptors (5-HTR), transporter (5-HTT), and tryptophan hydroxylase 1 (TPH1) was assessed in human OC (precursors and mature) and OB (nonmineralizing and mineralizing) by polymerase chain reaction. OC formation and resorption was measured in the presence of 5 SSRIs. OBs cultured with SSRIs for 28 days were assessed for alkaline phosphatase (ALP) and bone mineralization. Cell viability and apoptosis were determined by annexin V flow cytometry. RESULTS OCs and OB expressed TPH1, 5-HTT, and 5-HTR1B. The 5-HTR2A was expressed only in OB, whereas 5-HTR2B expression increased from precursor to mature OC. All SSRIs (except citalopram) dose-dependently inhibited OC formation and resorption between 1 μmol/L and 10 μmol/L; order of potency: sertraline > fluoxetine > paroxetine > fluvoxamine > citalopram. Similarly, SSRIs (except citalopram) inhibited ALP and bone mineralization by OB but only at 30 μmol/L. Apoptosis was induced by SSRIs in OC and OB in an identical pattern to inhibitory effects. Serotonin treatment had no effect on either OC or OB parameters. CONCLUSIONS These data demonstrate that SSRIs differentially inhibit bone cell function via apoptosis. This may explain the mechanisms of bone loss with chronic use and aid clinical choices.
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Affiliation(s)
- Jason M Hodge
- Barwon Biomedical Research, The Geelong Hospital, Geelong, Victoria, Australia
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Williams LJ, Pasco JA, Jacka FN, Hodge JM, Kotowicz MA, Berk M. Quantitative Heel Ultrasound (QUS) measures of bone quality in association with mood and anxiety disorders. J Affect Disord 2013; 146:395-400. [PMID: 23122528 DOI: 10.1016/j.jad.2012.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 09/26/2012] [Accepted: 09/26/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The common mental disorders are potential risk factors for low bone mass as a result of disease and/or medication-related processes. Quantitative heel ultrasound (QUS) is a portable and relatively cheap screening tool for determining fracture risk. Thus, we investigated the association between QUS parameters, mood and anxiety disorders in a population-based sample of 745 men and 897 women. METHODS Using a clinical interview (SCID-I/NP), mood and anxiety disorders were identified. Bone quality was established using QUS and included the following parameters: Broadband Ultrasound Attenuation (BUA), Speed of Sound (SOS) and Stiffness Index (SI). Anthropometry, socio-economic status (SES), medication use and lifestyle factors were determined. RESULTS In men, mood and anxiety disorders were associated with lower age-weight- and smoking-adjusted SOS, BUA and SI. In women, age was an effect modifier. Among younger women (≤ 40yr), mood disorders were associated with lower age-weight- and smoking-adjusted SOS and SI but not BUA. No differences were detected in older women or women with anxiety disorders. These patterns persisted after adjustment for activity, alcohol, calcium intake, SES and medications. LIMITATIONS Cross-sectional study design, and possible residual or unrecognised confounding. CONCLUSION Our data suggest that bone quality, as measured by QUS, is reduced among men and younger women with a history of mood disorders. Furthermore, an inverse association between anxiety disorders and bone quality was evident for men. Thus, QUS may be a useful screening tool for determining fracture risk within these populations.
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Saleh H, Eeles D, Hodge JM, Nicholson GC, Gu R, Pompolo S, Gillespie MT, Quinn JMW. Interleukin-33, a target of parathyroid hormone and oncostatin m, increases osteoblastic matrix mineral deposition and inhibits osteoclast formation in vitro. Endocrinology 2011; 152:1911-22. [PMID: 21363931 DOI: 10.1210/en.2010-1268] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IL-33 is an important inflammatory mediator in allergy, asthma, and joint inflammation, acting via its receptor, ST2L, to elicit Th₂ cell cytokine secretion. IL-33 is related to IL-1 and IL-18, which both influence bone metabolism, IL-18 in particular inhibiting osteoclast formation and contributing to PTH bone anabolic actions. We found IL-33 immunostaining in osteoblasts in mouse bone and IL-33 mRNA expression in cultured calvarial osteoblasts, which was elevated by treatment with the bone anabolic factors oncostatin M and PTH. IL-33 treatment strongly inhibited osteoclast formation in bone marrow and spleen cell cultures but had no effect on osteoclast formation in receptor activator of nuclear factor-κB ligand/macrophage colony-stimulating factor-treated bone marrow macrophage (BMM) or RAW264.7 cultures, suggesting a lack of direct action on immature osteoclast progenitors. However, osteoclast formation from BMM was inhibited by IL-33 in the presence of osteoblasts, T cells, or mature macrophages, suggesting these cell types may mediate some actions of IL-33. In bone marrow cultures, IL-33 induced mRNA expression of granulocyte macrophage colony-stimulating factor, IL-4, IL-13, and IL-10; osteoclast inhibitory actions of IL-33 were rescued only by combined antibody ablation of these factors. In contrast to osteoclasts, IL-33 promoted matrix mineral deposition by long-term ascorbate treated primary osteoblasts and reduced sclerostin mRNA levels in such cultures after 6 and 24 h of treatment; sclerostin mRNA was also suppressed in IL-33-treated calvarial organ cultures. In summary, IL-33 stimulates osteoblastic function in vitro but inhibits osteoclast formation through at least three separate mechanisms. Autocrine and paracrine actions of osteoblast IL-33 may thus influence bone metabolism.
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Affiliation(s)
- Hasnawati Saleh
- Prince Henry's Institute, Monash Medical Centre, Clayton Road, Clayton, Victoria 3168, Australia
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Pasco JA, Nicholson GC, Ng F, Henry MJ, Williams LJ, Kotowicz MA, Hodge JM, Dodd S, Kapczinski F, Gama CS, Berk M. Oxidative stress may be a common mechanism linking major depression and osteoporosis. Acta Neuropsychiatr 2008; 20:112-6. [PMID: 26951034 DOI: 10.1111/j.1601-5215.2008.00283.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Julie A Pasco
- 1 Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Australia
| | - Geoffrey C Nicholson
- 1 Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Australia
| | - Felicity Ng
- 1 Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Australia
| | - Margaret J Henry
- 1 Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Australia
| | - Lana J Williams
- 1 Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Australia
| | - Mark A Kotowicz
- 1 Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Australia
| | - Jason M Hodge
- 1 Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Australia
| | - Seetal Dodd
- 1 Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Australia
| | - Flavio Kapczinski
- 2Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Clarissa S Gama
- 2Programa de Pós-Graduação em Medicina: Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Michael Berk
- 1 Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Australia
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Abstract
Although the critical role of M-CSF in osteoclastogenesis is well documented, there has been no detailed analysis of how it regulates human osteoclast formation and function in vitro. We used a human osteoclastogenesis model employing CFU-GM osteoclast precursors cultured for 14 days on dentine with RANKL, with varying exposure to exogenous human M-CSF. Short-term treatment of precursors with M-CSF (10-100 ng/mL) resulted in increased proliferation with or without RANKL. Treatment with M-CSF (1-100 ng/mL) for 14 days caused a biphasic concentration-dependent stimulation of formation, fusion, and resorption peaking at 10-50 ng/mL and almost complete abolition of resorption at 100 ng/mL. Time-course studies using M-CSF (25 ng/mL) showed that osteoclast size, nuclei/cell, and resorption increased with longer duration of M-CSF treatment. When treatment was restricted to the first 4 days, M-CSF (25-100 ng/mL) stimulated formation of normal numbers of osteoclasts that resorbed less. Blockade of endogenous M-CSF signaling with neutralizing M-CSF antibody during the first week of culture extensively inhibited osteoclastogenesis, whereas blockade during the second week produced only a small reduction in resorption. Treatment with M-CSF during the second week of culture caused a small increase in osteoclast number and a concentration-dependent increase in cytoplasmic spreading with inhibition of resorption. We have shown that M-CSF modulates multiple steps of human osteoclastogenesis, including proliferation, differentiation and fusion of precursors. In the later stages of osteoclastogenesis, M-CSF modulates osteoclast-resorbing activity, but is not required for survival. Modulation of M-CSF signaling is a potential therapeutic target for conditions associated with excess bone resorption.
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Affiliation(s)
- Jason M Hodge
- The Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Victoria 3220, Australia.
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Baldock PA, Thomas GP, Hodge JM, Baker SU, Dressel U, O'Loughlin PD, Nicholson GC, Briffa KH, Eisman JA, Gardiner EM. Vitamin D action and regulation of bone remodeling: suppression of osteoclastogenesis by the mature osteoblast. J Bone Miner Res 2006; 21:1618-26. [PMID: 16995817 DOI: 10.1359/jbmr.060714] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Vitamin D acts through the immature osteoblast to stimulate osteoclastogenesis. Transgenic elevation of VDR in mature osteoblasts was found to inhibit osteoclastogenesis associated with an altered OPG response. This inhibition was confined to cancellous bone. This study indicates that vitamin D-mediated osteoclastogenesis is regulated locally by OPG production in the mature osteoblast. INTRODUCTION Vitamin D stimulates osteoclastogenesis acting through its nuclear receptor (VDR) in immature osteoblast/stromal cells. This mobilization of calcium stores does not occur in a random manner, with bone preferentially removed from cancellous bone. The process whereby the systemic, humoral regulator is targeted to a particular region of the skeleton is unclear. MATERIALS AND METHODS Bone resorption was assessed in mice with vitamin D receptor transgenically elevated in mature osteoblasts (OSVDR). Vitamin D-mediated osteoclastogenesis was examined in vitro using OSVDR osteoblasts and osteoblastic RANKL: osteoprotegerin (OPG) examined in vivo and in vitro after vitamin D treatment. RESULTS Vitamin D-mediated osteoclastogenesis was reduced in OSVDR mice on chow and calcium-restricted diets, with effects confined to cancellous bone. OSVDR osteoblasts had a reduced capacity to support osteoclastogenesis in culture. The vitamin D-mediated reduction in OPG expression was reduced in OSVDR osteoblasts in vivo and in vitro, resulting in a reduced RANKL/OPG ratio in OSVDR compared with wildtype, after exposure to vitamin D. CONCLUSIONS Mature osteoblasts play an inhibitory role in bone resorption, with active vitamin D metabolites acting through the VDR to increase OPG. This inhibition is less active in cancellous bone, effectively targeting this region for resorption after the systemic release of activated vitamin D metabolites.
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Affiliation(s)
- Paul A Baldock
- Bone Research Program, Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, New South Wales, Australia
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Abstract
Although osteopontin (OPN) is highly expressed in osteoclasts, OPN-deficient mice have a near-normal bone phenotype and its role in osteoclast differentiation and function remains uncertain. We used an adenoviral OPN-antisense vector (AdOPN-AS) to down-regulate OPN expression in a human in vitro osteoclastogenesis model employing CFU-GM precursors treated with RANKL and M-CSF. Cultures infected with AdOPN-AS showed reduced secretion of OPN compared to cultures infected with a control adenoviral vector expressing beta-galactosidase. Infection with AdOPN-AS co-incident with exposure to RANKL was associated with substantial (approximately 50%) inhibition of osteoclast formation with a concomitant reduction in dentine resorption. There was also a small reduction in the size of generated osteoclasts but no significant effect on the size of resorption pits/tracks nor on the amount of resorption per osteoclast. When the cultures were infected with AdOPN-AS after 4 days exposure to RANKL only minor effects on osteoclastogenesis were seen. Our data demonstrate that early down-regulation of OPN in vitro inhibits human osteoclastogenesis. Since mice totally lacking OPN do not have reduced osteoclast numbers our results imply the existence in vivo of an alternative molecular pathway(s).
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Affiliation(s)
- Cathy J Aitken
- The University of Melbourne, Department of Clinical and Biomedical Sciences, Barwon Health, Geelong, Victoria 3220, Australia
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Aitken CJ, Hodge JM, Nishinaka Y, Vaughan T, Yodoi J, Day CJ, Morrison NA, Nicholson GC. Regulation of human osteoclast differentiation by thioredoxin binding protein-2 and redox-sensitive signaling. J Bone Miner Res 2004; 19:2057-64. [PMID: 15537450 DOI: 10.1359/jbmr.040913] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2004] [Revised: 06/21/2004] [Accepted: 07/23/2004] [Indexed: 12/31/2022]
Abstract
UNLABELLED Differential expression of TBP-2 and Trx-1 occurs during osteoclastogenesis. Adenoviral overexpression of TBP-2 in osteoclast precursors inhibits Trx-1 expression, osteoclast formation, and AP-1 binding activity. TBP-2 and Trx-1 are key regulators of osteoclastogenesis. INTRODUCTION Thioredoxin binding protein-2 (TBP-2) negatively regulates thioredoxin-1 (Trx-1), a key endogenous modulator of cellular redox and signaling. In gene array analysis, we found that TBP-2 expression was reduced during human osteoclast differentiation compared with macrophage differentiation. Our aim was to determine the roles of TBP-2 and Trx-1 in human osteoclastogenesis and RANKL signaling. MATERIALS AND METHODS Osteoclasts or macrophages were generated from colony-forming unit-granulocyte macrophage (CFU-GM) precursors treated with sRANKL and macrophage-colony-stimulating factor (M-CSF), or M-CSF alone, respectively. Expression of TBP-2 and Trx-1 was quantified by real-time PCR and Western analysis. Adenoviral gene transfer was used to overexpress TBP-2 in precursors. NF-kappaB and activator protein 1 (AP-1) signaling was assessed with EMSA. RESULTS In the presence of sRANKL, expression of TBP-2 was decreased, whereas Trx-1 expression was increased. The antioxidant N-acetylcysteine reversed this pattern and markedly inhibited osteoclastogenesis. Adenoviral overexpression of human TBP-2 in precursors inhibited osteoclastogenesis and Trx-1 expression, inhibited sRANKL-induced DNA binding of AP-1, but enhanced sRANKL-induced DNA binding of NF-kappaB. CONCLUSIONS These data support significant roles for TBP-2 and the Trx system in osteoclast differentiation that are mediated by redox regulation of AP-1 transcription. A likely mechanism of stress signal induction of bone resorption is provided. Modulators of the Trx system such as antioxidants have potential as antiresorptive therapies.
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Affiliation(s)
- Cathy J Aitken
- Department of Clinical and Biomedical Sciences: Barwon Health, The University of Melbourne, Geelong, Victoria 3220, Australia
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Abstract
Osteopetrotic mice lacking functional M-CSF recover with ageing, suggesting alternate osteoclastogenesis pathways exist. One alternative is GM-CSF, treatment with which improves the osteopetrosis. Our objective was to determine whether GM-CSF could replace M-CSF in human osteoclastogenesis in vitro. Human CFU-GM precursors cultured with RANKL differentiate into osteoclasts without added M-CSF, indicating constitutive production of M-CSF. Addition of M-CSF antibody completely inhibited differentiation, demonstrating M-CSF-dependence in vitro. Co-treatment with low concentrations (0.01 ng/mL) of GM-CSF for 14 days or higher concentrations (10 ng/mL) for the first 1-2 days enhanced osteoclastogenesis but this effect was blocked with M-CSF antibody. Treatment with GM-CSF transiently increased M-CSF mRNA expression at 3 h but suppressed expression at 7-14 days. Neither FLT3-ligand nor VEGF supported osteoclastogenesis in the absence of M-CSF. Thus, in vitro human osteoclastogenesis is dependent on M-CSF and the stimulatory effects of GM-CSF are mediated by M-CSF. Rescue by GM-CSF in M-CSF-deficiency is unlikely to be directly mediated by FLT3-ligand or VEGF.
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Affiliation(s)
- Jason M Hodge
- Department of Clinical and Biomedical Sciences, Barwon Health, University of Melbourne, Geelong, Victoria 3220, Australia.
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Hodge JM, Kirkland MA, Aitken CJ, Waugh CM, Myers DE, Lopez CM, Adams BE, Nicholson GC. Osteoclastic potential of human CFU-GM: biphasic effect of GM-CSF. J Bone Miner Res 2004; 19:190-9. [PMID: 14969388 DOI: 10.1359/jbmr.0301232] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2003] [Revised: 08/18/2003] [Accepted: 09/05/2003] [Indexed: 11/18/2022]
Abstract
UNLABELLED Human osteoclasts can be efficiently generated in vitro from cord blood mononuclear cells and derived CFU-GM colonies. However, CFU-M colonies are poorly osteoclastogenic. Short-term (2-48 h) treatment with GM-CSF stimulates osteoclast formation by proliferating precursors, whereas longer exposure favors dendritic cell formation. INTRODUCTION Osteoclasts (OC) differentiate from cells of the myelomonocytic lineage under the influence of macrophage-colony stimulating factor (M-CSF) and RANKL. However, cells of this lineage can also differentiate to macrophages and dendritic cells (DC) depending on the cytokine environment. The aims of this study were to develop an efficient human osteoclastogenesis model and to investigate the roles of granulocyte macrophage-colony stimulating factor (GM-CSF) and M-CSF in human OC differentiation. MATERIALS AND METHODS A human osteoclastogenesis model, using as precursors colony forming unit-granulocyte macrophage (CFU-GM) colonies generated from umbilical cord mononuclear cells cultured in methylcellulose with GM-CSF, interleukin (IL)-3 and stem cell factor (SCF), has been developed. CFU-GM, colony forming unit-macrophage (CFU-M), or mixed colonies were cultured on dentine with soluble RANKL (sRANKL) and human M-CSF with and without GM-CSF. Major endpoints were OC number, dentine resorption, and CD1a+ DC clusters. RESULTS Osteoclast generation from CFU-GM and mixed colonies treated with M-CSF and sRANKL for 7-14 days was highly efficient, but CFU-M colonies were poorly osteoclastogenic under these conditions. Pretreatment of precursors with M-CSF for 7 or 14 days maintained the precursor pool, but OCs were smaller and resorption was reduced. The effect of GM-CSF treatment was biphasic, depending on the timing and duration of exposure. Short-term treatment (2-48 h) at the beginning of the culture stimulated cell proliferation and enhanced OC formation up to 100%, independent of sRANKL. Longer-term GM-CSF treatment in the presence of sRANKL, however, inhibited OC generation with the formation of extensive CD1a+ DC clusters, accompanied by downregulation of c-Fos mRNA. Delaying the addition of GM-CSF resulted in progressively less inhibition of osteoclastogenesis. CONCLUSIONS Human CFU-GM, but not CFU-M, progenitors have high osteoclastogenic potential. GM-CSF plays an important role in osteoclastogenesis and has a biphasic effect: Short-term treatment potentiates OC differentiation by proliferating precursors, but persistent exposure favors DC formation.
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Affiliation(s)
- Jason M Hodge
- Department of Clinical and Biomedical Sciences, Barwon Health, The Geelong Hospital, University of Melbourne, Geelong, Victoria, Australia
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Abstract
Originally, leptin was described as a product of adipocytes that acts on the hypothalamus to regulate appetite. However, subsequently, it has been shown that leptin receptors are distributed widely and that leptin has diverse functions, including promotion of hemopoietic and osteoblastic differentiation. It has been recognized for some time that both serum leptin and bone mass are correlated positively to body fat mass and, recently, we have shown a direct positive relationship between serum leptin and bone mass in nonobese women. We now report that leptin inhibits osteoclast generation in cultures of human peripheral blood mononuclear cells (PBMCs) and murine spleen cells incubated on bone in the presence of human macrophage colony-stimulating factor (hM-CSF) and human soluble receptor activator of NF-kappaB ligand (sRANKL). The half-maximal concentration inhibitory of leptin was approximately 20 nM in the presence of sRANKL at 40 ng/ml but decreased to approximately 2 nM when sRANKL was used at 5 ng/ml. The majority of the inhibitory effect occurred in the first week of the 3-week cultures. Inhibition did not occur when the PBMC cultures were washed vigorously to remove nonadherent cells or when purified CD14+ monocytes were used to generate osteoclasts, indicating an indirect or permissive effect via CD14- PBMC. Leptin increased osteoprotegerin (OPG) messenger RNA (mRNA) and protein expression in PBMC but not in CD14+ cells, suggesting that the inhibitory effect may be mediated by the RANKL/RANK/OPG system. Leptin may act locally to increase bone mass and may contribute to linkage of bone formation and resorption.
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Affiliation(s)
- Wayne R Holloway
- Department of Clinical and Biomedical Sciences: Barwon Health, The Geelong Hospital, The University of Melbourne, Australia
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Collier FM, Huang WH, Holloway WR, Hodge JM, Gillespie MT, Daniels LL, Zheng MH, Nicholson GC. Osteoclasts from human giant cell tumors of bone lack estrogen receptors. Endocrinology 1998; 139:1258-67. [PMID: 9492061 DOI: 10.1210/endo.139.3.5825] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although estrogen is important in human skeletal homeostasis, the major target cell in bone is unknown. Estrogen receptors (ER) have been demonstrated in osteoblasts and bone marrow stromal cells, but their presence in osteoclasts remains controversial because completely pure preparations have not been available. We have examined expression of ER-alpha and ER-beta messenger RNA (mRNA) by RT-PCR in samples from human giant cell tumor of bone (GCT), including: whole tumor, cultured mononuclear cells, and a pure osteoclast population obtained by microisolation. Whole tumor expressed both ER-alpha and calcitonin receptor (CTR) mRNA and apparently lower levels of ER-beta mRNA. Passaged cultures of tumor mononuclear stromal cells also expressed ER-alpha and low ER-beta but not CTR mRNA. In pure preparations of microisolated osteoclasts, expression of ER-alpha or ER-beta mRNA was not detected, whereas expression of CTR mRNA was readily identified. Microisolated GCT mononuclear cells expressed ER-alpha, but no detectable CTR mRNA. Fluorescence in situ hybridization (FISH) using an ER-alpha riboprobe demonstrated strong signal in the mononuclear cells but multinucleated osteoclasts showed no detectable signal. In contrast, CTR mRNA was detected in multinucleated osteoclasts but not in stromal-like tumor cells by FISH. 17Beta-estradiol consistently showed no effect on bone resorbing activity of osteoclasts from GCT cultured on cortical bone, although calcitonin was a potent inhibitor. These findings indicate that significant expression of ER does not occur in osteoclasts derived from human GCT and suggest that estrogen effects are mediated by other cells of the bone environment.
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Affiliation(s)
- F M Collier
- The University of Melbourne, Department of Medicine, The Geelong Hospital, Australia
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Holloway WR, Collier FM, Herbst RE, Hodge JM, Nicholson GC. Complex shape changes in isolated rat osteoclasts: involvement of protein kinase C in the response to calcitonin. Calcif Tissue Int 1997; 61:306-12. [PMID: 9312201 DOI: 10.1007/s002239900340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The cytoplasmic spreading of osteoclasts has been used to assess responsiveness to agents such as calcitonin and associated signal transduction mechanisms. Although cyclic AMP and intracellular calcium are known mediators of calcitonin effects in osteoclasts, the role of protein kinase C (PKC) is less clear. We have used time-lapse videomicroscopy of isolated rat osteoclasts to characterize shape changes induced by calcitonin, forskolin, and phorbol 12-myristate-13-acetate (PMA) in the absence and presence of PKC blockers. Treatment with calcitonin reduced cytoplasmic plan area but increased perimeter length, resulting in a characteristic "stellate" appearance, whereas forskolin produced "nonstellate" contraction. The response of osteoclasts to PMA was dose dependent. High concentrations (10(-7)-10(-6) M) produced biphasic responses with transitory, calcitonin-like "stellate" contraction followed by sustained expansion, whereas low concentrations (10(-11)-10(-9) M) produced expansion only. The effects of low-concentration PMA could be prevented by pretreatment with a PKC blocker, whereas the effects of high concentrations were only partially inhibited. The effects of forskolin were unchanged by pretreatment with the PKC blocker. Treatment with calcitonin in the presence of various PKC blockers resulted in paradoxical transient expansion followed by contraction. These results indicate that calcitonin-induced shape change in osteoclasts is a complex process involving protein kinase C in addition to cyclic AMP-dependent mechanisms and possibly other factors.
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Affiliation(s)
- W R Holloway
- The University of Melbourne, Department of Medicine, The Geelong Hospital, Box 281, Geelong 3220, Australia
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Holloway WR, Collier FM, Herbst RE, Hodge JM, Nicholson GC. Osteoblast-mediated effects of zinc on isolated rat osteoclasts: inhibition of bone resorption and enhancement of osteoclast number. Bone 1996; 19:137-42. [PMID: 8853857 DOI: 10.1016/8756-3282(96)00141-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Zinc is an important element in biology yet little is understood of its role in bone cell metabolism and function. This study examined the effects of zinc on osteoclast (OC) function in cultures derived from neonatal rats and in cocultures of OC and UMR 106-01 osteoblast-like cells (UMR/OC cocultures). Treatment with zinc (10(-12)-10(-4) mol/L) had no effect on either bone resorption or the number of multinucleate cells positive for tartrate-resistant acid phosphatase (TRACP + ve MNC) in OC cultured for 24 h on bone slices. However, in UMR/OC cocultures, 10(-4) mol/L zinc (but not lower concentrations) decreased resorption pit formation by approximately 50% and increased TRACP + ve MNC number by approximately 40%. When osteoblast-like cells were pretreated with zinc prior to, but not during, coculture with OC, effects on TRACP + ve MNC and pit number persisted, although the effect was reduced. Zinc treatment also inhibited resorption and stimulated TRACP and calcitonin receptor (CTR) + ve MNC numbers in long-term (96-120 h) UMR/OC cocultures. Our results indicate that zinc increases TRACP + ve CTR + ve MNC numbers yet inhibits bone-resorbing activity, and that these effects are dependent on the presence of osteoblastic cells. Zinc is abundant in bone and may act as a local regulator of bone cells.
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Affiliation(s)
- W R Holloway
- University of Melbourne, Department of Medicine, Geelong Hospital, Australia
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39
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Nagelberg DB, Hodge JM, Ketzer JM. Reducing health risks through peer health education: a preliminary report. J Am Coll Health Assoc 1980; 28:234-5. [PMID: 7381120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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