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Combined Effects of Exercise and Denosumab Treatment on Local Failure in Post-menopausal Osteoporosis–Insights from Bone Remodelling Simulations Accounting for Mineralisation and Damage
Denosumab has been shown to increase bone mineral density (BMD) and reduce the fracture risk in patients with post-menopausal osteoporosis (PMO). Increase in BMD is linked with an increase in bone matrix mineralisation due to suppression of bone remodelling. However, denosumab anti-resorptive action...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212042/ https://www.ncbi.nlm.nih.gov/pubmed/34150724 http://dx.doi.org/10.3389/fbioe.2021.635056 |
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author | Martínez-Reina, Javier Calvo-Gallego, José L. Pivonka, Peter |
author_facet | Martínez-Reina, Javier Calvo-Gallego, José L. Pivonka, Peter |
author_sort | Martínez-Reina, Javier |
collection | PubMed |
description | Denosumab has been shown to increase bone mineral density (BMD) and reduce the fracture risk in patients with post-menopausal osteoporosis (PMO). Increase in BMD is linked with an increase in bone matrix mineralisation due to suppression of bone remodelling. However, denosumab anti-resorptive action also leads to an increase in fatigue microdamage, which may ultimately lead to an increased fracture risk. A novel mechanobiological model of bone remodelling was developed to investigate how these counter-acting mechanisms are affected both by exercise and long-term denosumab treatment. This model incorporates Frost's mechanostat feedback, a bone mineralisation algorithm and an evolution law for microdamage accumulation. Mechanical disuse and microdamage were assumed to stimulate RANKL production, which modulates activation frequency of basic multicellular units in bone remodelling. This mechanical feedback mechanism controls removal of excess bone mass and microdamage. Furthermore, a novel measure of bone local failure due to instantaneous overloading was developed. Numerical simulations indicate that trabecular bone volume fraction and bone matrix damage are determined by the respective bone turnover and homeostatic loading conditions. PMO patients treated with the currently WHO-approved dose of denosumab (60 mg administrated every 6 months) exhibit increased BMD, increased bone ash fraction and damage. In untreated patients, BMD will significantly decrease, as will ash fraction; while damage will increase. The model predicted that, depending on the time elapsed between the onset of PMO and the beginning of treatment, BMD slowly converges to the same steady-state value, while damage is low in patients treated soon after the onset of the disease and high in patients having PMO for a longer period. The simulations show that late treatment PMO patients have a significantly higher risk of local failure compared to patients that are treated soon after the onset of the disease. Furthermore, overloading resulted in an increase of BMD, but also in a faster increase of damage, which may consequently promote the risk of fracture, specially in late treatment scenarios. In case of mechanical disuse, the model predicted reduced BMD gains due to denosumab, while no significant change in damage occurred, thus leading to an increased risk of local failure compared to habitual loading. |
format | Online Article Text |
id | pubmed-8212042 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-82120422021-06-19 Combined Effects of Exercise and Denosumab Treatment on Local Failure in Post-menopausal Osteoporosis–Insights from Bone Remodelling Simulations Accounting for Mineralisation and Damage Martínez-Reina, Javier Calvo-Gallego, José L. Pivonka, Peter Front Bioeng Biotechnol Bioengineering and Biotechnology Denosumab has been shown to increase bone mineral density (BMD) and reduce the fracture risk in patients with post-menopausal osteoporosis (PMO). Increase in BMD is linked with an increase in bone matrix mineralisation due to suppression of bone remodelling. However, denosumab anti-resorptive action also leads to an increase in fatigue microdamage, which may ultimately lead to an increased fracture risk. A novel mechanobiological model of bone remodelling was developed to investigate how these counter-acting mechanisms are affected both by exercise and long-term denosumab treatment. This model incorporates Frost's mechanostat feedback, a bone mineralisation algorithm and an evolution law for microdamage accumulation. Mechanical disuse and microdamage were assumed to stimulate RANKL production, which modulates activation frequency of basic multicellular units in bone remodelling. This mechanical feedback mechanism controls removal of excess bone mass and microdamage. Furthermore, a novel measure of bone local failure due to instantaneous overloading was developed. Numerical simulations indicate that trabecular bone volume fraction and bone matrix damage are determined by the respective bone turnover and homeostatic loading conditions. PMO patients treated with the currently WHO-approved dose of denosumab (60 mg administrated every 6 months) exhibit increased BMD, increased bone ash fraction and damage. In untreated patients, BMD will significantly decrease, as will ash fraction; while damage will increase. The model predicted that, depending on the time elapsed between the onset of PMO and the beginning of treatment, BMD slowly converges to the same steady-state value, while damage is low in patients treated soon after the onset of the disease and high in patients having PMO for a longer period. The simulations show that late treatment PMO patients have a significantly higher risk of local failure compared to patients that are treated soon after the onset of the disease. Furthermore, overloading resulted in an increase of BMD, but also in a faster increase of damage, which may consequently promote the risk of fracture, specially in late treatment scenarios. In case of mechanical disuse, the model predicted reduced BMD gains due to denosumab, while no significant change in damage occurred, thus leading to an increased risk of local failure compared to habitual loading. Frontiers Media S.A. 2021-06-04 /pmc/articles/PMC8212042/ /pubmed/34150724 http://dx.doi.org/10.3389/fbioe.2021.635056 Text en Copyright © 2021 Martínez-Reina, Calvo-Gallego and Pivonka. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Bioengineering and Biotechnology Martínez-Reina, Javier Calvo-Gallego, José L. Pivonka, Peter Combined Effects of Exercise and Denosumab Treatment on Local Failure in Post-menopausal Osteoporosis–Insights from Bone Remodelling Simulations Accounting for Mineralisation and Damage |
title | Combined Effects of Exercise and Denosumab Treatment on Local Failure in Post-menopausal Osteoporosis–Insights from Bone Remodelling Simulations Accounting for Mineralisation and Damage |
title_full | Combined Effects of Exercise and Denosumab Treatment on Local Failure in Post-menopausal Osteoporosis–Insights from Bone Remodelling Simulations Accounting for Mineralisation and Damage |
title_fullStr | Combined Effects of Exercise and Denosumab Treatment on Local Failure in Post-menopausal Osteoporosis–Insights from Bone Remodelling Simulations Accounting for Mineralisation and Damage |
title_full_unstemmed | Combined Effects of Exercise and Denosumab Treatment on Local Failure in Post-menopausal Osteoporosis–Insights from Bone Remodelling Simulations Accounting for Mineralisation and Damage |
title_short | Combined Effects of Exercise and Denosumab Treatment on Local Failure in Post-menopausal Osteoporosis–Insights from Bone Remodelling Simulations Accounting for Mineralisation and Damage |
title_sort | combined effects of exercise and denosumab treatment on local failure in post-menopausal osteoporosis–insights from bone remodelling simulations accounting for mineralisation and damage |
topic | Bioengineering and Biotechnology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212042/ https://www.ncbi.nlm.nih.gov/pubmed/34150724 http://dx.doi.org/10.3389/fbioe.2021.635056 |
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