Background

The physiological balance between bone resorption and bone formation is now known to be mediated by a cascade of events parallel to the classic osteoblast-osteoclast interaction. Thus, osteoimmunology now encompasses the role played by other cell types, such as cytokines, lymphocytes and chemokines, in immunological responses and how they help modulate bone metabolism. All these factors have an impact on the RANK/RANKL/OPG pathway, which is the major pathway for the maturation and resorption activity of osteoclast precursor cells, responsible for osteoporosis development. Recently, immunoporosis has emerged as a new research area in osteoimmunology dedicated to the immune system’s role in osteoporosis.

Methods

The first part of this review presents theoretical concepts on the factors involved in the skeletal system and osteoimmunology. Secondly, existing treatments and novel therapeutic approaches to treat osteoporosis are summarized. These were selected from to the most recent studies published on PubMed containing the term osteoporosis. All data relate to the results of in vitro and in vivo studies on the osteoimmunological system of humans, mice and rats.

Findings

Treatments for osteoporosis can be classified into two categories. They either target osteoclastogenesis inhibition (denosumab, bisphosphonates), or they aim to restore the number and function of osteoblasts (romozumab, abaloparatide). Even novel therapies, such as resolvins, gene therapy, and mesenchymal stem cell transplantation, fall within this classification system.

Conclusion

This review presents alternative pathways in the pathophysiology of osteoporosis, along with some recent therapeutic breakthroughs to restore bone homeostasis.

中文翻译：

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免疫疏松症的病理生理学：创新治疗靶点

背景

现在已知骨吸收和骨形成之间的生理平衡是由与经典的成骨细胞-破骨细胞相互作用平行的级联事件介导的。因此，骨免疫学现在涵盖了其他细胞类型（如细胞因子、淋巴细胞和趋化因子）在免疫反应中所起的作用以及它们如何帮助调节骨代谢。所有这些因素都会影响 RANK/RANKL/OPG 通路，该通路是破骨细胞前体细胞成熟和再吸收活性的主要途径，负责骨质疏松症的发展。最近，免疫疏松症已成为骨免疫学的一个新研究领域，致力于研究免疫系统在骨质疏松症中的作用。

方法

本综述的第一部分介绍了有关骨骼系统和骨免疫学所涉及因素的理论概念。其次，总结了治疗骨质疏松症的现有治疗方法和新的治疗方法。这些是从 PubMed 上发表的包含骨质疏松症这一术语的最新研究中挑选出来的。所有数据均与人类、小鼠和大鼠骨免疫系统的体外和体内研究结果相关。

发现

骨质疏松症的治疗可分为两类。它们要么针对破骨细胞生成抑制（地诺单抗、双膦酸盐），要么旨在恢复成骨细胞的数量和功能（romozumab、abaloparatide）。即使是新的疗法，如resolvins、基因疗法和间充质干细胞移植，也属于这一分类系统。

结论

这篇综述介绍了骨质疏松症病理生理学中的替代途径，以及最近在恢复骨稳态方面取得的一些治疗突破。