Abstract
Osteoporosis is a chronic disease requiring long-term, sometimes lifelong, management. With the aging population, the prevalence of osteoporosis is increasing, and with it so is the risk of hip fracture and subsequent poor quality of life and higher mortality. Current therapies for osteoporosis have various significant side effects limiting patient compliance and use. Recent evidence has demonstrated the significant role of exosomes in osteoporosis both in vivo and in vitro. In this review, we summarize the pathogenesis of senile osteoporosis, highlight the properties and advantages of exosomes, and explore the recent literature on the use of exosomes in osteogenesis regulation. This is a very helpful review as several exosomes-based therapeutics have recently entered clinical trials for non-skeletal applications, such as pancreatic cancer, renal transplantation, and therefore it is urgent for bone researchers to explore whether exosomes can become the next class of orthobiologics for the treatment of osteoporosis.
Highlights
Osteoporosis is a systemic skeletal disease characterized by low bone mass and decreased bone quality, both of which contribute to an increase in bone fragility (van den Bergh et al, 2012)
This review aims to cover the knowledge advances that have been made on the pathogenesis of osteoporosis, the properties of exosomes, and is primarily focused on postmenopausal or senile osteoporosis
A recent animal study suggested that magnetic hydroxyapatite (MHA) scaffolds are capable of altering osteoclast-derived exosomal cargoes and decreasing the efficiency of exosome uptake by osteoblasts, further promoting osteoblast proliferation and reversing osteoporosis (Zhu et al, 2020)
Summary
Osteoporosis is a systemic skeletal disease characterized by low bone mass and decreased bone quality, both of which contribute to an increase in bone fragility (van den Bergh et al, 2012). Available drugs for osteoporosis can be divided into antiresorptive modulators, which include estrogen, estrogen receptor modulators, calcitonin and bisphosphonates, and anabolic therapies, which includes teriparatide. These drugs usually cause adverse effects, and result in decreased adherence. Bisphosphonates, the most common current therapy for osteoporosis, result in general side effects including gastrointestinal irritation, bone and joint pain and jaw osteonecrosis (Marx, 2003; Ruggiero et al, 2004). THE PATHOGENESIS OF OSTEOPOROSIS is associated with a decline in serum estrogen that has the potential to promote bone formation through inhibition of receptor activator of nuclear factor-κB ligand (RANKL) (Eghbali-Fatourechi et al, 2003), resulting in bone loss and disruption of bone microarchitecture. Given that exosomes, which are extracellular vesicles, have this ability, we set out to investigate these vesicles in depth
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