从雌激素为中心到衰老和氧化应激:骨质疏松症发病机制的新视角。
From estrogen-centric to aging and oxidative stress: a revised perspective of the pathogenesis of osteoporosis.
机构信息
Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas 72205-7199, USA.
出版信息
Endocr Rev. 2010 Jun;31(3):266-300. doi: 10.1210/er.2009-0024. Epub 2010 Jan 5.
Estrogen deficiency has been considered the seminal mechanism of osteoporosis in both women and men, but epidemiological evidence in humans and recent mechanistic studies in rodents indicate that aging and the associated increase in reactive oxygen species (ROS) are the proximal culprits. ROS greatly influence the generation and survival of osteoclasts, osteoblasts, and osteocytes. Moreover, oxidative defense by the FoxO transcription factors is indispensable for skeletal homeostasis at any age. Loss of estrogens or androgens decreases defense against oxidative stress in bone, and this accounts for the increased bone resorption associated with the acute loss of these hormones. ROS-activated FoxOs in early mesenchymal progenitors also divert ss-catenin away from Wnt signaling, leading to decreased osteoblastogenesis. This latter mechanism may be implicated in the pathogenesis of type 1 and 2 diabetes and ROS-mediated adverse effects of diabetes on bone formation. Attenuation of Wnt signaling by the activation of peroxisome proliferator-activated receptor gamma by ligands generated from lipid oxidation also contributes to the age-dependent decrease in bone formation, suggesting a mechanistic explanation for the link between atherosclerosis and osteoporosis. Additionally, increased glucocorticoid production and sensitivity with advancing age decrease skeletal hydration and thereby increase skeletal fragility by attenuating the volume of the bone vasculature and interstitial fluid. This emerging evidence provides a paradigm shift from the "estrogen-centric" account of the pathogenesis of involutional osteoporosis to one in which age-related mechanisms intrinsic to bone and oxidative stress are protagonists and age-related changes in other organs and tissues, such as ovaries, accentuate them.
雌激素缺乏被认为是女性和男性骨质疏松症的主要发病机制,但人类的流行病学证据和最近啮齿动物的机制研究表明,衰老和随之而来的活性氧(ROS)增加是主要原因。ROS 极大地影响破骨细胞、成骨细胞和骨细胞的生成和存活。此外,FoxO 转录因子的氧化防御对于任何年龄的骨骼稳态都是必不可少的。雌激素或雄激素的丧失会降低骨骼对氧化应激的防御能力,这解释了与这些激素急性丧失相关的骨吸收增加。ROS 激活的早期间充质祖细胞中的 FoxO 也会使 ss-catenin 远离 Wnt 信号通路,导致成骨细胞生成减少。这种机制可能与 1 型和 2 型糖尿病的发病机制以及 ROS 介导的糖尿病对骨形成的不良影响有关。配体由脂质氧化产生,激活过氧化物酶体增殖物激活受体 γ,从而抑制 Wnt 信号通路,这也导致随着年龄的增长,成骨作用减少,这为动脉粥样硬化和骨质疏松症之间的联系提供了一种机制解释。此外,随着年龄的增长,糖皮质激素的产生和敏感性增加会通过减少骨血管和间质液的体积来降低骨骼水合作用,从而增加骨骼脆弱性。这一新出现的证据提供了一个范式转变,从“雌激素为中心”的发病机制解释退行性骨质疏松症,到内在的与年龄相关的机制在骨骼和氧化应激中起主要作用,以及年龄相关的变化在其他器官和组织,如卵巢,强调它们。
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