Pain in Osteoporosis: From Pathophysiology to a Therapeutic Approach

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: closed (1 November 2019) | Viewed by 14488

Special Issue Editor


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Guest Editor
Researcher, Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
Interests: metabolic bone disorders; osteoporosis; Paget’s disease of bone; rare bone diseases
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Special Issue Information

Dear Colleagues,

Osteoporosis (OP) is the most common metabolic bone disease. It has become a major public health problem in many countries due to the increase in life expectancy. It has been estimated that, by the year 2025, more than 30 million women and men aged > 65 years will be affected by osteoporosis in the EU. Fractures occur in patients with OP after low energy traumas, and, particularly, hip fractures may be a significant cause of mortality. Pain, functional loss, social isolation, and emotional disturbances may negatively affect patients’ general well-being and quality of life. Vertebral fractures (VFs) represent a typical finding in patients with osteoporosis, with up to 12% of postmenopausal women having at least one vertebral deformity, most of which are osteoporotic VFs. These women show a higher risk of further vertebral and other osteoporotic fractures, impairing health status. Osteoporotic fractures carry a high social burden, and sites typically include the femoral neck, vertebrae, and distal forearm. Chronic pain, disability, and impaired quality of life secondary to fractures are commonly observed in patients with osteoporosis, leading to increased financial costs. Although osteoporosis is known as a silent disease affecting aging populations, its primary symptom remains pain. Acute pain is reported by patients with osteoporosis-related fractures, but chronic pain, mainly back pain, is also a characteristic of severe osteoporosis. Pain is associated not only with fractures but also with bodily changes in patients with osteoporosis that may include sensory, affective, and cognitive aspects. Chronic pain leads to progressive loss of independence and the need for long-term care, especially in the elderly. Pain prevention is linked to the appropriate treatment of osteoporosis, and pain management in patients with osteoporosis requires a multidimensional approach to preserve and improve quality of life. The present Special Issue aims to the main causes of pain in patients with osteoporosis and suggest possible strategies for its management, treatment, and prevention.

Dr. Daniela Merlotti
Guest Editor

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Keywords

  • Osteoporosis
  • Musculoskeletal pain
  • Vertebral fractures
  • Sarcopenia
  • Bisphosphonate treatment
  • Pain management
  • Quality of life

Published Papers (3 papers)

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Research

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12 pages, 909 KiB  
Article
Clinical Impact of the Fracture Risk Assessment Tool on the Treatment Decision for Osteoporosis in Patients with Knee Osteoarthritis: A Multicenter Comparative Study of the Fracture Risk Assessment Tool and World Health Organization Criteria
by Bo Young Kim, Hyoun-Ah Kim, Ju-Yang Jung, Sang Tae Choi, Ji-Min Kim, Sang Hyon Kim, Seong-Ryul Kwon, Chang-Hee Suh and Sung-Soo Kim
J. Clin. Med. 2019, 8(7), 918; https://doi.org/10.3390/jcm8070918 - 26 Jun 2019
Cited by 6 | Viewed by 3331
Abstract
Background: To compare the frequency of high-risk osteoporotic fracture in patients with knee OA (OA) using the fracture risk assessment tool (FRAX) and the bone mineral density (BMD). Methods: We retrospectively assessed 282 Korean patients with knee OA who visited five medical centers [...] Read more.
Background: To compare the frequency of high-risk osteoporotic fracture in patients with knee OA (OA) using the fracture risk assessment tool (FRAX) and the bone mineral density (BMD). Methods: We retrospectively assessed 282 Korean patients with knee OA who visited five medical centers and 1165 healthy controls (HCs) aged ≥50 years without knee OA. After matching for age, sex, and body mass index, 478 subjects (239 patients with knee OA and 239 HCs) were included. Results: Based on the BMD, the frequency of osteoporosis was 40.2% in patients with knee OA and 36.4% in HCs. The predicted mean FRAX major osteoporotic fracture probabilities calculated with or without femur neck BMD differed significantly between the knee OA and HCs (6.9 ± 3.8% versus 6.1 ± 2.8%, p = 0.000 and 8 ± 3.6% versus 6.8 ± 2.3%, p < 0.001, respectively). The mean FRAX hip fracture probabilities calculated with or without femur neck BMD differed significantly in the knee OA and HCs (2.1 ± 2.4% versus 1.7 ± 1.8%, p = 0.006 and 3 ± 2.3% versus 2.4 ± 1.6%, p < 0.001, respectively). Conclusion: Our study suggests that FRAX may have a clinical impact on treatment decisions to reduce osteoporotic facture in patients with knee OA. Full article
(This article belongs to the Special Issue Pain in Osteoporosis: From Pathophysiology to a Therapeutic Approach)
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15 pages, 1796 KiB  
Article
Inhibition of Osteoclastogenesis by Thioredoxin-Interacting Protein-Derived Peptide (TN13)
by Mi Jeong Kim, Won Sam Kim, Jae-Eun Byun, Jung Ha Choi, Suk Ran Yoon, Inpyo Choi and Haiyoung Jung
J. Clin. Med. 2019, 8(4), 431; https://doi.org/10.3390/jcm8040431 - 29 Mar 2019
Cited by 9 | Viewed by 3265
Abstract
Overactivated osteoclasts lead to many bone diseases, including osteoporosis and rheumatoid arthritis. The p38 MAPK (p38) is an essential regulator of the receptor activator of nuclear factor-κB ligand (RANKL)-mediated osteoclastogenesis and bone loss. We previously reported TAT conjugated thioredoxin-interacting protein-derived peptide (TAT-TN13) as [...] Read more.
Overactivated osteoclasts lead to many bone diseases, including osteoporosis and rheumatoid arthritis. The p38 MAPK (p38) is an essential regulator of the receptor activator of nuclear factor-κB ligand (RANKL)-mediated osteoclastogenesis and bone loss. We previously reported TAT conjugated thioredoxin-interacting protein-derived peptide (TAT-TN13) as an inhibitor of p38 in hematopoietic stem cells (HSCs). Here, we examined the role of TAT-TN13 in the differentiation and function of osteoclasts. TAT-TN13 significantly suppressed RANKL-mediated differentiation of RAW 264.7 cells and bone marrow macrophages (BMMs) into osteoclasts. TAT-TN13 also inhibited the RANKL-induced activation of NF-κB and nuclear factor of activated T-cells cytoplasmic 1 (NFATc1), leading to the decreased expression of osteoclast-specific genes, including tartrate-resistant acid phosphatase (TRAP) and Cathepsin K. Additionally, TAT-TN13 treatment protected bone loss in ovariectomized (OVX) mice. Taken together, these results suggest that TAT-TN13 inhibits osteoclast differentiation by regulating the p38 and NF-κB signaling pathway; thus, it may be a useful agent for preventing or treating osteoporosis. Full article
(This article belongs to the Special Issue Pain in Osteoporosis: From Pathophysiology to a Therapeutic Approach)
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Review

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14 pages, 255 KiB  
Review
Osteoporosis from an Endocrine Perspective: The Role of Hormonal Changes in the Elderly
by Rossella Cannarella, Federica Barbagallo, Rosita A. Condorelli, Antonio Aversa, Sandro La Vignera and Aldo E. Calogero
J. Clin. Med. 2019, 8(10), 1564; https://doi.org/10.3390/jcm8101564 - 01 Oct 2019
Cited by 41 | Viewed by 7209
Abstract
Introduction: Osteoporosis is increasingly prevalent in the elderly, with fractures mostly occurring in women and men who are older than 55 and 65 years of age, respectively. The aim of this review was to examine the evidence regarding the influence of hormones on [...] Read more.
Introduction: Osteoporosis is increasingly prevalent in the elderly, with fractures mostly occurring in women and men who are older than 55 and 65 years of age, respectively. The aim of this review was to examine the evidence regarding the influence of hormones on bone metabolism, followed by clinical data of hormonal changes in the elderly, in the attempt to provide possible poorly explored diagnostic and therapeutic candidate targets for the management of primary osteoporosis in the aging population. Material and methods: An extensive Medline search using PubMed, Embase, and Cochrane Library was performed. Results: While the rise in Thyroid-stimulating hormone (TSH) levels has a protective role on bone mass, the decline of estrogen, testosterone, Insulin-like growth factor 1 (IGF1), and vitamin D and the rise of cortisol, parathyroid hormone, and follicle-stimulating hormone (FSH) favor bone loss in the elderly. Particularly, the AA rs6166 FSH receptor (FSHR) genotype, encoding for a more sensitive FSHR than that encoded by the GG one, is associated with low total body mass density (BMD), independently of circulating estrogen. A polyclonal antibody with a FSHR-binding sequence against the β-subunit of murine FSH seems to be effective in ameliorating bone loss in ovariectomized mice. Conclusions: A complete hormonal assessment should be completed for both women and men during bone loss evaluation. Novel possible diagnostic and therapeutic tools might be developed for the management of male and female osteoporosis. Full article
(This article belongs to the Special Issue Pain in Osteoporosis: From Pathophysiology to a Therapeutic Approach)
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