C o m m e n t a r y2 0 4A new player in sex steroid deficiency-related bone lossOsteoporosis is a leading cause of morbidity in the increasing population of aging adults. In postmenopausal women, fracture incidence far exceeds the combined incidence of breast cancer, stroke, and myocardial infarction. Bone loss arises from accelerated resorption by osteoclasts, which outpaces the accompanying increase in bone formation by osteoblasts (1). Postmenopausal osteoporosis has traditionally been solely attributed to declining estrogen levels. However, the rapid loss of bone during the late perimenopausal transition, particularly when estrogen levels are relatively normal, is proposed to be mediated, at least in part, by rising follicle-stimulating hormone levels (FSH levels) (2, 3). Nonetheless, these hormonal changes do not fully explain the increased bone formation, high BM T cell counts, or macrophage activation that have been noted across the menopausal transition (4). Alterations in immune cell function have largely been attributed to increased production of TNFα, which further enhances osteoclast formation and function (5, 6). Consistent with this, ablation of the Tnfa gene in mice prevents gonadectomy-induced bone loss, osteoclast and osteoblast activation, and accompanying immune cell abberations (5). However, the mechanisms that drive TNFα production during hypogonadal states remain relatively unclear. In this issue, Li et al. (7) show that gut microbiota play a fundamental role in the enhanced TNFα production that occurs upon the induction of estrogen deficiency in mice. It has previously been shown that lowering the inflammatory burden does suppress the effects of estrogen deficiency. For example, TNFα or IL-1 blockade in early postmenopausal women decreases bone resorption markers (8). Likewise, mice in which Tnfa or Il6 is deleted are relatively resistant to ovariectomy-induced bone loss (9). Li et al. evaluated how gut microbiota contribute to the inflammation seen with estrogen deficiency by using a strategy in which mice raised in an environment devoid of gut bacterial colonization (germ-free mice) were chemically castrated with leuprolide (7). Impressively, these hypogonadal, germ-free mice did not experience the marked bone loss that occurred in hypogonadal mice with unperturbed gut flora. Likewise, osteoclast numbers were not increased in germ-free mice. Even more impressive was the observation that the reintroduction of flora into germ-free mice reversed the osteoprotection exerted by an absence of microbiota; this, in essence, proved a fundamental role for gut microbiota in regulating skeletal integrity. Mice raised in a germ-free environment are indeed known to have increased bone mass and fewer osteoclasts (10). The findings of Li et al. now suggest that the same pathways are responsible for the bone loss accompanying sex steroid deficiency.
Germ-free mice maintain barrier functionWhat is the mechanism through which gut microbiota mediate bone loss during sex steroid deficiency? It is widely acce...