Use of bone turnover markers in postmenopausal osteoporosis

Degradable calcium phosphate-coated porous zinc scaffold combined with platelet-rich plasma implantation for rabbit radius defect

Bone defects seriously affect patients' quality of life and are difficult to repair, and the use of biodegradable porous scaffolds for bone defect repair has gradually become a hot spot in the field of bone repair. The porous biodegradable metal scaffold constructed with Zn covered with calcium and phosphorus coating is a high-quality bone repair material. However, rapid bone defect repair cannot be achieved only by the trace elements Ca, P, and Zn, which are beneficial to bone regeneration, so a material that promotes bone regeneration must be compounded. Platelet-rich plasma is a class of liquid complexes that can promote bone regeneration, and its composite with biodegradable metal scaffolds can solve the problem of the lack of mechanical load bearing of platelet-rich plasma in bone defects. In this study, a porous Zn scaffold was prepared by hot-press sintering of NaCl template, and a calcium phosphate coating was prepared by chemical deposition strategy, and the scaffold was made by compositing it with stable platelet-rich plasma via Poloxamer 407, and the in vitro and in vivo studies on the scaffold's biocompatibility and osteogenesis were carried out using the rabbit radial bone defect model. The results showed that the biodegradable porous scaffold/PRP composite scaffold had good biocompatibility and no cytotoxicity. It can promote osteogenic differentiation and calcium deposition of rabbit BMSCs in vitro and also promote the formation of new bone around the scaffold in vivo. The biodegradable porous scaffold/PRP composite scaffold has a good application prospect in bone defect repair.

Nonessential amino acid is not nonessential in geriatric patients: implications for maxillofacial wound healing and bone repair

BACKGROUND

Nonessential amino acids (NEAAs) are traditionally regarded as dispensable because they can be synthesized endogenously from glucose-derived intermediates. Emerging evidence, however, shows that the capacity for de novo NEAA biosynthesis declines in aged tissues, rendering several of these molecules conditionally essential during periods of stress such as surgery or fracture repair.

MAIN BODY

In the cranio-maxillofacial arena - where bone and soft-tissue regeneration must occur in an environment already compromised by osteoporosis, multimorbidity, and restricted oral intake - insufficient NEAA supply may translate into delayed union, wound dehiscence, and heightened infection risk. This narrative review integrates biochemical, preclinical, and clinical data to map age-dependent changes in the serine/glycine, glutamine/glutamate, arginine/citrulline, cysteine/trans-sulfuration, and alanine cycles, examines their impact on osteogenesis and mucosal healing, and evaluates nutritional or pharmacological strategies to restore NEAA sufficiency. Particular attention is paid to serine-one-carbon metabolism, the intestinal-renal arginine axis, and redox-sensitive cysteine pathways, all of which are intimately linked to collagen deposition, osteoblast differentiation, and immune modulation.

CONCLUSION

We conclude that proactive optimization of NEAA status - through targeted supplementation or metabolic activation - represents a low-risk, biologically rational adjunct to enhance postoperative outcomes in geriatric maxillofacial patients.

Elevated levels of β C-terminal telopeptide of type 1 collagen and N-terminal mid-fragment of osteocalcin in patients with non-traumatic osteonecrosis of the femoral head

OBJECTIVE

To investigate the role of serum β C-terminal telopeptide of type 1 collagen (β-CTx) and N-terminal mid-fragment of osteocalcin (N-MID) concentration in non-traumatic osteonecrosis of the femoral head (NONFH).

MATERIALS AND METHODS

In this retrospective case-control study, serum β-CTx and N-MID levels were measured in 64 NONFH patients and 64 healthy controls. Propensity score matching (PSM) was used to balance the baseline characteristics of the two groups. The study was conducted at Linyi People's Hospital between January 2023 and February 2024. The primary outcomes included the differences in serum β-CTx and N-MID levels between the two groups, their correlations with clinical parameters, and their diagnostic performance for NONFH.

RESULTS

The serum concentration of β-CTx and N-MID was significantly higher in NONFH patients compared to healthy controls (β-CTx: 0.70 ± 0.30 ng/ml vs. 0.36 ± 0.16 ng/ml, P < 0.001; N-MID: 21.35 ± 8.24 ng/ml vs. 13.27 ± 3.87 ng/ml, P < 0.001). No significant differences were observed in serum β-CTx and N-MID levels among different etiological subgroups or ARCO stages. Pearson analysis revealed a positive correlation between serum β-CTx and N-MID levels, as well as β-CTx and pain duration. The ROC curve analysis showed that β-CTx had an AUC of 0.876 (95% CI 0.815-0.938) with a cut-off value of 0.505 ng/ml, sensitivity of 90.63%, and specificity of 76.56%. N-MID had an AUC of 0.860 (95% CI 0.797-0.924) with a cut-off value of 17.050 ng/ml, sensitivity of 84.38%, and specificity of 78.13%.

CONCLUSION

Serum β-CTx and N-MID levels are significantly elevated in patients with NONFH and may serve as potential biomarkers for the diagnosis of NONFH. Further studies with larger sample sizes are needed to validate these findings and explore their clinical applications.

Therapeutic potential of Sweroside in postmenopausal osteoporosis: Inhibition of osteoclast differentiation and promotion of osteoclast apoptosis via NF-κB and MAPK pathways

Postmenopausal osteoporosis (PMOP) is a common metabolic bone disorder resulting from disrupted bone remodeling due to estrogen deficiency, leading to an increased risk of fractures in postmenopausal women. Sweroside, a natural compound derived from lonicerae japonicae flos, has demonstrated neuroprotective and antioxidant properties, yet its effects on PMOP remain underexplored. In vitro studies indicated that Sweroside inhibited osteoclast differentiation and bone resorption in a concentration-dependent manner. Further investigations revealed that these effects were linked to the suppression of osteoclast-specific gene expression, the modulation of the mitogen-activated protein kinase (MAPK) and nuclear factor kappa-B (NF-κB) signaling pathways, and the promotion of osteoclast apoptosis via p53 activation. Additionally, in vivo experiments using ovariectomized (OVX) mice showed that Sweroside alleviated bone loss and enhanced bone density. Overall, these findings suggest that Sweroside could be a promising therapeutic candidate for PMOP by modulating critical signaling pathways to inhibit osteoclast formation and bone resorption.

Ejiao as a preventive agent for osteoporosis - a scoping review of current evidence

Ejiao, a traditional Chinese medicinal product derived from donkey's hide, has long been used to promote blood formation and treat various ailments. Recently, growing pharmacological evidence has suggested that Ejiao and its formulations may also possess bone-protecting properties, making it a potential candidate for preventing and treating osteoporosis. This scoping review aims to summarise the current scientific evidence on the anti-osteoporosis potential of Ejiao and its formulations in osteoporosis prevention. A comprehensive literature search was conducted using PubMed, Web of Science, Scopus, and China National Knowledge Infrastructure up to October 2024. Primary studies published in English or Mandarin, regardless of study design, that investigated the effects of Ejiao on bone in vivo or bone cells in vitro were included. A total of 22 studies were included, comprising five studies on Ejiao alone and 17 studies on Ejiao-based formulations. The findings indicated that Ejiao alone enhanced osteoblast differentiation by increasing alkaline phosphatase synthesis and reducing bone remodelling markers in ovariectomised rats. However, its direct effect on bone mineralisation and density remains uncertain due to the absence of an exogenous mineral source. In contrast, Ejiao-based formulations, such as calcium-Ejiao oral liquid and Donkey-hide glue reinforcing bone oral solution, demonstrated more pronounced bone-protective effects, including improving bone density, enhancing bone repair, and supporting vitamin D metabolism in both animal models and clinical studies. These findings suggest that while Ejiao alone may promote osteoblast activity, its role in osteoporosis management may be more effective when combined with essential minerals. Further long-term studies and human clinical trials are needed to clarify its therapeutic potential and underlying molecular mechanisms.

Self-assembled water soluble and bone-targeting phosphorylated quercetin ameliorates postmenopausal osteoporosis in ovariectomy mice

Natural compounds have shown promising application prospects in preventing or treating various diseases, including osteoporosis on account of their abundant sources, low price, multi-targeting and multiple biological effects. As a bioactive natural product, quercetin (Que) has previously demonstrated to ameliorate osteoporosis (OP), however, its poor bioavailability resulting from low water solubility, poor stability and lack of bone-targeting largely restricted its efficacy and clinical applications. Inspired by the bone-targeting capability of phosphate compounds, we reported a one-step procedure for synthesis of phosphorylated Que (p-Que) by direct phosphorylating phenol groups of Que for the first time. The phosphate groups on p-Que could not only improve the water dispersibility of Que, but also endow p-Que desirable bioavailability and bone-targeting feature. The results from biological assays suggested that p-Que could inhibit osteoclastogenesis and bone resorption and alleviate trabeculae loss in osteoporotic mice. In conclusion, this work demonstrated that phosphorylation strategy can effectively solve low water solubility, lack of bone-targeting capability and poor bioavailability of natural compounds, providing a novel and efficient approach for development of OP nanomedicines.

Prevention of osteoporosis in ovariectomized mice with calcium yak caseinate

Moderate calcium supplementation coupled with enhanced calcium absorption rates in postmenopausal women is crucial for the prevention of postmenopausal osteoporosis (PMOP). Here, calcium yak caseinate (CYC) was provided to ovariectomized (OVX) mice as a nutrition supplement for 6 wk and was shown to effectively improve PMOP. It was observed that CYC remarkably improved the bone physical index (bone length and weight) of OVX mice, and significantly reduced the levels of serum calcium, alkaline phosphatase, and carboxy-terminal telopeptide of type I collagen, while significantly increasing the level of serum procollagen I N-terminal propeptide. It is of particular significance that low-dose CYC (L-CYC) was observed to prevent the decline of bone mineral density in OVX mice. Moreover, CYC supplementation has been shown to attenuate the deterioration of trabecular bone structure and to maintain the morphology and number of trabeculae. Additionally, it has been demonstrated to prevent skeletal muscle atrophy to a certain extent. This study indicated that L-CYC effectively inhibited bone resorption while facilitating bone formation, thereby improving bone quality in OVX mice.

Bone-derived factors mediate crosstalk between skeletal and extra-skeletal organs

Bone has long been acknowledged as a fundamental structural entity that provides support and protection to the body's organs. However, emerging research indicates that bone plays a crucial role in the regulation of systemic metabolism. This is achieved through the secretion of a variety of hormones, cytokines, metal ions, extracellular vesicles, and other proteins/peptides, collectively referred to as bone-derived factors (BDFs). BDFs act as a medium through which bones can exert targeted regulatory functions upon various organs, thereby underscoring the profound and concrete implications of bone in human physiology. Nevertheless, there remains a pressing need for further investigations to elucidate the underlying mechanisms that inform the effects of bone on other body systems. This review aims to summarize the current findings related to the roles of these significant modulators across different organs and metabolic contexts by regulating critical genes and signaling pathways in vivo. It also addresses their involvement in the pathogenesis of various diseases affecting the musculoskeletal system, circulatory system, glucose and lipid metabolism, central nervous system, urinary system, and reproductive system. The insights gained from this review may contribute to the development of innovative therapeutic strategies through a focused approach to bone secretomes. Continued research into BDFs is expected to enhance our understanding of bone as a multifunctional organ with diverse regulatory roles in human health.

Serum alkaline phosphatase/creatinine ratio serving as a screening tool for low lumbar bone mineral density in patients with degenerative lumbar scoliosis

PURPOSE

(1) To figure out a simple and effective indicator that could assist in the assessment of bone mineral density (BMD) based on big data and (2) to verify its predictive value for low BMD among patients with degenerative lumbar scoliosis (DLS).

METHODS

A total of 6,167 participants from the National Health and Nutrition Examination Survey (NHANES) database (2009-2010, 2013-2014, 2017-2018) and 166 patients who were diagnosed with DLS and hospitalized in our center between June 2019 and April 2023 were enrolled in the study. Cases were divided into two groups based on whether the T-score was below - 1. The Osteopenia Index (OI) was defined as the ratio of alkaline phosphatase (ALP) (IU/L) to creatinine (mg/dL). Multivariable logistic regression was performed to identify risk factors, while restricted cubic spline (RCS) analysis was applied to explore the potential non-linear relationship. Patients with DLS from our center were used to validate the diagnostic value of OI through receiver operating characteristic curve (ROC) analysis.

RESULTS

Participants from NHANES were divided into three subgroups according to the tertiles of OI: subgroup 1 (OI < 68), subgroup 2 (68 ≤ OI < 93), and subgroup 3 (OI ≥ 93). A multivariable logistic regression model adjusted for age, gender, and race revealed that elevated OI was a significant risk factor for osteopenia (subgroup 2 vs. subgroup 1: odds ratio [OR] = 1.473, 95% confidence interval [CI] = 1.173-1.849; subgroup 3 vs. subgroup 1: OR = 2.092, 95% CI = 1.566-2.796). Moreover, the RCS plot showed that the risk of osteopenia gradually increased with the elevation of OI. In patients with DLS, OI showed a significant correlation with lumbar T-score (ρ = - 0.392) and HU value (ρ = - 0.373) (both P < 0.001). ROC analysis revealed that the area under the curve of OI was 0.757, and the cut-off value was set at 124.73 according to the Youden index. A nomogram based on a logistic regression model adjusted for age, gender, and blood urea nitrogen was plotted, with a McFadden R² of 0.212.

CONCLUSION

OI correlated significantly with lumbar BMD and HU value. Logistic regression and RCS analysis demonstrated that OI could serve as a simple, economical, and effective screening tool for low lumbar BMD in DLS patients, with its predictive ability further enhanced when adjusted for age and gender.

"The effect of aerobic exercise on bone formation and resorption markers and the quality of life tests in postmenopausal osteopenic patients"

The aim of the current study was to examine the effects of light- to moderate intensity aerobic exercise on bone mineral density (BMD) in postmenopausal osteopenic women by using bone formation and resorption markers. In the current study, P1NP and CTX levels increased in both the exercise and the control group. The aim of the current study was to examine the effects of light- to moderate-intensity aerobic exercise on bone mineral density (BMD) in postmenopausal osteopenic women by using rapidly responsive bone formation and resorption markers.

PURPOSE

In this prospective, randomized, controlled, single-blind clinical study, women aged 45-65 years with BMD T scores between - 1 and - 2.5 measured by double X-ray absorptiometry (DXA) were included after evaluation of exclusion criteria and the women were divided into 2 groups: aerobic exercise group and control group (exercise, n = 25; control, n = 25). At baseline and at the 12-week follow-up, the serum levels of bone formation and resorption biomarkers, including procollagen type 1 N-terminal propeptide (P1NP), cross-linked C-telopeptide of type I collagen (CTX), osteocalcin, oxidative markers such as malondialdehyde, nonbone-specific total alkaline phosphatase, 25(OH)D3, and parathyroid hormone (PTH), were examined in all patients.

RESULTS

A statistically significant increase in P1NP and CTX levels was noted in both the exercise and control groups at the 12-week evaluation compared to baseline (p > 0.05). Although there was no significant change in osteocalcin levels in the control group (p > 0.05), a statistically significant increase was observed in the exercise group (p < 0.05). In the exercise group, no significant changes were observed in bone formation or resorption markers, including P1NP, CTX, osteocalcin, and total ALP, or in oxidative stress markers, such as malondialdehyde, compared to those in the control group (p > 0.05).

CONCLUSION

In conclusion, the current study revealed that regular walking exercise of light to moderate intensity significantly contributes to improvements in pain, walking speed, balance, lower extremity dynamic balance, and activities of daily living in postmenopausal women with osteopenia compared to inactive individuals.

TRIAL REGISTRATION

Clinical Trial Number NCT06866561.

Bone Modelling and Remodelling in Cold Environment

People engaged in various activities in cold environments-such as those living in cold climates, polar workers, cold storage workers, and athletes engaged in winter sports-are frequently affected by cold environments. Therefore, it is of great significance to explore the modelling and remodelling of bones in cold environments. Cold environments can shorten the length of bones, thin the thickness of bones, decrease bone mineral density (BMD), change the biomechanical properties of bones, and lead to bone loss. In addition, cold directly affects the bone microenvironment. Exposure to cold causes spindle-like and fibroblast-like changes in bone marrow mesenchymal stem cells (BMSCs) and decreases their proliferation, and cold exposure promotes the osteogenic differentiation of BMSCs partly through the p38 MAPK pathway. Cold also alters the dendritic differentiation of OBs by reducing the transmembrane glycoprotein E11/podoplanin and damages endothelial cells (ECs) by elevating levels of VEGF, resulting in a reduced blood supply and thus fewer OBs. In addition, cold promotes lipolysis of marrow adipose tissue (MAT), but in combination with exercise, it can promote the differentiation of BMSCs into MAT. Cold environments interfere with angiogenesis and inhibit bone growth by affecting factors such as platelet-derived growth factor type BB (PDGF-BB), slit guidance ligand 3 (SLIT3), Notch, and VEGF. In addition, cold environments may promote bone resorption by activating sympathetic nerves to activate β-adrenergic receptors and regulating leptin secretion, and regulate bone metabolism by activating the p38 MAPK signalling pathway and increasing the synthesis of brown fat, which ultimately inhibit bone formation and enhance bone resorption. In this paper, we describe the effects of cold environments on bones in the locomotor system in terms of bone structure, bone mass, biomechanical properties, and various skeletal cells, bone blood vessels, and bone fat systems in the bone microenvironment.

Curcumin Ameliorated Glucocorticoid-Induced Osteoporosis While Modulating the Gut Microbiota and Serum Metabolome

Glucocorticoid-induced osteoporosis (GIOP) is the leading cause of secondary osteoporosis. Recently, the "bone-gut axis" theory has linked bone development with gut microbial diversity, community composition, and metabolites. Curcumin, a well-studied polyphenol, shows potential in mitigating bone loss and osteoporosis. Alendronate, a standard therapeutic agent for osteoporosis, serves as a positive control in this investigation. The study demonstrates the potency of curcumin in reducing bone loss and restoring bone mineral density, enhancing trabecular parameters notably through increased trabecular number, volume, and thickness and reduced bone marrow cavity size. Gut microbiome sequencing revealed that both curcumin and alendronate treatments similarly enhanced gut microbial diversity and altered microbiota composition, increasing beneficial bacteria (Akkermansia_muciniphila, Dubosiella_sp910585105, and Ruminococcus_sp910584195) while reducing harmful bacteria (Treponema_D_sp910584475 and Duncaniella_sp910584825). Furthermore, significant changes in serum levels of metabolites including raffinose, ursolic acid, spermidine, inosine, hypoxanthine, thiamine, and pantothenic acid were observed post-treatment with curcumin or alendronate. Importantly, these beneficial metabolites and microorganisms were negatively correlated with inflammatory cytokines. In conclusion, curcumin holds promise for use against GIOP by modulating the gut microbiome and serum metabolome as well as reducing systemic inflammation.

Laboratory-based Biomarkers for Risk Prediction, Auxiliary Diagnosis and Post-operative Follow-up of Osteoporotic Fractures

PURPOSE OF REVIEW

Osteoporosis (OP) is characterized by degraded bone microstructure, loss of bone mass and increased risk of fragility fractures. Currently, T-score determined by dual-energy X-ray absorptiometry (DEXA) measurements has been regarded as the gold standard for the diagnosis of osteoporosis. However, multiple factors have indicated that the T-score is insufficient to identify individuals with osteoporosis at a potentially high risk of fracture, or accurately detect those who require treatment, or continuously monitor the risk of re-fracture and clinical outcomes after treatment. This review covers publications in a range of ten years and comprehensively summarizes the studies in laboratory-based biomarkers for osteoporotic fractures (OF), aiming to provide physicians and surgeons with an update of clinical research in identification, verification and application of these tools, and to provide useful information for the design of future clinical studies.

RECENT FINDINGS

It was found that bone formation markers (such as PINP, BGP, ECM1 and SOST), bone resorption markers (such as β-CTX, TRAcP5b, osteocalcin, RANKL, RANKL/OPG ratio, and t-PINP/β-CTX), hormonal biomarkers (such as IGF- 1, PTH, leptin, adiponectin and AMH), indicators of inflammation and oxidative stress (SII, IL- 6, LTL, FlOP_360, FlOP_400, and GGT), microRNAs (such as miR- 21, miR- 320a- 3p, miR- 491 - 5p, miR- 485 - 3p, miR- 19b- 1- 5p, miR- 203a, miR- 31 - 5p, miR- 502 - 3p, miR- 4739, miR- 497, miR- 19b, and miR- 107), other biomarkers (SAF-AGEs and glycine), adipocytokines (irisin and Omentin- 1), senescence biomarkers (RDW), and lncRNAs (MIAT) may be useful biomarkers for clinical practice. Further validation of these biomarkers and a better understanding of the underlying molecular mechanisms may help in the development and application of these biomarkers for risk prediction of OF, differential diagnosis among OP, OF and healthy individuals, as well as post-operative monitoring of re-fracture risk and treatment outcomes.

Elevated baseline CTX levels predict enhanced therapeutic efficacy of zoledronic acid in augmenting lumbar spine bone mineral density among Chinese osteoporosis patients

This study examined the link between baseline CTX levels and zoledronic acid's effectiveness in boosting bone density in osteoporosis patients. Among 472 Chinese patients, higher initial CTX levels correlated with greater lumbar spine bone density improvement after treatment. However, no such correlation was found for hip or femoral neck bones. This suggests CTX levels may aid in treatment selection for lumbar spine, though further research is needed. The findings have clinical implications for optimizing osteoporosis treatment.

PURPOSE

To elucidate the correlation between baseline CTX levels and the therapeutic efficacy of zoledronic acid in augmenting bone mineral density (BMD) among individuals with osteoporosis.

METHODS

This study studied patients diagnosed with primary osteoporosis who were hospitalized at least twice and received annual zoledronic acid therapy. Patients were stratified into three groups based on their initial CTX levels prior to zoledronic acid administration. ANOVA was employed to compare BMD alterations across the groups. Generalized estimating equations (GEE) were utilized to analyze the relationship between baseline CTX levels and subsequent BMD changes post-zoledronic acid treatment. Statistical analyses were conducted using SPSS version 26.0.

RESULTS

A total of 472 patients were evaluated and categorized into three cohorts according to their initial CTX levels, arranged in ascending order. Notably, group 3, characterized by the highest initial CTX levels, demonstrated a significantly more pronounced increase in lumbar spine BMD compared to the other two groups. Specifically, when group 1 served as the reference, group 3 exhibited a 0.4-unit elevation in lumbar spine T-score. Conversely, no discernible relationship was observed between baseline CTX levels and BMD changes in the hip or femoral neck following zoledronic acid treatment.

CONCLUSIONS

Our findings among a Chinese population indicate that elevated CTX levels, particularly exceeding 0.480 ng/ml, are notably associated with enhanced therapeutic efficacy of zoledronic acid in boosting lumbar spine BMD. However, this correlation appears less robust with respect to improvements in hip and femoral neck BMD.

FKBP5 Induces Senescence in BMSCs and Inhibits Osteogenic Differentiation Through the Canonical WNT/β-Catenin Signalling Pathway in Senile Osteoporosis

Senile osteoporosis and its associated fractures significantly contribute to increased morbidity, mortality, and healthcare costs among older adults. Further research is needed to elucidate the molecular mechanisms underlying senile osteoporosis. This study found that FKBP5 expression in bone marrow mesenchymal stem cells (BMSCs) increases with age and is inversely correlated with patients' bone mineral density and CT values. Functional analyses revealed that FKBP5 plays a crucial regulatory role in BMSC osteogenic differentiation, acting through the canonical WNT/β-catenin signalling pathway. FKBP5 binds to β-catenin, promoting its ubiquitination and degradation. Importantly, administration of SAFit2, a selective FKBP5 inhibitor, enhanced bone mineral density in an animal model of senile osteoporosis. These findings suggest that FKBP5 may represent a novel therapeutic target and provide new insights into the treatment of senile osteoporosis.

How Accurately Does Bone Mineral Density Predict Bone Strength? A Clinical Observational Study of Osteoporosis Vertebral Compression Fractures in Postmenopausal Women

OBJECTIVES

Dual energy x-ray absorptiometry (DXA) provides incomplete information about bone strength. There are few data on the relationship between osteoporosis-related examinations and bone strength. The objective of the present study was to determine which osteoporosis-related examinations best predicted trabecular bone strength, and to enhance a formula for predicting bone strength on the basis of bone density examination.

METHODS

This observational study included postmenopausal women (aged over 50 years) who underwent unilateral percutaneous kyphoplasty (PKP) surgery in the lumbar spine between September 2021 and June 2023. The pressure within each balloon expansion circle was extracted to reflect the true bone strength. The NHANES 2013-2014 data were used to assess the performance of the formula. The performance of the formula was compared with that of the observed actual fractures. Bland-Altman analysis was used to compare the agreement between the formula and the fracture risk assessment tool (FRAX) score.

RESULTS

A total of 40 postmenopausal women (mean age ± standard deviation, 70.90 years ± 10.30) were enrolled. The average balloon pressure was 59.23 psi (± 12.40, means ± SDs). The mean BMD of total lumbar spine (average of L1-L4) was 0.89 g/cm2 ± 0.20 (mean ± standard), and the Pearson correlation coefficient between lumbar BMD and bone strength was 0.516. After adjusting for age and BMI, the DXA response rate to bone strength reached 72%. Calibration plots of the observed actual fractures versus those estimated via the bone strength formula were considered good fits. The Bland-Altman analysis revealed a nonsignificant difference between the formula and the FRAX score in predicting fracture risk.

CONCLUSIONS

After adjustment, the DXA response rate to bone strength reached 72%, indicating a strong correlation. In addition, Bone Strength = DXA × 27 - Age × 0.585-BMI × 0.887 + 98.

PPARγ-SMAD6 axis-mediated inhibition of osteogenic differentiation is involved in BPS-induced osteoporosis

Bisphenol S (BPS) is extensively utilized in personal care products, foods, and paper products, raising growing concerns about its potential environmental hazards. However, few studies have reported the effects of BPS exposure on bone homeostasis. In this study, using data from the National Health and Nutrition Examination Survey, we found a negative correlation between urinary BPS and bone mineral density (BMD). To further investigate the underlying mechanisms, C57BL/6 mice were exposed to a human-equivalent dose of BPS for 6 months. Micro-CT analysis demonstrated reduced femoral BMD in the mice, indicating that osteoporosis was caused by chronic exposure. RNA-seq analysis showed that BPS activated PPARγ in human primary mesenchymal stem cells (MSCs). Additionally, 3D molecular docking confirmed a direct interaction between BPS and PPARγ. Bioinformatics analysis identified SMAD6 as a downstream target of PPARγ. Mechanistically, the BPS-PPARγ interaction activated PPARγ, promoting SMAD6 transcription, which inhibited the osteogenic differentiation of MSCs. High-throughput virtual screening further revealed that olodanrigan effectively blocked the BPS-PPARγ interaction, and in vitro assays revealed that olodanrigan blocked the inhibition of osteogenic differentiation of MSCs induced by BPS. Additionally, olodanrigan supplementation inhibited PPARγ levels, thereby reversing BPS-induced osteoporosis. In summary, this study elucidates the role of the PPARγ-SMAD6 axis in mediating BPS-induced osteoporosis and highlights olodanrigan as a promising therapeutic intervention, offering new insights into the health risks posed by BPS and potential targets for treatment.

Diagnostic Approach to Abnormal Alkaline Phosphatase Value

Alkaline phosphatase (ALP) is abundantly represented in nature, being fundamental for a number of processes. In addition to its fundamental function in skeletal mineralization, its roles in the pathogenesis of other diseases are being explored. The measurement of total ALP activity in serum or in plasma is a useful biomarker in clinical practice. Indeed, routine measurement of serum total ALP is a long-standing established part of initial biochemical evaluation of patients both in the hospital setting and on an ambulatory basis. Raised or reduced values of this enzyme activity are indicative of a number of diseases, most commonly affecting the skeleton and the biliary tract. Electrophoretic assays are preferable for visualizing and investigating the cause of increased serum total ALP activities, and bone ALP immunoassays are preferable for investigating and monitoring individuals with bone and mineral metabolic abnormalities. Here, we give a holistic vision of this fundamental enzyme, suggesting a clinical approach to the identification of diseases causing abnormal values. Finally, a therapeutic role has emerged as substitutive therapy in patients with hypophosphatasia, even though ongoing and future studies are exploring its role in other therapeutic areas. This narrative review was based on articles found by searching PubMed from its inception until July 2024 for the terms alkaline phosphatases, isozymes, isoforms, bone alkaline phosphatase, liver alkaline phosphatase, intestinal alkaline phosphatase, placental alkaline phosphatase, liver function tests, γ-glutamyltransferase, skeletal diseases, and liver diseases. We limited our research to papers published in the English language, with emphasis placed on those describing differential diagnosis whenever available.

Perspectives of exosomal ncRNAs in the treatment of bone metabolic diseases: Focusing on osteoporosis, osteoarthritis, and rheumatoid arthritis

Bone metabolic disorders, constituting a group of prevalent and grave conditions, currently have a scarcity of therapeutic alternatives. Over the recent past, exosomes have been at the forefront of research interest, owing to their nanoparticulate nature and potential for therapeutic intervention. ncRNAs are a class of heterogeneous transcripts that they lack protein-encoding capacity, yet they can modulate the expression of other genes through multiple mechanisms. Mounting evidence underscores the intricate role of exosomes as ncRNAs couriers implicated in the pathogenesis of bone metabolic disorders. In this review, we endeavor to elucidate recent insights into the roles of three ncRNAs - miRNAs, lncRNAs, and circRNAs - in bone metabolic ailments such as osteoporosis, osteoarthritis, and rheumatoid arthritis. Additionally, we examine the viability of exosomal ncRNAs as innovative, cell-free modalities in the diagnosis and therapeutic management of bone metabolic disorders. We aim to uncover the critical function of exosomal ncRNAs within the context of bone metabolic diseases.

Calycosin alleviates ovariectomy-induced osteoporosis by promoting BMSCs autophagy via the PI3K/Akt/mTOR pathway

Calycosin, the main extract from the traditional Chinese medicine (TCM) Astragalus membranaceus, has demonstrated anti-osteoporotic properties in ovariectomized (OVX) mice. However, the specific pathways through which it prevents osteoporosis remain unexplored. This study aimed to investigate the pathways by which calycosin promotes autophagy in bone marrow mesenchymal stem cells (BMSCs) and alleviates ovariectomy-induced osteoporosis. Mice were divided into three groups: sham, OVX, and OVX + calycosin. Following a 12-week intervention period, assessments included analysis of bone microstructure, serum concentrations of LC3II and ALP, and evaluation of Trap expression in femoral tissue. Immunohistochemical staining was used to assess the expression levels of PI3K, Runx2, and Beclin-1 in bone tissue. Additionally, levels of Runx2, ALP, p-PI3K, PI3K, mTOR, p-mTOR, Beclin-1, and ULK1 were analyzed. Osteogenic differentiation of BMSCs was evaluated using ALP and Alizarin red staining. OVX significantly impaired BMSCs osteogenic differentiation, resulting in bone loss. In contrast, calycosin increased bone mass, promoted osteogenesis, and reduced cancellous bone loss. Parameters, such as BMD, BV/TV, Tb.N, and Tb.Th, were significantly higher in the OVX + calycosin group compared to the OVX group. Additionally, Tb.Sp was notably reduced in the OVX + calycosin group. Calycosin also upregulated levels of Runx2, ALP, p-PI3K, p-mTOR, ULK1, and Beclin-1. In cellular studies, calycosin promoted BMSCs osteogenesis under OVX conditions; however, this effect was inhibited by LY294002. Calycosin effectively combats bone loss and improves bone structure. Its mechanism likely involves the promotion of autophagy in osteoblasts, thereby stimulating BMSC osteogenic differentiation. This effect may be mediated through the PI3K/Akt/mTOR pathway. These findings suggest that calycosin has the potential to serve as an alternative therapy for treating osteoporosis.

Epiregulin ameliorates ovariectomy-induced bone loss through orchestrating the differentiation of osteoblasts and osteoclasts

Epiregulin plays a role in a range of biological activities including malignancies. This study aims to investigate the potential contribution of epiregulin to bone cell differentiation and bone homeostasis. The data showed that epiregulin expression was upregulated during osteogenesis but downregulated during adipogenesis. Functionally, epiregulin promoted osteoblast differentiation while inhibiting adipocyte differentiation from mesenchymal progenitor cells. Epidermal growth factor receptor (EGFR), one of the two known receptors for epiregulin, exerted opposing effects compared to epiregulin. Intriguingly, silencing EGFR almost completely abolished the dysregulation of osteoblast and adipocyte differentiation induced by epiregulin, suggesting that EGFR is indispensable for mediating epiregulin function. Further mechanistic exploration indicated that epiregulin/EGFR signaled via the inactivation of mechanistic target of rapamycin complex 1 (mTORC1) pathway. Moreover, epiregulin downregulated RANKL expression in bone marrow stromal cells (BMSCs) and inhibited the differentiation of bone marrow osteoclast precursor cells into osteoclasts. Treatment of ovariectomized female mice with recombinant epiregulin increased osteoblasts and bone formation, decreased osteoclasts and bone resorption, and ameliorated cancellous bone loss. Consistently, epiregulin treatment improved the potential of BMSCs to differentiate into osteoblasts. Collectively, this study has identified a critical role of epiregulin in regulating osteoblast differentiation through EGFR-mediated inactivation of the mTORC1 pathway, as well as osteoclast differentiation via a mechanism associated with RANKL signaling. Additionally, it highlights the potential of epiregulin as a strategy for combating osteoporosis.

Vitamin D and calcium supplementation in women undergoing pharmacological management for postmenopausal osteoporosis: a level I of evidence systematic review

The present systematic review investigates whether different doses of vitamin D and calcium supplementation in women with postmenopausal osteoporosis undergoing antiresorptive therapy have an association with BMD (spine, hip, femur neck), serum markers of osteoporosis (bone-ALP, NTX, CTX), the rate of pathological vertebral and non-vertebral fractures, adverse events, and mortality. This systematic review was conducted according to the PRISMA 2020 guidelines. PubMed, Google Scholar, Embase, and Scopus databases were accessed in September 2024. All randomised clinical trials (RCTs) comparing two or more treatments for postmenopausal osteoporosis supplemented with vitamin D and/or calcium were accessed. Only studies that indicated daily vitamin D and/or calcium supplementation doses were accessed. Data from 37 RCTs (43,397 patients) were retrieved. Patients received a mean of 833.6 ± 224.0 mg and 92.8 ± 228.7 UI of calcium and vitamin D supplementation, respectively. The mean length of the follow-up was 25.8 ± 13.3 months. The mean age of the patients was 66.4 ± 5.6 years, and the mean BMI was 25.2 ± 1.6 kg/m2. There was evidence of a statistically significant negative association between daily vitamin D supplementation and gastrointestinal adverse events (r = - 0.5; P = 0.02) and mortality (r = - 0.7; P = 0.03). No additional statistically significant associations were evidenced. In postmenopausal women who undergo antiresorptive treatment for osteoporosis, vitamin D was associated with a lower frequency of gastrointestinal adverse events and mortality. Calcium supplementation did not evidence an association with any of the endpoints of interest.Level of evidence Level I, systematic review of RCTs.

Innovations in aggregation-induced emission materials for theranostics in the musculoskeletal system

Aggregation-induced emission (AIE) offers a promising solution for achieving lower background and more reliable signals in biomedical imaging. AIE materials also exhibiting photostability and resistance to photobleaching. These characters are crucial for monitoring musculoskeletal functions and offering targeted therapies for related diseases. This review compiles research on AIEgens targeting various molecules, cells, or tissues within the musculoskeletal system under physiological or pathological conditions and classifies them according to different clinical applications. A sort of AIEgens is applied in monitoring osteogenic differentiation and bone component analysis. Additionally, AIEgens targeting intra-articular inflammatory or rheumatic related molecules, such as reactive oxygen species, enable early-stage diagnosis and targeted therapies of arthritis. Researchers have also developed novel materials containing AIEgens for joint tissue repair. This review highlights the advantages of these applications while also exploring future demands and development directions in musculoskeletal system imaging and treatment, aiming to promote further design of AIEgens and their clinical applications in musculoskeletal diseases.

COPB1 deficiency triggers osteoporosis with elevated iron stores by inducing osteoblast ferroptosis

Background

Osteoporosis (OP) is a systemic bone metabolic disease that results from an imbalance between bone formation and bone resorption. The accumulation of iron has been identified as an independent risk factor for osteoporosis. Ferroptosis, a novel form of programmed cell death, is driven by iron-dependent lipid peroxidation. Nevertheless, the precise role of ferroptosis in iron accumulation-induced osteoporosis remains uncertain.

Methods

We utilized proteomics and ELISA to screen key regulatory molecules related to iron accumulation in osteoporosis populations. HE staining was used to assess osteocyte changes in Hamp knockout (KO) iron accumulation mouse models. Western Blot, qPCR, ALP staining, and Alizarin Red staining were employed to explore the effects of siRNA-mediated gene knockdown on osteogenic differentiation in the MC3T3 cell line. ELISA, micro-CT, von Kossa staining, toluidine blue staining, TRAP staining, and calcein analysis were used to study the bone phenotype of conditional gene knockout mice. RNA-seq, endoplasmic reticulum activity probes, transmission electron microscopy (TEM), Western Blot, co-immunoprecipitation (Co-IP), flow cytometry, and ChIP-seq were employed to investigate the regulatory mechanisms of the target gene in osteogenic differentiation. OVX and Hamp KO mice were used to establish osteoporosis models, and AAV-mediated overexpression was employed to explore the intervention effects of the target gene on osteoporosis.

Results

The experiments demonstrate that iron accumulation can lead to changes in COPB1 expression levels in bone tissue. Cellular and animal experiments revealed that COPB1 deficiency reduces the osteogenic ability of osteoblasts. Transcriptome analysis and phenotypic experiments revealed that COPB1 deficiency induces ferroptosis and endoplasmic reticulum stress in cells. Further investigation confirmed that COPB1 plays a key role in endoplasmic reticulum stress by inhibits SLC7A11 transcription via ATF6. This reduces cystine uptake, ultimately inducing ferroptosis. Overexpression of COPB1 can restore osteogenic function in both cells and mice.

Conclusion

This study elucidated the essential role of COPB1 in maintaining bone homeostasis and highlights it as a potential therapeutic target for treating iron accumulation-related osteoporosis.

The translational potential of this article

Our data elucidate the critical role of COPB1 in maintaining bone homeostasis and demonstrate that COPB1 can directly promote bone formation, making it a potential therapeutic target for the future treatment of osteoporosis.

Advances in biomarkers and diagnostic significance of organ aging

A complete understanding of aging is a critical first step in treating age-related diseases and postponing aging dysfunction in the context of an aging global population. Aging in organisms is driven by related molecular alterations that gradually occur in many organs. There has previously been a wealth of knowledge of how cells behave as they age, but when aging is investigated as a disease, the discovery and selection of aging biomarkers and how to diagnose the aging of the organism are crucial. Here, we provide a summary of the state of the field and suggest future potential routes for research on organ senescence markers. We reviewed research on biomarkers of risk of aging from the perspective of organ aging and summarized the biomarkers currently used on three scales. We emphasize that the combination of traditional markers with emerging multifaceted biomarkers may be a better way to diagnose age-related diseases.

Influence of disease activity and gonadal status on bone mineral density and turnover in acromegaly

INTRODUCTION

The purpose of this study was to evaluate the impact of disease activity and gonadal status on bone mineral density (BMD) and turnover markers (BTMs) in individuals with acromegaly.

MATERIALS AND METHODS

Subjects underwent laboratory tests for PTH, 25-hydroxyvitamin D, calcium, phosphorus, osteocalcin (OC) and C-telopeptide (CTX-1) and bone densitometry at the lumbar spine (LS), femoral neck (FN) and total hip (TH).

RESULTS

Sixty participants (48.6 ± 11.0 years; 66,7% female) were included in this cross-sectional study. Phosphorus, OC, CTX-1, and LS BMD were greater in the active disease group than in the controlled/cured disease group (P = 0.025, P < 0.001, P = 0.007, and P = 0.016, respectively). When analyzing gonadal status, phosphorus, OC and CTX-1 were greater in the hypogonadal group than in the eugonadal group (P = 0.017, P = 0.015, and P = 0.033, respectively). Patients with hypogonadism had a higher prevalence of reduced bone mass compared to eugonadal patients (44 vs. 17%, P = 0.023).

CONCLUSION

This study revealed increased levels of phosphorus and BTMs in patients with active acromegaly. In this group, the greater LS BMD values are likely due to the anabolic effects of GH and IGF-1 and/or to the influence of LS arthropathy. Moreover, hypogonadism negatively impacts bone metabolism in acromegaly, leading to elevated BTMs and a higher prevalence of reduced bone mass in individuals affected by both conditions.

The Roles of Forkhead Box O3a (FOXO3a) in Bone and Cartilage Diseases - A Narrative Review

Bone and cartilage diseases are significantly associated with musculoskeletal disability. However, no effective drugs are available to cure them. FOXO3a, a member of the FOXO family, has been implicated in cell proliferation, ROS detoxification, autophagy, and apoptosis. The biological functions of FOXO3a can be modulated by post-translational modifications (PTMs), such as phosphorylation and acetylation. Several signaling pathways, such as MAPK, NF-κB, PI3K/AKT, and AMPK/Sirt1 pathways, have been implicated in the development of bone and cartilage diseases by mediating the expression of FOXO3a. In particular, FOXO3a acts as a transcriptional factor in mediating the expression of various genes, such as MnSOD, CAT, BIM, BBC3, and CDK6. FOXO3a plays a critical role in the metabolism of bone and cartilage. In this article, we mainly discussed the biological functions of FOXO3a in bone and cartilage diseases, such as osteoporosis (OP), osteoarthritis (OA), rheumatoid arthritis (RA), ankylosing spondylitis (AS), and intervertebral disc degeneration (IDD). FOXO3a can promote osteogenic differentiation, induce osteoblast proliferation, inhibit osteoclast activity, suppress chondrocyte apoptosis, and reduce inflammatory responses. Collectively, up-regulation of FOXO3a expression shows beneficial effects, and FOXO3a has become a potential target for bone and cartilage diseases.

Association of neutrophil to high-density lipoprotein cholesterol ratio with fragility fracture in osteoporotic patients: a case-control study

BACKGROUND

Systematic inflammation plays an important role in the pathogenesis of osteoporosis. Neutrophil to high-density lipoprotein cholesterol ratio (NHR) has been considered as a novel inflammatory marker. To date, the clinical association between NHR and fragility fracture is not yet well-known. Thus, the present study explored whether NHR levels in patients with osteoporosis were associated with an increased risk of fragility fracture.

METHODS

This case-control study included 271 osteoporotic patients with and without a history of fragility fracture from January 2017 to December 2021. Laboratory tests and physical examinations were conducted in all participants, and NHR was calculated.

RESULTS

The mean NHR levels in patients with fragility fractures were significantly higher compared to those without fragility fractures (2.91 ± 1.18 vs. 2.21 ± 0.91, P < 0.001). Additionally, there was a significant positive correlation between NHR and fragility fracture (r = 0.310, P < 0.001). Moreover, we could detect a statistical increment of the area under receiver operating characteristics curve (from 0.681 to 0.805, P < 0.001) upon the combination of NHR and Fracture Risk Assessment Tool (FRAX) score for determining the presence of fragility fracture among the study patients. In multivariable logistic regression models, elevated NHR level was an independent risk factor for fragility fracture (adjusted OR: 1.924, 95% CI: 1.443-2.564, P < 0.001) when adjusted for alkaline phosphatase and FRAX score.

CONCLUSIONS

As a valuable and convenient inflammatory biomarker calculated from routine blood examinations, NHR might help to identify individuals with osteoporosis who are at high risk of fragility fracture.

Total flavonoids isolated from Eucommia ulmoides can alleviate bone loss and regulate intestinal microbiota in ovariectomized rats

Ethnopharmacological relevance

Eucommia ulmoides, recognized as a traditional Chinese medicinal herb, can tonify liver and kidney and strengthen bones and muscles. Modern pharmacological research has proved that E. ulmoides could prohibit the occurrence of osteoporosis and arthritis.

Aim

To investigate the effect and action mechanism of total flavonoids isolated from the leaves of E. ulmoides (TFEL) on bone loss in ovariectomized (OVX) rats, and to study its effect on intestinal flora.

Materials and methods

The 3-month-old female rats were randomly divided into six groups: sham operation group, OVX model group, estradiol group, TFEL low (TFEL-L) (50), mid (-M) (100) and high (-H) (200 mg/kg/d) dose groups. After 13 weeks of treatment, the rats were sacrificed to measure bone turnover markers, related tissue biochemical indices, microstructure parameters, and osteoclastogenesis promotor RANKL and inhibitor OPG expression levels. Additionally, fecal samples were obtained for high-throughput sequencing to analyze the intestinal flora.

Results

Oral administration of TFEL for 13 weeks increased the serum level of bone formation marker PINP and decreased the level of bone resorption marker NTX-I. The femoral microstructure parameters of the TFEL-M and TFEL-H groups were significantly improved compared with the OVX group, which were also confirmed by H&E histological staining. High-throughput sequencing indicated that TFEL may regulate the composition of intestinal flora and intestinal microecology.

Conclusion

TFEL can prevent osteoporosis in OVX rats and has no toxic side effects. Meanwhile, TFEL can increase the diversity and improve the composition of intestinal flora in OVX rats.

Association of serum alkaline phosphatase levels with bone mineral density, osteoporosis prevalence, and mortality in US adults with osteoporosis: evidence from NHANES 2005-2018

This study examined the association of serum total alkaline phosphatase (T-ALP) with bone mineral density (BMD) and osteoporosis prevalence in the general population, and investigated its association with mortality in individuals with osteoporosis, using data from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. Elevated serum T-ALP levels were significantly associated with both reduced BMD and an increased risk of osteoporosis in all participants. Moreover, elevated T-ALP levels were linked to higher all-cause mortality among individuals with osteoporosis during this period.

INTRODUCTION

The evidence regarding the association between serum T-ALP, BMD and osteoporosis prevalence in general population is incomplete, and limited evidence is available concerning its association with mortality among individuals with osteoporosis. The study investigated the association of serum T-ALP with BMD and osteoporosis prevalence in the general population, and examined its association with mortality in individuals with osteoporosis.

METHODS

All participants were adults from the NHANES (2005-2018), and mortality data were obtained from the National Death Index up to December 31, 2019. Firstly, the association of serum T-ALP with BMD and osteoporosis risk was assessed using linear regression model, subgroup analysis, analysis of covariance and weighted logistic regression model, respectively. Secondly, survival analysis including Kaplan-Meier curves, Cox proportional hazards models, and restricted cubic spline regression models were utilized to analyze the relationship between serum T-ALP levels and mortality risk.

RESULTS

The study included 13,724 participants aged 18 to 85 years, and 944 were diagnosed with osteoporosis, among whom 221 died during a median of 133 months follow-up. Totally, elevated serum T-ALP was significantly associated with low BMD in femoral neck and lumbar spine, and the results exhibited consistency across diverse age, genders, races, and BMI subgroups. Moreover, for each 1 SD increase in T-ALP, there was a 0.5% increase in the prevalence of osteoporosis [OR (95%CI): 1.005 (1.005, 1.005), p < 0.001]. Among individuals with osteoporosis, for every 1 SD increase in T-ALP, the all-cause mortality increased by 0.4% [HR (95%CI):1.004 (1.002, 1.006), p < 0.001]. Meanwhile, comparing participants with highest serum T-ALP levels (> 79 IU/L) to those with lowest levels (< 53 IU/L) further raised the prevalence of osteoporosis [OR (95%CI):1.292 (1.021, 1.636), p = 0.033] and all-cause mortality [HR (95% CI):1.232 (1.041, 1.459), p = 0.015].

CONCLUSIONS

Based on a representative sample of US adults, elevated serum T-ALP levels were found to be significantly associated with both reduced BMD and an increased risk of osteoporosis across all participants, as well as with a higher all-cause mortality in individuals with osteoporosis.

Icariin Facilitates Osteogenic Differentiation and Suppresses Adipogenic Differentiation of Bone Marrow Mesenchymal Stem Cells by Enhancing SOST Methylation in Postmenopausal Osteoporosis

PURPOSE

Postmenopausal osteoporosis (PMO) is mainly concerned with the imbalance of bone resorption and bone formation. Icariin (ICA) plays a vital role in bone protection. This study investigated the mechanism of ICA in PMO rats.

METHODS

The rats were treated with ovariectomy (OVX) and ICA. Bone structure parameters were measured by Micro-CT. BMSCs were obtained from normal rats, OVX rats, and ICA-treated rats. BMSCs were infected with SOST overexpression lentivirus, and TWS119, an activator of Wnt pathway, was introduced for joint experiment. The binding of ERα to SOST promoter was verified. OVX/ICA rats were injected with DNA methyltransferase inhibitor 5-Aza-dC.

RESULT

ICA increased bone mass and decreased bone marrow fat content in OVX rats. ICA facilitated osteogenic differentiation and repressed adipogenic differentiation of BMSCs. Overexpressing SOST antagonized the effect of ICA, whereas TWS119 rescued the effect of overexpressing SOST. ICA reduced SOST expression by attenuating the effect of ERα. Methylation of SOST inhibited ERα binding to SOST promoter. In vivo experiments confirmed that ICA improved bone mass and reduced bone marrow fat content by enhancing SOST methylation.

CONCLUSION

Overall, ICA upregulated SOST methylation and inhibited the binding of ERα to SOST promoter, thereby promoting osteogenic differentiation and repressing adipogenic differentiation of BMSCs.

Efficacy and Mechanism of Highly Active Umbilical Cord Mesenchymal Stem Cells in the Treatment of Osteoporosis in Rats

BACKGROUND

Osteoporosis increases bone brittleness and the risk of fracture. Umbilical cord mesenchymal stem cell (UCMSC) treatment is effective, but how to improve the biological activity and clinical efficacy of UCMSCs has not been determined.

METHODS

A rat model of osteoporosis was induced with dexamethasone sodium phosphate. Highly active umbilical cord mesenchymal stem cells (HA-UCMSCs) and UCMSCs were isolated, cultured, identified, and infused intravenously once at a dose of 2.29 × 106 cells/kg. In the 4th week of treatment, bone mineral density (BMD) was evaluated via cross-micro-CT, tibial structure was observed via HE staining, osteogenic differentiation of bone marrow mesenchymal stem cells (BMMSCs) was examined via alizarin red staining, and carboxy-terminal cross-linked telopeptide (CTX), nuclear factor-κβ ligand (RANKL), procollagen type 1 N-terminal propeptide (PINP) and osteoprotegerin (OPG) levels were investigated via enzyme-linked immunosorbent assays (ELISAs). BMMSCs were treated with 10-6 mol/L dexamethasone and cocultured with HA-UCMSCs and UCMSCs in transwells. The osteogenic and adipogenic differentiation of BMMSCs was subsequently examined through directional induction culture. The protein expression levels of WNT, β-catenin, RUNX2, IFN-γ and IL-17 in the bone tissue were measured via Western blotting.

RESULTS

The BMD in the healthy group was higher than that in the model group. Both UCMSCs and HA-UCMSCs exhibited a fusiform morphology; swirling growth; high expression of CD73, CD90 and CD105; and low expression of CD34 and CD45 and could differentiate into adipocytes, osteoblasts and chondrocytes, while HA-UCMSCs were smaller in size; had a higher nuclear percentage; and higher differentiation efficiency. Compared with those in the model group, the BMD increased, the bone structure improved, the trabecular area, number, and perimeter increased, the osteogenic differentiation of BMMSCs increased, RANKL expression decreased, and PINP expression increased after UCMSC and HA-UCMSC treatment for 4 weeks. Furthermore, the BMD, trabecular area, number and perimeter, calcareous nodule counts, and OPG/RANKL ratio were higher in the HA-UCMSC treatment group than in the UCMSC treatment group. The osteogenic and adipogenic differentiation of dexamethasone-treated BMMSCs was enhanced after the coculture of UCMSCs and HA-UCMSCs, and the HA-UCMSC group exhibited better effects than the UCMSC coculture group. The protein expression of WNT, β-catenin, and runx2 was upregulated, and IFN-γ and IL-17 expression was downregulated after UCMSC and HA-UCMSC treatment.

CONCLUSION

HA-UCMSCs have a stronger therapeutic effect on osteoporosis compared with that of UCMSCs. These effects include an improved bone structure, increased BMD, an increased number and perimeter of trabeculae, and enhanced osteogenic differentiation of BMMSCs via activation of the WNT/β-catenin pathway and inhibition of inflammation.

Reference Intervals (RIs) of the Bone Turnover Markers (BTMs) in Children and Adolescents: A Proposal for Effective Use

BACKGROUND/OBJECTIVES

Bone turnover markers (BTMs) can provide information on the bone growth of apparently healthy children and adolescents or useful results in the diagnosis and monitoring of the disease condition, comparing them with appropriate reference intervals (RIs). The aim of this study was to establish the RI for the BTM [specific bone alkaline phosphatase (BALP), carboxy-terminal cross-linked collagen type I telopeptide (CTX), N-terminal propeptide pro-collagen type I (PINP), osteocalcin (OC), resistant to acid tartrate phosphatase isoform 5b (TRAcP-5b)] on serum samples from children and adolescents.

METHOD

202 samples from children and adolescents (ages 1-18 years) (51.48% male), considered apparently healthy. The biomarker was analyzed on automatic immunometric equipment (TGSTA Technogenetics) and the IDS-iSYS automated system kits The RI of the studied parameters was calculated according to CLSI Guideline C28-A3 with stratification by age and sex. Evaluation of the distribution of values and the meaning of the biomarker concentrations were used to calculate general and specific RI for an age group.

RESULTS

BTM concentrations vary with pubertal growth. The pattern of change differs for each bone marker. General and age-specific RI were calculated: 1-14 years, 15-18 years for BALP and CTX; 1-13 years, 14-18 years for Oc and PINP and 1-12 years, 13-18 years for TRAcP.

DISCUSSION AND CONCLUSIONS

Concentrations for biomarker studied vary with age and gender. The proof of concentrations with insignificant changes until puberty led to identification of two groups of RI relating to the covariables (age and sex) for each biomarker.

Gene expression and hormonal signaling in osteoporosis: from molecular mechanisms to clinical breakthroughs

Osteoporosis is well noted to be a universal ailment that realization impaired bone mass and micro architectural deterioration thus enhancing the probability of fracture. Despite its high incidence, its management remains highly demanding because of the multifactorial pathophysiology of the disease. This review highlights recent findings in the management of osteoporosis particularly, gene expression and hormonal control. Some of the newest approaches regarding the subject are described, including single-cell RNA sequencing and long non-coding RNAs. Also, the review reflects new findings on hormonal signaling and estrogen and parathyroid hormone; patient-specific approaches due to genetic and hormonal variation. Potential new biomarkers and AI comprised as factors for improving the ability to anticipate and manage fractures. These hold great potential of new drugs, combination therapies and gene based therapies for osteoporosis in the future. Further studies and cooperation of scientists and clinicians will help to apply such novelties into practical uses in the sphere of medicine in order to enhance the treatment of patients with osteoporosis.

Adipose Mesenchymal Stem Cell-Derived Exosomes as Nanocarriers for Treating Musculoskeletal Disorders

Musculoskeletal disorders are a series of diseases involving bone, muscle, cartilage, and tendon, mainly caused by chronic strain, degenerative changes, and structural damage due to trauma. The disorders limit the function of patients due to pain and significantly reduce their quality of life. In recent years, adipose-derived mesenchymal stem cells have been extensively applied in regeneration medicine research due to their particular abilities of self-renewal, differentiation, and targeted homing and are more easily accessed compared with other sources. The paracrine effect of ADSCs plays a crucial role in intercellular communication by releasing mass mediators, including cytokines and growth factors, particularly the exosomes they secrete. Not only do these exosomes possess low immunogenicity, low toxicity, and an enhanced ability to penetrate a bio-barrier, but they also inherit their parent cells' characteristics and carry various bioactive molecules to release to targeted cells, modulating their biological process. Meanwhile, these characteristics also make exosomes a natural nanocarrier capable of targeted drug delivery to specific sites, enhancing the bioavailability of drugs within the body and achieving precision therapy with fewer toxic side effects. Furthermore, the integration of exosomes with tissue engineering and chemical modification strategies can also significantly enhance their efficacy in facilitating tissue repair. However, the current research on ADSC-Exos for improving MSDs remains at an early stage and needs further exploration. Therefore, this review summarized the ADSC-Exo as a nanodrug carrier characteristics and mechanism in the treatment of fracture, osteoporosis, osteoarthritis, intervertebral disc degeneration, and tendon injury, which push forward the research progress of ADSC-Exo therapy for MSDs.

Correlation and mediation analysis between plasmapheresis donation behavior and bone mineral density and bone metabolism biomarkers: a cross-sectional study based on plasmapheresis donors at high risk of osteoporosis in China

Background

As a group of more than 3.67 million people, the bone health of Chinese plasmapheresis donors, which the main population is also a risk group of osteoporosis (OP), has raised concerns. Therefore, this article investigates the relationship between bone mineral density (BMD), bone metabolism indicators, and plasmapheresis donation behavior among some high-risk plasmapheresis donors for OP in China, and further explores the mediating factors through reasonable statistical methods.

Methods

Recruiting long-term and highly active plasmapheresis donors and new donors to measure the total calcium, albumin (ALB), 25-hydroxy vitamin D (25OHD), parathyroid hormone (PTH), type I procollagen amino-terminal peptide (P1NP), and type I collagen carboxy-terminal peptide (β-CTX) and serum ferritin (SF). Then, multiple linear regression was used to adjust confounding factors. Using restrictive cubic splines to explore the nonlinear relationship. Using the Bootstrap method, investigate whether SF has a mediating effect between plasmapheresis donation behavior and bone metabolism biomakers. Finally, analyze the differences in BMD between the two.

Results

Compared to new donors, repeat donors have a lower 25OHD, β-CTX and SF levels, while P1NP and PTH levels are high, with statistical differences. The Bootstrap analysis results show that SF level is a partial mediating factor between plasmapheresis donation behavior and bone metabolism biomakers, with a mediating effect ratio of 21.8%. There was no significant difference in the BMD between the two.

Conclusion

Long-term and frequently plasmapheresis donation does not affect the bone mass of even elderly donors at high risk for osteoporosis under the existing collection standards and anticoagulant use in China. However, as a self-regulation way, it does increase the osteogenic activity of the body.

The Role of Inflammatory and Nutritional Indices in Postmenopausal Osteoporosis: A Retrospective Study

Background: Postmenopausal osteoporosis is characterized by impaired bone metabolism, inflammation, and nutritional deficiencies. This study aimed to evaluate the potential of inflammatory and nutritional markers in identifying decreased bone mineral density (BMD) in postmenopausal women. Methods: This cross-sectional study retrospectively analyzed postmenopausal women from January 2018 and December 2023. A total of 368 women were divided into three groups based on T-scores: 61 women with osteoporosis (T-score ≤ -2.5), 153 women with osteopenia (-1 > T-score > -2.5), and 154 women with normal BMD (T-score > -1). Inflammatory and nutritional biomarkers included the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune inflammation value (PIV), geriatric nutritional risk index (GNRI), triglycerides, total cholesterol, and body weight index (TCBI), prognosis nutritional index (PNI), hemoglobin, albumin, lymphocyte, and platelet (HALP) score, 25-OH Vitamin D level, Na, K, Ca, Mg, and their ratios. Results: The GNRI was significantly lower in the osteoporosis group compared to the control group. The NLR, PLR, SII, SIRI, PIV, TCBI, PNI, and HALP were similar between the groups. The GNRI and TCBI showed a positive correlation with T-scores. The Mg level was lower in the osteoporosis group than in the control group and osteopenia group, and the Na/Mg ratio was higher. Additionally, the Ca/Mg ratio was lower in the osteoporosis group than in the control group. The T-score was positively correlated with Mg and Ca/Mg, while the Na/Mg ratio showed a significant negative correlation. Vitamin D, other minerals, and their ratios did not show significant differences between the groups. Conclusions: Our findings suggest that the GNRI could serve as a useful indicator for assessing bone health and the risk of osteoporosis. Furthermore, maintaining appropriate levels of Mg and balanced Na/Mg and Ca/Mg ratios appears crucial for BMD.

Effects of vitamin K supplementation on bone mineral density at different sites and bone metabolism in the middle-aged and elderly population

Aims

This meta-analysis and systematic review aimed to comprehensively investigate the effects of vitamin K supplementation on bone mineral density (BMD) at various sites and bone metabolism in middle-aged and older adults.

Methods

The databases of PubMed, Web of Science, and Cochrane Library were thoroughly searched from inception to July 2023.

Results

The results revealed that vitamin K supplementation increased BMD at the lumbar spine (p = 0.035). Moreover, the pooled effects demonstrated a notable increase in carboxylated osteocalcin (cOC) (p = 0.004), a decrease in uncarboxylated osteocalcin (ucOC) (p < 0.001), and no significant effect on total osteocalcin (tOC) (p = 0.076). Accordingly, the ratio of cOC to ucOC (p = 0.002) significantly increased, while the ratio of ucOC to tOC decreased (p = 0.043). However, there was no significant effect of vitamin K supplementation on other bone metabolism markers, such as cross-linked telopeptide of type 1 collagen (NTx), bone alkaline phosphatase (BAP), and procollagen I N-terminal propeptide (PINP). Subgroup analysis revealed that vitamin K notably enhanced bone health in females by increasing lumbar spine BMD (p = 0.028) and decreasing ucOC (p < 0.001). Vitamin K, especially vitamin K2, exhibited effects on maintaining or increasing lumbar spine BMD, and influencing the balance of cOC and ucOC.

Conclusion

This review suggests that the beneficial effects of vitamin K supplementation on bone health primarily involve enhancing the carboxylation of OC rather than altering the total amount of OC.

Bu-Sui-Dan Enhances Osteoblast Differentiation by Upregulating VGLL4 to Counteract TEAD4-Mediated RUNX2 Transcription Suppression in Ovariectomized Rats

ETHNOPHARMACOLOGICAL RELEVANCE

Postmenopausal osteoporosis (PMOP) has been considered as a major causative factor for bone-joint pain and inducing pathologic fractures. Bu-Sui-Dan (BSD), a classic ancient herbal formula, has been shown to exhibit osteoprotective effects by promoting bone marrow development and bone growth. However, the exact mechanism of BSD are still unexplored.

AIM OF STUDY

The study aimed to investigate the protective effect of BSD against osteoporotic injury, and to explore whether BSD regulated BMSCs' osteogenic differentiation by targeting VGLL4, which in turn improved PMOP.

MATERIALS AND METHODS

The anti-osteoporotic effect of BSD was studied in ovariectomized (OVX) rats and bone marrow mesenchymal stem cells (BMSCs). Micro-CT imaging and HE staining were performed, and the levels of osteogenic protein RUNX2 and osteogenesis-related factor VGLL4 were determined. Co-immunoprecipitation (Co-IP) was further employed to delve into the effects of BSD on the interactions between TEAD4 and RUNX2. The key osteogenic factors 1ALP, COLl1A1, and Osterix expression were detected by RT-qPCR. Co-IP and proximity ligation assay (PLA) were employed to scrutinize the influence of BSD on TEAD4 and RUNX2 inter-binding. Moreover, VGLL4 knockdown in BMSCs was conducted to confirm the role of VGLL4 in the therapeutic mechanism of BSD.

RESULTS

BSD showed a dose-dependent protective effect against osteoporotic injury, as evidenced by improvement in bone volume, bone microarchitecture, and histomorphometry. Additionally, BSD treatment increased the levels of RUNX2 and its downstream target genes including ALP, COL1A1, and Osterix. Moreover, BSD upregulated VGLL4 expression and lessened TEAD4-RUNX2 interactions. In BMSCs experiment, BSD-containing serum could promote osteogenic differentiation of BMSCs, boosted the expression of osteogenesis-related factors and VGLL4 level. The knockdown of VGLL4 in BMSCs diminished the promotion effect of BSD in osteoblast differentiation, suggesting that VGLL4 play a vital role in the therapeutic effects exerted by BSD.

CONCLUSION

BSD ameliorated osteoporosis injury and promoted osteoblast differentiation through upregulation of VGLL4 levels, which in turn antagonized TEAD4-mediated RUNX2 transcriptional repression. Our study implied that BSD may be an osteoporosis therapeutic agent.

Citrus tamurana Hort. ex Tanaka (Hyuganatsu orange)-derived arabinogalactan suppresses bone turnover in postmenopausal women: A randomized placebo-controlled study

AIM

To evaluate Hyuganatsu oranges (Citrus tamurana Hort. Ex Tanaka) derived arabinogalactan for bone turnover, we performed a randomized placebo-controlled trial.

METHODS

Sixty-three postmenopausal women were age-stratified and randomly assigned to receive arabinogalactan-rich hyuganatsu juice (study group) or a placebo drink (control group) for 90 days. We measured blood tartrate-resistant acid phosphatase 5b (TRACP5b), type I procollagen N-terminal propeptide (P1NP), and other bone turnover biomarker levels at baseline, days 45 and 90 (T90) of the intervention, and day 30 of recovery. Cumulative effects were compared between groups using repeated-measures linear mixed model analysis. The primary endpoint was the difference between the pre- and post-intervention TRACP5b and P1NP levels.

RESULTS

Using repeated measures linear mixed model analysis, the study group had significantly lower TRACP5b and P1NP levels at day 90 than the control group (mean [95% confidence interval]; TRACP5b: 310.0 [269.2-350.9] vs. 386.4 [341.2-431.6] mU/dL; P1NP: 53.7 [48.6-58.7] vs. 70.3 [64.1-76.4] ng/mL), whereas other biomarker levels showed no change.

CONCLUSION

Arabinogalactan-rich Hyuganatsu juice suppressed bone mineral turnover and potentially improved ovarian hormone deficiency-induced osteoporosis in postmenopausal women.

Hypopituitarism and bone disease: pathophysiology, diagnosis and treatment outcomes

Hypopituitarism is a rare but significant endocrine disorder characterized by the inadequate secretion of one or more pituitary hormones. The intricate relationship between hypopituitarism and bone health is a topic of growing interest in the medical community. In this review the authors explore associations between hypopituitarism and bone health, with specific examination of the impact of growth hormone deficiency, central hypogonadism, central hypocortisolism, and central hypothyroidism. Pathogenesis, diagnosis, and treatment options as well as challenges posed by osteopenia, osteoporosis, and fractures in hypopituitarism are discussed.

The Effects of Testosterone on Bone Turnover Markers Among Hormone-Naive Transgender Men

Purpose

Transgender medicine has become rapidly recognized and evolving in the health care system. The consequences of hormone therapy are among the most concerning health issues in the transgender population. This study aims to compare bone turnover markers before and after testosterone administration in hormone-naive transgender men.

Methods

This prospective study included 20 hormone-naive transgender men. Comparisons of serum C-terminal cross-linking telopeptide of type I collagen (CTX) at baseline with 12 weeks and 24 weeks were analyzed using Wilcoxon signed-rank test. Serum procollagen type I N-propeptide (P1NP) and osteocalcin levels at 24 weeks compared to baseline were also assessed. Pearson's correlation coefficient analysis was used to compare the correlation between serum bone turnover markers and sex hormone levels.

Results

At 12 weeks after testosterone administration, significant higher serum CTX level compared to baseline (p-value 0.035) was demonstrated. At 24 weeks after testosterone administration, there were significant differences in serum CTX, P1NP, and osteocalcin levels compared to baseline (p-value 0.019, <0.001, and 0.003, respectively). Serum CTX, P1NP, and osteocalcin levels significantly increased 28.30%, 44.26%, and 21.89%, respectively, at 24 weeks after testosterone treatment. There was a moderate negative correlation between serum CTX and estradiol level.

Conclusion

Testosterone administration in transgender men significantly increased the levels of bone turnover markers. Further, well-controlled studies of bone health in transgender men are required to prove and assess the other aspects of bone status over a long-term follow-up period.Thai Clinical Trial Registry identification number TCTR20220817002.

Association between changes in serum bone metabolism markers and bone microarchitecture changes during basic combat training - The ARMI study

IMPORTANCE

U.S. Army Basic Combat Training (BCT) improves tibial volumetric bone mineral density (BMD) and structure in most, but not all soldiers. Few studies have investigated whether changes in serum bone biomarkers during BCT are associated with changes in tibial BMD and bone structure following BCT.

OBJECTIVE

To characterize bone biomarker changes during BCT and to investigate the relationship between changes in bone biomarkers and changes in tibial BMD and bone structure.

METHODS

We enrolled 235 trainees entering BCT in this ten-week prospective observational study. Trainees provided fasted blood samples and questionnaires weekly throughout BCT. Procollagen type 1 N-terminal propeptide (PINP) and C-terminal telopeptide of type 1 collagen (CTX) were measured by enzyme-linked immunoabsorbent assays every two weeks during BCT. We evaluated body composition and mass via dual-energy X-ray absorptiometry and bone structure, microarchitecture, and mineral density at the distal tibia via high-resolution peripheral quantitative computed tomography at baseline and post-BCT.

RESULTS

Both male (n = 110) and female trainees (n = 125) were young (20.9 ± 3.7 and 20.7 ± 4.3 years, respectively), with normal to overweight BMIs (25.2 ± 4.1 and 24.2 ± 3.6 kg/m2, respectively). In female trainees, PINP increased during and post-BCT compared to baseline, with the greatest increase in PINP at week four (45.4 % ± 49.6, p < 0.0001), whereas there were no changes in CTX. PINP also increased in male trainees, but only at weeks two and four (21.9 % ± 24.5, p = 0.0027 and 35.9 % ± 35.8, p < 0.0001, respectively). Unlike female trainees, in males, CTX was lower than baseline at weeks four, eight, and post-BCT. The change in PINP from baseline to week four of BCT was positively associated with changes in tibial BMD, Tb.BMD, Tb.Th, Tb.BV/TV, Ct.Th, Ct.Ar, and Ct.Po from the baseline to post-BCT.

CONCLUSION

The bone formation marker PINP increases during U.S. Army BCT, especially during the first four weeks. Increases in PINP, but not CTX, were correlated with improved BMD and bone structure in the distal tibia.

Lumbar Magnetic Resonance Imaging Shows Sex-Specific Alterations During Musculoskeletal Aging-A Radio-Anatomic Investigation Involving 202 Individuals

Background/Objectives: Musculoskeletal aging can clinically hardly be distinguished from degenerative disease, especially if symptoms are nonspecific, like lower back pain and reduced physical resilience. However, age-related changes are considered to be physiological until they cause osteoporotic fractures or sarcopenia-related restrictions. This radio-anatomic investigation examines whether findings in lumbar magnetic resonance imaging (MRI) mirror age- and sex-related musculoskeletal differences that help to identify the onset of sarcopenia. Methods: Lumbar MRI investigations from 101 women and 101 men were retrospectively evaluated for vertebral and muscular cross-sectional diameter sizes and T2-signal intensities ("T2-brightness") in axial sections in the L5-level. The results were correlated with the individual's age to find specific alterations that were indicative of sarcopenia or attributable to the aging process. Results: In women (average age 62.6 (34-85) years), musculoskeletal cross-sectional area sizes and diameters were significantly smaller (p < 0.00001) compared to those in men (average age 57.0 (21-90) years). The most pronounced structural age-related change was the increasing mean posterior paravertebral muscle brightness (MPPVB), which exceeded the mean vertebral brightness (MVB) earlier and to a greater extent in women than in men (p < 0.00001). The brightness difference (∆MVB - MPPVB) was found to indicate (pre-)sarcopenia at values below 25. Conclusions: Significant age-related deterioration in muscle quantity and quality was more obvious in women, correlated with the onset of menopause, and progressed to lower levels during aging.

NDR2 is critical for osteoclastogenesis by regulating ULK1-mediated mitophagy

Bone homeostasis primarily stems from the balance between osteoblasts and osteoclasts, wherein an augmented number or heightened activity of osteoclasts is a prevalent etiological factor in the development of bone loss. Nuclear Dbf2-related kinase (NDR2), also known as STK38L, is a member of the Hippo family with serine/threonine kinase activity. We unveiled an upregulation of NDR2 expression during osteoclast differentiation. Manipulation of NDR2 levels through knockdown or overexpression facilitated or hindered osteoclast differentiation, respectively, indicating a negative feedback role for NDR2 in the osteoclastogenesis. Myeloid NDR2-dificient mice (Lysm+NDR2fl/fl) showed lower bone mass and further exacerbated ovariectomy-induced or aging-related bone loss. Mechanically, NDR2 enhanced autophagy and mitophagy through mediating ULK1 instability. In addition, ULK1 inhibitor (ULK1-IN2) ameliorated NDR2 conditional KO-induced bone loss. Finally, we clarified a significant inverse association between NDR2 expression and the occurrence of osteoporosis in patients. The NDR2/ULK1/mitophagy axis is a potential innovative therapeutic target for the prevention and management of bone loss.

NVP-BHG712 alleviates ovariectomy-induced osteoporosis by modulating osteoclastogenesis

Postmenopausal osteoporosis (PMOP) is closely related to the pathogenesis of osteoclasts, with the Cathepsin K (CTSK) protein playing a crucial role. Our study aimed to screen small molecule compounds targeting CTSK and evaluate their impact on PMOP. Through molecular docking, we identified NVP-BHG712 as significantly inhibiting osteoclast differentiation and bone resorption. NVP-BHG712 also effectively suppressed CTSK activity and exhibited strong binding affinity to CTSK protein. Furthermore, NVP-BHG712 regulated the expression of inflammatory factors and modulated the balance between M1 and M2 macrophage polarization. In the mouse model of ovariectomy-induced osteoporosis, NVP-BHG712 rescued bone loss by inhibiting excessive osteoclast activation. These findings suggest that NVP-BHG712 may be a promising treatment for pathological osteoporosis by alleviating osteoclast function.

Fracture severity dependence of bone and muscle performance in patients following single or multiple vertebral fractures

BACKGROUND

Few studies focus on the clinical, laboratory, radiological, and biological characteristics of bone and muscle of multiple vertebral fractures, which are associated with a more poor prognosis compared with single fracture.

PURPOSE

To compare the BMD, bone turnover, muscularity, fatty infiltration of muscle, and prevalence of co-morbidities in patients with single and multiple vertebral fractures.

METHODS

We recruited 100 patients with single fracture (age 66.96 ± 8.24 years) and 100 with multiple fractures (age 69.90 ± 7.80 years); performed dual-energy X-ray absorptiometry of the femoral neck, hip, and lumbar vertebrae; and measured biochemical markers of bone turnover, muscularity, and fatty infiltration.

RESULTS

Patients with multiple vertebral fractures had lower hip BMD (p=0.010) than those with single fractures, but there was no difference in femoral neck and lumbar vertebral BMD nor in muscularity. However, fatty infiltration, an indicator of muscle quality, was significantly higher in participants with multiple fractures (p=0.006). Diabetes was significantly more common in patients with multiple fractures (p=0.042). There were no significant differences in markers of bone turnover, and Seperman analyses showed no correlations of CTX-1 or tPINP with the BMD of the hip, femoral neck, or lumbar spine. However, high CTX-1 was associated with high tPINP (r=0.4805; p<0.0001), and marked fatty infiltration was associated with low hip, lumbar vertebral, and femoral neck BMD. Cox regression analyses showed that age (OR 1.057; 95% CI 1.016-1.101; p=0.006) and low hip BMD (OR 0.016; 95% CI, 0.000-0.549; p=0.022) were associated with a higher risk of multiple fractures.

CONCLUSION

Patients with multiple fractures tend to have lower hip BMD, a history of type 2 diabetes, and more substantial fatty infiltration of muscle than in those with single fractures. Age and hip BMD rather than lumbar vertebrae BMD were found to be independent risk factors for multiple vertebral compression fractures, implying that hip BMD may be a more sensitive predictor for multiple vertebral fractures. More improvements in hip BMD and focus on older persons may be useful means of preventing multiple fractures.

Osteocalcin and Chinese visceral adiposity index are associated with the risk of ASCVD and arterial stiffness in patients with T2DM

This study aims to discover the association between serum osteocalcin, the Chinese visceral adiposity index (CVAI), and atherosclerotic cardiovascular disease (ASCVD) risk, and their impact on arterial stiffness in T2DM patients. We included 639 T2DM patients aged 30 and older who received the assessment of ASCVD risk using the China-PAR equation, Osteocalcin and arterial stiffness in this cross-sectional study. We found that osteocalcin and CVAI as independent risk factors for both medium-high-risk ASCVD (osteocalcin: men, OR,0.96, 95% CI 0.92, 1.00; women, OR, 0.93, 95% CI 0.8, 1.08, respectively)(CVAI: men, OR,1.01,95% CI 1.00,1.02; women: OR, 1.08, 95% CI 1.02,1.14, respectively) and arterial stiffness (osteocalcin: men, OR, 0.98, 95% CI 0.94,1.01; women, OR, 0.98, 95% CI 0.90,1.06, respectively)(CVAI: men, OR,1.0, 95% CI 0.99,1.01; women, OR, 1.02, 95% CI 1.00,1.04, respectively) in both men and women patients with T2DM. Combining osteocalcin levels and CVAI improved the prediction accuracy of arterial stiffness in men patients with T2DM (difference of AUC(Model 4 vs. Model 1):1.5%, NRI: 0.06 [0.0,0.4]). All P-values were < 0.05. The results suggested that osteocalcin levels and CVAI are independent risk factors for ASCVD risk and arterial stiffness in T2DM. Combining osteocalcin and CVAI can enhance the early detection of atherosclerosis through male patients with T2DM.

Zoledronate Sequential Therapy After Denosumab Discontinuation to Prevent Bone Mineral Density Reduction: A Randomized Clinical Trial

Importance

Discontinuation of denosumab without transitioning to another antiresorptive agent results in rapid bone loss and an increased risk of fracture. Previous randomized studies reported inconsistent results regarding the efficacy of zoledronate as sequential therapy.

Objective

To investigate the use of sequential therapy with zoledronate to prevent bone loss and decreased bone mineral density (BMD) after denosumab discontinuation in the first year.

Design, Setting, and Participants

The Denosumab Sequential Therapy prospective, open-label, parallel-group randomized clinical trial was conducted at a referral center and 2 affiliated hospitals in Taiwan. Recruitment was conducted from April 1, 2019, to May 31, 2021, and a 2-year follow-up was planned. The trial included postmenopausal women and men aged 50 years or older who received regular denosumab treatment for at least 2 years and did not have previous exposure to other antiosteoporosis medication or meet other exclusion criteria.

Intervention

Participants were assigned via stratified randomization to 1 of 2 groups: group A received continuous denosumab treatment (60 mg twice yearly) as the positive control, whereas group ZOL received 1 dose of zoledronate (5 mg) in the first year.

Main Outcomes and Measures

The coprimary outcomes were BMD percentage changes in the lumbar spine (LS-BMD), total hip (TH-BMD), and femoral neck (FN-BMD), respectively. An intention-to-treat analysis was performed.

Results

This study included 101 patients (95 women [94.1%]; median age, 72.0 [IQR, 67.0-76.0] years). There were 25 patients in group A (23 women [92.0%]; median age, 74.0 [IQR, 70.0 to 78.0] years) and 76 in group ZOL (72 women [94.7%]; median age, 71.0 [IQR, 65.7 to 76.0] years). In the first year, group ZOL had a significant median decrease in LS-BMD (-0.68% [IQR, -3.22% to 2.75%]) compared with group A (1.30% [IQR, -0.68% to 5.24%]) (P = .03). No significant differences between groups A and ZOL were observed for TH-BMD (median, 1.12% [IQR, -0.06% to 2.25%] vs 0% [-1.47% to 2.15%]) (P = .24) and FN-BMD (median, 0.17% [IQR, -2.29% to 2.90%] vs 0.18% [-2.73% to 3.88%]) (P = .71). We observed a significant difference in the median LS-BMD percentage change for the ZOL subgroup with 3 or more years of denosumab treatment before enrollment (-3.20% [IQR, -7.89% to 0.68%]) compared with group A (1.30% [IQR, -0.68% to 5.24%]) (P = .003).

Conclusions and Relevance

In this randomized trial of sequential therapy after denosumab discontinuation, bone loss was observed in LS-BMD in the first year among patients receiving zoledronate. A longer duration of denosumab treatment was associated with a further decrease in LS-BMD after zoledronate sequential therapy. Further randomized clinical trials and large-scale studies that investigate the strategies of sequential therapy after long-term denosumab treatment are needed.

Trial Registration

ClinicalTrials.gov Identifier: NCT03868033.