Comment on: Patients' preferences for anti-osteoporosis drug treatment: a cross-European discrete choice experiment: reply

Cost-effectiveness of sequential treatment with abaloparatide followed by alendronate vs. alendronate monotherapy in women at increased risk of fracture: A US payer perspective

OBJECTIVES

Emerging evidence supports sequential therapy with anabolic followed by antiresorptive in patients at high-risk of fragility fractures. This study assessed the cost-effectiveness of sequential treatment with abaloparatide (ABL) followed by alendronate (ALN) [(ABL/ALN)] compared to ALN monotherapy and to sequential treatment starting with antiresorptive therapy (ALN/ABL/ALN).

METHODS

A previously validated Markov microsimulation model was used to estimate the cost-effectiveness of sequential ABL/ALN compared to ALN monotherapy and to sequential ALN/ABL/ALN from a lifetime US payer perspective. In line with practice guidelines, patients were assumed to receive ABL for 18 months followed by 5 years of ALN, or ALN monotherapy for 5 years, or a sequence of ALN for 2 years followed by 18 months of ABL and then by 3 years ALN. Evaluation was conducted for patients aged 50-80 years old with a BMD T-score ≤-3.5 and without a history of prior fracture, or with a T-score between -2.5 and -3.5 and a history of ≥ 1 osteoporotic fracture.

RESULTS

Sequential ABL/ALN was cost-effective (threshold of US$150,000 per QALY) vs generic ALN monotherapy in women ≥60 years with a BMD T-score ≤-3.5 and in women with BMD T-score between -2.5 and -3.5 and history of osteoporotic fracture. In all simulated populations, sequential ABL/ALN therapy was dominant (lower costs, more QALYs) compared with sequential ALN/ABL/ALN, resulting from limited effect of ABL in patients previously treated with an antiresorptive agent.

CONCLUSIONS

Sequential ABL/ALN therapy is cost-effective vs ALN monotherapy for US postmenopausal women aged ≥60 years at increased risk of fractures.

MicroRNA‑223 promotes osteoblast differentiation of MC3T3‑E1 cells by targeting histone deacetylase 2

MicroRNAs (miRNAs) have emerged as pivotal regulators in various physiological and pathological processes at the post‑transcriptional level, and may serve important roles in osteogenic differentiation. However, their roles and functions are not fully understood. In the present study, miR‑223‑5p was identified as a modulator of osteoblastic differentiation in MC3T3‑E1 cells. Reverse transcription‑quantitative polymerase chain reaction and western blotting demonstrated that miR‑223‑5p was significantly upregulated in MC3T3‑E1 cells following the induction of osteoblast differentiation. Overexpression of miR‑223‑5p promoted osteogenic differentiation both in vitro and vivo. Expression of histone deacetylase 2 (HDAC2), which acts as a negative regulator of osteogenesis, was regulated by miR‑223‑5p. Collectively, the results of the present study revealed a novel miR‑223‑5p/HDAC2 axis that regulates osteoblast differentiation, and may serve as a potential target for enhancing bone formation in vivo.

Expression of microRNA-21 in osteoporotic patients and its involvement in the regulation of osteogenic differentiation

Expression of microRNA-21 in bone tissue and serum of patients with osteoporosis (OP) and its involvement in the regulation of osteogenic differentiation of rat bone marrow mesenchymal stem cells (BMSCs) were investigated. Bone tissue and serum were collected from 48 patients with OP and 48 normal subjects. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to detect the expression of six microRNAs. Among these microRNAs, the expression level of microRNA-21 in bone tissue and serum of OP patients was the lowest. In addition, BMSCs of SD rats were isolated and cultured. Subculture was performed 3 times, transfection of microRNA-21 was performed and osteogenic differentiation was induced. Control group [negative control (NC)] was transfected with microRNA-21 mimics followed by osteogenic induction. Experimental groups were transfected with microRNA-21 analogue (mimics) and microRNA-21 inhibitor (inhibitor) followed by osteogenic induction. Ten days after osteogenic induction, alkaline phosphatase (ALP) staining and alizarin red staining were performed to measure the mineralized stained area and the number of mineralized nodules in each treatment group. RT-qPCR was used to detect the expression of osteogenic genes in each group of cells. RT-qPCR results showed that microRNA-21 expression was lower in bone tissue and serum of patients with OP than that of normal subjects. Moreover, compared with control group, BMSCs showed increased stained mineralized areas, deeper color and increased number of mineralized nodules. In addition, increased mRNA expression of osteogenic genes was evident after microRNA-21 mimics transfection and osteogenic induction (p<0.05). Compared with control group, BMSCs showed decreased stained mineralized areas, lighter color, decreased number of mineralized nodules, and decreased mRNA expression of osteogenic genes after microRNA-21 inhibitor transfection and osteogenic induction (p<0.05). MicroRNA-21 is expressed at low level in bone tissue and serum in patients with OP, and microRNA-21 can promote osteogenic differentiation of BMSCs. Our study provided theoretical basis for drug treatment of OP.