肌少-骨质疏松症发病机制

Pathogenesis of Sarcopenia-Osteoporosis

  • 摘要: 肌少-骨质疏松症(osteosarcopenia, OS)患者同时存在肌少症(sarcopenia, SP)和骨质疏松症(osteoporosis, OP), SP是指肌纤维数量减少、力量下降, 引起骨骼肌功能受损; OP表现为骨质流失、密度降低和骨微结构退化。在骨骼肌与骨骼之间的相互作用中, 机械负荷是维持肌-骨单元的重要因素。肌肉质量增加可促进骨骼生长和发育, 进而促进骨密度和强度增加。随着年龄增长, 骨骼肌质量逐渐下降, 导致骨骼负荷减少, 引发骨骼废用性萎缩。激素失衡、慢性炎症、氧化应激、蛋白质分解与合成失衡、体力活动减少和营养不良等因素均与OS的发生密切相关。白细胞介素(interleukin, IL)-6、肿瘤坏死因子α(tumor necrosis factor α, TNF-α)是骨代谢的重要调节因子, 其水平升高与骨矿物质密度呈负相关。IL-6、TNF-α还可通过干扰PI3K/Akt信号通路, 抑制肌肉蛋白质合成, 导致肌萎缩。NOD样受体3(NOD-like receptor protein 3, NLRP3)通过激活损伤相关分子, 引起核因子-κB(nuclear factor-kappa B, NF-κB)通路上调, NLRP3招募pro-Caspase-1, 促进IL-1β和IL-18释放, 导致慢性炎症增加, 诱发OS。肌骨之间相互依存及多种生物学因素交互作用共同导致OS的发生。随着全球老龄化加剧, OS发病率将持续上升, 急需针对其机制开展深入探究, 为OS的预防和治疗提供相关理论依据。

     

    Abstract: Osteosarcopenia(OS) is the coexistence of sarcopenia(SP) and osteoporosis(OP). SP is a decrease in the number and strength of muscle fibers, causing impaired skeletal muscle function, and OP manifests itself as bone loss, decreased density, and degradation of bone microarchitecture. Mechanical loading is an important factor in maintaining the skeletal muscle-skeletal units in the interaction between skeletal muscle and bone. Increased muscle mass promotes bone growth and development and improves bone density and strength. As we age, skeletal muscle mass progressively decreases, leading to reduced skeletal loading which triggers wasting atrophy of the skeleton. Hormonal imbalance, chronic inflammation, oxidative stress, imbalance between protein degradation and synthesis, decreased physical activity and malnutrition are all closely associated with the development of OS. Interleukin(IL)-6 and tumor necrosis factor α(TNF-α)are important regulators of bone metabolism, and their elevated levels are negatively correlated with bone mineral density. IL-6 and TNF-α also inhibit protein synthesis in muscle by interfering with PI3K/Akt signaling pathways. NOD-like receptor protein 3(NLRP3) causes up-regulation of the NF-κB(nuclear factor-kappa B) pathway by activating damage-related molecules, and NLRP3 recruits pro-Caspase-1 to promote the release of IL-1β and IL-18, leading to increased chronic inflammation and inducing OS. The interdependence between skeletal muscle and bone and the interaction of multiple biological factors combine to contribute to the development of OS. As global aging increases, the incidence of OS will continue to rise, and in-depth investigation of its mechanisms is urgently needed to provide a theoretical basis for OS prevention and treatment.

     

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