Bone Overview
Bone is a specialized mineralized connective tissue composed of a dense extracellular matrix predominantly consisting of type I collagen and hydroxyapatite crystals, which together provide mechanical strength and rigidity[1][3][7]. It contains four main cell types: osteoblasts (bone-forming), osteocytes (mature, matrix-embedded), osteoclasts (bone-resorbing), and bone lining cells, all coordinating bone remodeling and homeostasis[1][7]. Bone serves structural, protective, metabolic, and hematopoietic functions, and its dynamic remodeling is tightly regulated by local and systemic factors, including various hormones, cytokines, and growth factors[1][7][9]. In clinical medicine, bone is a tissue system rather than a molecular or protein target; therapies for bone diseases commonly target molecular mediators (such as RANKL, parathyroid hormone receptor, sclerostin) or pathways involved in bone cell activity and matrix regulation, rather than "bone" as a discrete target in the sense of a single molecular entity[2][4].
Mechanism of Action
Bisphosphonates: Inhibit osteoclast-mediated bone resorption Denosumab: RANKL inhibitor, reduces osteoclast formation/function Parathyroid hormone analogs: Intermittent stimulation of bone formation (anabolic effect) Romosozumab: Sclerostin inhibitor, increases bone formation and reduces resorption Calcitonin: Directly inhibits osteoclast activity
Biological Functions
Disease Associations
Safety Considerations
- Osteonecrosis of the jaw (bisphosphonates, denosumab)
- Atypical femoral fractures (bisphosphonates)
- Hypercalcemia (parathyroid hormone analogs)
- Hypocalcemia (denosumab)
- Increased risk of osteosarcoma (teriparatide, in preclinical models)
- Cardiovascular risks (romosozumab)
- General mineral metabolism disturbances
Interacting Drugs
Associated Biomarkers
Biomarker |
---|
Bone mineral density (BMD) |
Serum calcium and phosphate |
Alkaline phosphatase (bone-specific isoform) |
Telopeptides (e.g., CTX, NTX) as markers of bone turnover |
Osteocalcin |
Sclerostin |