Inflammatory diseases and bone fragility

Abstract

Systemic osteoporosis and increased fracture rates have been described in chronic inflammatory diseases such as rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus, inflammatory bowel diseases, and chronic obstructive pulmonary disease. Most of these patients receive glucocorticoids, which have their own deleterious effects on bone. However, the other main determinant of bone fragility is the inflammation itself, as shown by the interactions between the inflammatory mediators, the actors of the immune system, and the bone remodelling. The inflammatory disease activity is thus on top of the other well-known osteoporotic risk factors in these patients. Optimal control of inflammation is part of the prevention of osteoporosis, and potent anti-inflammatory drugs have positive effects on surrogate markers of bone fragility. More data are needed to assess the anti-fracture efficacy of a tight control of inflammation in patients with a chronic inflammatory disorder. This review aimed at presenting different clinical aspects of inflammatory diseases which illustrate the relationships between inflammation and bone fragility.

1,25-Dihydroxyvitamin D suppresses M1 macrophages and promotes M2 differentiation at bone injury sites

“…Additionally, knowing the effects of 1,25(OH) 2 D treatment on bone repair is particularly important because there is an increasing interest in the supplementation of vitamin D for the prevention and treatment of various human diseases (e.g., multiple sclerosis, inflammatory bowel disease, and diabetes) due to an association of vitamin D deficiency with these diseases (18)(19)(20)(21). More importantly, these diseases are frequently attended by an increasing risk of bone injuries (22)(23)(24).…”

Risk factors for reduced bone mineral density measurements in milk‐allergic patients

“…Two additional explanations, the intrinsic inflammatory state of asthma per se and the potential impact of inhaled steroid treatment in IgE-CMA patients, require some attention. 22 In both of these scenarios, a first hit of a reduced calcium intake would be required in conjunction with a second risk factor, to lead to a decreased BMD.…”

Osteoporosis in cirrhotics before and after liver transplantation: relation with malnutrition and inflammatory status

“…In cirrhosis patients, chronic systemic inflammation is implicated by elevated levels of pro-inflammatory cytokines such as interleukin-6 (IL-6), interleukin-1ß (IL-1ß), and tumor necrosis factor-a (TNF-a) as well as tumor necrosis factor receptor p55 [15][16][17]. Chronic low-grade inflammation is also associated with low BMD [18,19] and increased fracture risk [20], as higher levels of complement activity, IL-6, C-reactive protein (CRP) and TNF-a have been demonstrated in non-cirrhotic subjects with BMD loss, osteoporosis and fragility-related fractures [21,22]. However, there are very few data on the potential role of malnutrition and systemic inflammation in osteoporosis in cirrhosis patients before and after LT.…”