Osteoporosis management-current and future perspectives - A systemic review

Abstract

Introduction: Osteoporosis is a geriatric metabolic ailment distinguished by low bone mineral density (BMD) and strength with enhanced micro-architectural retrogression of the extracellular matrix, further increasing bone fragility risk. Osteoporotic fractures and associated complications become common in women and men after 55 and 65 years, respectively. The loss in BMD markedly enhances the risk of fracture, non-skeletal injury, and subsequent pain, adversely affecting the quality of life.

Methods: Data summarised in this review were sourced and summarised, including contributions from 2008 to 2023, online from scientific search engines, based on scientific inclusion and exclusion criteria.

Results: Biochemical serum markers such as BALP, collagen, osteocalcin, and cathepsin-K levels can reveal the osteoporotic status. DEXA scan techniques evaluate the whole body's BMD and bone mineral content (BMC), crucial in osteoporosis management. Anabolic and anti-osteoporotic agents are commonly used to enhance bone formation, minimize bone resorption, and regulate remodelling. The challenges and side effects of drug therapy can be overcome by combining the various drug moieties.

Conclusion: The current review discusses the management protocol for osteoporosis, ranging from lifestyle modification, including physical exercise, pharmaceutical approaches, drug delivery applications, and advanced therapeutic possibilities of AI and machine learning techniques to reduce osteoporosis complications and fracture risk.

Keywords: Anabolic agents; Artificial intelligence; Bisphosphonates; Bone mineral density; Calcium; Osteoporosis.

Graphical abstract

Fig. 1

Inclusion and exclusion criteria used for data acquisition for the manuscript; where; OP: Osteoporosis; WHO: World Health Organization.

Fig. 2

Osteoporosis treatment protocol; where; DEXA: Dual x-ray absorptiometry; FRAX: Fracture Risk Assessment Tool; HRT: Hormone replacement therapy.

Fig. 3

Mechanism of action of bisphosphonates in inhibiting bone resorption and regulating bone homeostasis. where; HMG-CoA: 3-hydroxy-3-methylglutaryl coenzyme A; BMP: Bonemorphogenetic proteins; NO: Nitric oxide.

Fig. 4

Osteoporosis management by therapeutic agents.

Fig. 5

Mechanism of action of various therapeutic agents in controlling osteoporotic complications and regulating bone remodelling. Where: Macrophage colony-stimulating factor (M-CSF); Receptor activator of nuclear factor kappa beta (RANK); Osteoprotegerin (OPG), Osteoprotegerin ligand (RANKL); Parathyroid hormone 1 receptor (PTH1R), Cathepsin K (CatK). The balance of the OPG, RANKL and RANK maintains bone remodelling. OPG bind with RANK and inhibit the binding of RANKL and controls the bone resorption. Hemopoietic stem cell lineage differentiates into osteoclast (OC) and promotes bone resorption, the anti-resorptive agents such as bisphosphonates, calcitonin, HRT, SERMs, CatK act on OC and prevents bone resorption. Osteoprogenitor cell (mesenchymal stem cell) differentiates into osteoblast (OB), the anabolic agents such as teriparatide and strontium ranalete (SrRa) acts on OB and promote bone formation (SrRa inhibits bone resorption also). Abaloparatide promote bone formation through PTHR1 signalling pathway. Romosozumab act as sclerotin, a protein produced by osteocyte and promote bone formation. Denosumab inhibits the binding of RANKL and inhibits OC differentiation.

Fig. 6

Overall pharmacological and non-pharmacological strategies used for osteoporosis management. Where: Cat K: Cathepsin K; PTH peptides: Parathyroid hormone-related peptide; HRT:Hormone replacement therapy; SERMs: Selective estrogen receptor modulators. Instead of pharmacological treatment options; the non-pharmacological treatment options like kyphoplasty, vertebroplasty, hip protectors, and physical exercise, along with healthy diet and avoid smoking and alcohol usage for better osteoporosis management.