Action mechanism of bone remodeling imbalance in osteoporosis and relevant medical treatment strategy

doi:10.3969/j.issn.2095-4344.2843

Abstract

Abstract:

BACKGROUND: Currently, bone remodeling imbalance is considered as a core reason leading to osteoporosis. An effective early intervention is performed to regulate bone remodeling imbalance at initial stage that can reverse osteoporosis and improve prognosis to some extent. Antiresorptive and anabolic agents are two types of anti-osteoporosis drugs addressing bone remodeling imbalance. Therefore, investigating the mechanism of bone remodeling imbalance is essential to guide medical treatment in osteoporosis. In addition, clinical application and therapeutic effect between antiresorptive and anabolic agents urgently need to be systematically summarized and may serve as a guide for clinical medication.

OBJECTIVE: To review mechanism of bone remodeling imbalance in osteoporosis, summarize action mechanism of antiresorptive and anabolic agents in regulating bone remodeling imbalance, and compare their clinical effects so as to give clinical medical guidance.

METHODS: Related articles were searched in PubMed databases, Web of Science and CNKI from inception to February 2020. The key words were “osteoporosis, bone remodeling, antiresorptive, anabolic, bisphosphonate, RANKL inhibitor, PTH analogue, anti-sclerostin antibody” in English and Chinese. Initially, 144 articles were searched, and according to the inclusion and exclusion criteria, 84 eligible articles were included in final analysis.

RESULTS AND CONCLUSION: (1) Bone remodeling is activated by bone damaging. Reversible and irreversible deficits are two bone reforming types followed by remodeling. (2) The reversible one goes through bone resorption, bone refilling and secondary mineralization process for 3 months and new forming bone exhibits high mechanical strength. (3) The irreversible deficit occurred after bone remodeling imbalance that bone forming rate is much lower than resorption rate. Although there is certain amount of new forming bone generated in breaking area but the bone quality is unsatisfied, which tends to break again. (4) Bisphosphonates and RANKL inhibitors belong to antiresorptive agents, and are capable to reduce bone resorption, but bone forming mass is also decreased accordingly. (5) In addition, anabolic agents including PTH analogues and anti-sclerostin antibodies are benefit for reconstructing damaged bone structure, especially haversian canal, and significantly promote bone quality and mechanical property as well.

Key words: bone, osteoporosis, bone repair, bone remodeling, mechanics, drug therapy, mechanism, review

CLC Number:

Yan Wei, Wang Zhonghan, Liu He. Action mechanism of bone remodeling imbalance in osteoporosis and relevant medical treatment strategy[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(30): 4866-4874.

Figures/Tables 5

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