Advances in Our Understanding of the Mechanism of Action of Drugs (including Traditional Chinese Medicines) for the Intervention and Treatment of Osteoporosis

Abstract

Osteoporosis (OP) is known as a silent disease in which the loss of bone mass and bone density does not cause obvious symptoms, resulting in insufficient treatment and preventive measures. The losses of bone mass and bone density become more severe over time and an only small percentage of patients are diagnosed when OP-related fractures occur. The high disability and mortality rates of OP-related fractures cause great psychological and physical damage and impose a heavy economic burden on individuals and society. Therefore, early intervention and treatment must be emphasized to achieve the overall goal of reducing the fracture risk. Anti-OP drugs are currently divided into three classes: antiresorptive agents, anabolic agents, and drugs with other mechanisms. In this review, research progress related to common anti-OP drugs in these three classes as well as targeted therapies is summarized to help researchers and clinicians understand their mechanisms of action and to promote pharmacological research and novel drug development.

The analysis of Modified Qing’ E Formula on the differential expression of exosomal miRNAs in the femoral head bone tissue of mice with steroid-induced ischemic necrosis of femoral head

“…In China, MQEF is used for the treatment of postmenopausal osteoporosis and non-traumatic femoral head necrosis and has received positive responses ( 28 ). The use of MQEF is based on Chinese medical theory and lacks modern pharmacological studies.…”

Modified Qing’ e Pills exerts anti-osteoporosis effects and prevents bone loss by enhancing type H blood vessel formation

“…It is currently used mainly for back pain caused by osteoporosis and is included in the Chinese osteoporosis treatment guidelines. It has various pharmacological activities, such as anti-inflammatory, anti-aging, and estrogenic properties ( 11 , 36 ). Although MQEP has been used in China for more than 1,300 years, its mechanism of action is still unclear and is only explained based on TCM theories; its clinical use relies more on the experience of TCM doctors.…”

“…The modified Qing’ e Pills (MQEP) is an herbal compound used in China for over a thousand years and as a complementary treatment for primary osteoporosis with good clinical efficacy ( 11 ). Some studies have shown that MQEP can improve bone microstructure and biomechanics in ovariectomized osteoporosis models, and this effect is achieved by increasing β-catenin protein expression ( 12 ).…”

Mechanistic advances in osteoporosis and anti‐osteoporosis therapies

“…Among them, the combination of drugs with different mechanisms may bring additional benefits 264 . Furthermore, the sequential use of drugs can avoid the increased risk of specific side effects and minimize the resistance caused by the long‐term use of a single drug 265 . However, it is not recommended to use two anti‐absorbent agents at the same time because of the excessive inhibition of bone turnover and increased risk of fracture 266 …”