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Physiological and pathophysiological bone turnover — role of the immune system
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Journal Article
Physiological and pathophysiological bone turnover — role of the immune system
2016
Overview
Key Points
Receptor activator of NF-κB ligand (RANKL) and osteoprotegerin (OPG) are key downstream effectors of bone resorption; tumour necrosis factor (TNF) might synergize with RANKL to superinduce osteoclastic bone resorption
B cells, regulated by T cells, are a key source of basal OPG whereas activated T cells and B cells are key sources of TNF and RANKL in inflammatory conditions
Short-term antiresorptive therapies might safely prevent bone loss associated with combination antiretroviral therapy
Anergic and parathyroid-hormone-treated T cells secrete the protein Wnt-10b, which promotes bone formation
Novel therapeutic strategies targeting the immune system might promote bone formation and decrease bone resorption to manage osteoporotic bone loss and prevent fracture
In this Review, Weitzmann and Ofotokun examine the evolution of the field of osteoimmunology and how advances in our understanding of the immuno–skeletal interface might lead to novel approaches to prevent and treat bone loss, and avert fractures.
Osteoporosis develops when the rate of osteoclastic bone breakdown (resorption) exceeds that of osteoblastic bone formation, which leads to loss of BMD and deterioration of bone structure and strength. Osteoporosis increases the risk of fragility fractures, a cause of substantial morbidity and mortality, especially in elderly patients. This imbalance between bone formation and bone resorption is brought about by natural ageing processes, but is frequently exacerbated by a number of pathological conditions. Of importance to the aetiology of osteoporosis are findings over the past two decades attesting to a deep integration of the skeletal system with the immune system (the immuno–skeletal interface (ISI)). Although protective of the skeleton under physiological conditions, the ISI might contribute to bone destruction in a growing number of pathophysiological states. Although numerous research groups have investigated how the immune system affects basal and pathological osteoclastic bone resorption, recent findings suggest that the reach of the adaptive immune response extends to the regulation of osteoblastic bone formation. This Review examines the evolution of the field of osteoimmunology and how advances in our understanding of the ISI might lead to novel approaches to prevent and treat bone loss, and avert fractures.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
/ Analysis
/ Animals
/ Bone Diseases, Metabolic - immunology
/ Bone Diseases, Metabolic - metabolism
/ Bone Diseases, Metabolic - physiopathology
/ Bone Remodeling - physiology
/ Bone Resorption - immunology
/ Bone Resorption - metabolism
/ Bone Resorption - physiopathology
/ Fractures, Bone - immunology
/ Fractures, Bone - metabolism
/ Fractures, Bone - physiopathology
/ HIV
/ Human immunodeficiency virus
/ Humans
/ Ligands
/ Medicine
