Clinical characteristics associated with bone mineral density improvement after 1-year alendronate/vitamin d3 or calcitriol treatment: Exploratory results from a phase 3, randomized, controlled trial on postmenopausal osteoporotic women in China

Efficacy of Danshen injection combined with Calcitriol and Calcium/Vitamin-D for the treatment of osteoporotic fractures: A retrospective case-control study

Objective

To explore the efficacy of Danshen injection combined with calcitriol and calcium/Vitamin-D in the treatment of osteoporotic fractures.

Methods

This was a case-control study. We retrospectively reviewed clinical data of 91 patients with osteoporotic fractures who received treatment in Rui'an People's Hospital from February 2021 to July 2022. The data were divided into a control group with 44 records of patients who received treatment with calcitriol and calcium/Vitamin-D, and a study group with 47 patients who received Danshen injection combined with calcitriol and calcium/Vitamin-D. The control group individuals were coordinated with the patients in terms of their age and gender. Treatment effects, inflammatory response levels, and bone metabolic status levels were comparable between the two groups before and after the treatment.

Results

The total efficacy of the treatment in the study group was better than that in the control group (P<0.05). After the treatment, levels of serum inflammatory factors in both groups decreased compared to those before the treatment, and the study group displayed lower levels than the control group (P<0.05). After the treatment, the bone metabolism status of both groups improved, and the improvement effect of the study group was better (P<0.05). The incidences of adverse reactions were similar in both groups (P>0.05).

Conclusions

Danshen injection combined with calcitriol and calcium/Vitamin-D for the treatment of osteoporotic fractures can effectively reduce inflammation, regulate bone metabolism, and improve fracture treatment efficacy with a favorable safety profile.

Efficacy of the systemic co-administration of vitamin D3 in reversing the inhibitory effects of sodium alendronate on orthodontic tooth movement: A preliminary experimental animal study

INTRODUCTION

Bisphosphonates can severely slow down orthodontic tooth movement (OTM) by reducing bone turnover. This calls for materials and methods to reverse or neutralize their effects on OTM. We propose systemic vitamin D3 (D3) for this purpose.

METHODS

Thirty-two male Wistar rats were randomized into 4 groups of 8 each. Three groups were administered D3 (3 systemic doses of 24,000 IU/kg each), alendronate (ALN) (5 doses of 7 mg/kg each), and ALN+D3 (same doses as mentioned above). One group served as the negative control. The incisors were distalized at 30 g of force for 2 weeks. OTMs were measured blindly. Radicular pressure areas were searched histologically (blindly) for capillaries, Howship's lacunae, osteoclasts, and osteoblasts. Data were analyzed statistically (α = 0.05, α = 0.0083, β <0.1).

RESULTS

OTMs in the groups D3, ALN+D3, ALN, and control were 1.900 ± 0.237, 1.629 ± 0.219, 0.975 ± 0.145, and 1.565 ± 0.324 mm (analysis of variance, P <0.001), respectively. OTM in the ALN group was smaller than all other groups (Tukey, P <0.001). OTM in the D3 group was greater than in the control group (P = 0.054). The ALN+D3 group had greater OTM than the ALN group (P <0.001) but was not significantly different from the D3 (P = 0.153) or control (P = 0.951) groups. All histologic variables were significantly different across groups (Kruskal-Wallis, P <0.001). All the markers in the D3 group were more frequent than those of the other groups (Mann-Whitney U, P <0.001). There were fewer markers in the ALN group than in the control group (P ≤0.001). The ALN+D3 group had more markers than the ALN group in terms of capillaries, osteoclasts, and osteoblasts (P ≤0.007). The ALN+D3 group was similar to the control group regarding capillaries, osteoclasts, and osteoblasts (P ≥0.382).

CONCLUSIONS

Systemic vitamin D3 may accelerate OTM and increase histologic biomarkers of bone turnover. ALN reduces OTM and its histologic biomarkers. Systemic vitamin D3 can reverse this inhibitory effect of ALN on OTM back to normal.

Construction of multilayered molecular reservoirs on a titanium alloy implant for combinational drug delivery to promote osseointegration in osteoporotic conditions

In this study, β-cyclodextrin (β-CD) molecules are used as molecular reservoirs and grafted onto chitosan molecules for calcitriol (VD3) loading, which is a hormonally active metabolite of vitamin D. The resultant molecular complex is co-assembled with an antiosteoporosis drug calcitonin (CT) to form bio-functional multilayer structure on Ti6Al7Nb substrate via layer-by-layer self-assembly, which is capable of releasing VD3 and calcitonin in a sustained manner to modulate osteoblasts, osteoclasts, and macrophages at the bone-implant interface. In vitro results show that the released VD3 and CT individually upregulated the expression of calcium-binding protein (including Calbindin D9k and Calbindin D28k) and BMP2 in osteoblasts in peri-implant regions to stimulate their Ca deposition and differentiation. RAW264.7 cells (a murine macrophage) on the biofunctional implant displayed improved M2 phenotypical differentiation and expression of BMP2 and VEGF genes, but M1 phenotypical differentiation potential and MCF and TRAP gene expression levels are evidently lower. Results from in vivo micro-CT and histological analysis also demonstrate that VD3/CT co-loaded implant can dramatically enhance the bone remodeling under osteoporotic conditions with significantly enhanced interfacial shear strength and improved osseointegration as compared to other groups. The insights in this study offer new avenues for the rational functionalization of titanium implants to effectively repair osteoporotic fractures. STATEMENT OF SIGNIFICANCE: A promising strategy to enhance the recovery rate of osteoporotic fractures is to immobilize antiosteoporotic drugs onto the surface of titanium-based implants. In this study, we grafted beta-cyclodextrin (β-CD) onto chitosan (Chi) molecules to load VD3, which was co-assembled with calcitonin (CT) onto Ti6Al7Nb implants by the layer-by-layer assembly technique. The obtained functional titanium alloy implant (Ti6Al7Nb/LBL/Chi-CD@VD3/ CT) could stably release VD3 and calcitonin agents in a sustained manner. RAW264.7 cells grown on Ti6Al7Nb/LBL/Chi-CD@VD3/CT showed superior M2 phenotypical differentiation efficiency, but lower MCF/TRAP gene expression levels. In vitro and in vivo results showed that the released VD3 and CT individually upregulated the expression of calcium binding proteins and BMP2 in osteoblasts, promoting new bone formation in the peri-implant region.

The association between CD31hiEmcnhi endothelial cells and bone mineral density in Chinese women

Osteoporosis is the most common bone disease in humans. During bone remodeling, specialized blood vessels influenced by the endothelial cells (CD31^hiEmcn^hi, also called type H cells) are formatted to supply nutrients. Reductions in vascular supply are associated with bone loss resulting in osteoporosis. Therefore, the objective of the present study was to explore the association between the CD31^hiEmcn^hi endothelial cells and bone mineral density (BMD). In this prospective study, 134 Chinese women were enrolled and examined. BMD was measured by DEXA method while the percentage of CD31^hiEmcn^hi endothelial cells in the intertrochanteric part was measured by flow cytometry. The percentage of CD31^hiEmcn^hi endothelial cells in postmenopausal subjects was significantly lower compared with premenopausal women (8.7 ± 4.0% vs 13.2 ± 5.6%, P < 0.01). Meanwhile, the CD31^hiEmcn^hi endothelial cell levels in osteopenia and osteoporosis were significantly lower compared with subjects with normal BMD (9.84 ± 4.2% in osteopenia and 7.11 ± 3.2% in osteoporosis vs 12.7 ± 5.6% in subjects with normal T score, P < 0.01). Multiple regression analyses showed that the CD31^hiEmcn^hi endothelial cells level was positively associated with femur neck and total hip BMD, but not with lumbar BMD. Our study suggests a significantly positive association between CD31^hiEmcn^hi endothelial cells and local BMD in Chinese women. The proportion of CD31^hiEmcn^hi endothelial cells is a marker of bone quality and represents a potential target for treatment of bone loss.

East meets West: current practices and policies in the management of musculoskeletal aging

Healthy aging is defined as the process of developing and maintaining the functional ability that enables wellbeing in older age. Healthy aging is dependent upon intrinsic capacity, a composite of physical and mental capacities, and the environment an individual inhabits and their interactions with it. Maintenance of musculoskeletal health during aging is a key determinant of functional ability. Sarcopenia, osteoporosis and osteoarthritis, are a triad of musculoskeletal diseases of aging that are major contributors to the global burden of disease and disability worldwide. The prevention and management of these disorders is of increasing importance with pressure mounting from the aging population. In a new initiative, the Chinese Medical Association, Chinese Society of Osteoporosis and Bone Mineral Research, and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases jointly organized a symposium to discuss current practices and policies in the management of musculoskeletal aging. The meeting allowed experts from Europe and China to share their experience and recommendations for the management of these three major diseases. Discussing and analyzing similarities and differences in their practice should lead, through a mutual enrichment of knowledge, to better management of these diseases, in order to preserve intrinsic capacity and retard the age-related degradation of physical ability. In future, it is hoped that sharing of knowledge and best practice will advance global strategies to reduce the burden of musculoskeletal disease and promote healthy aging tailored to meet the individual patient’s needs.

Role of tumor-derived exosomes in bone metastasis

Tight coupling between bone resorption and formation is essential for bone remodeling. Disruption of this equilibrium can lead to skeletal disorders. Osseous metastatic disease is a severe consequence of tumor cell dissemination from numerous primary cancer sites, including the prostate, lungs and breasts. Metastatic disease is one of the most common causes of mortality in patients with cancer. Rapid advances in the therapeutic options for bone disease, including the use of bisphosphonates, have achieved effective clinical effects. However, the overall survival time of patients with bone metastatic has not significantly improved. Exosomes, which originate from tumor tissue and preferentially the bone, provide a reasonable way to understand the mechanism of neoplastic bone metastasis. Recently, several studies have indicated that tumor-derived exosomes are involved in cancer progression. However, the potential role that exosomes serve in the pathological communication between tumor and bone cells within the skeletal microenvironment remains an emerging field. The present review reports some recent findings on the detrimental roles of exosomes in bone metastasis. In addition, since exosomes are involved in metabolic organ cross-talk, this review highlights the involvement of cancer-derived exosomes in the regulation of skeletal metastatic diseases. Lastly, the potential promising clinical applications and emerging therapeutic opportunities targeting exosomes are discussed as novel strategies for cancer therapy.