Targeting “Immunoporosis” as a novel concept of Immunotherapy in the management and treatment of Osteoporosis

Abstract

Osteoporosis is a skeleton disease characterized by low bone mass, bone tissue deterioration, and alterations in bone microarchitecture. It is estimated that there are more than 500 million patients worldwide who suffer from osteoporosis-related fractures. There are several risk factors for osteoporosis. These comprise common risk factors like aging and steroid deficiency, as well as specific risk factors such as glucocorticoid use, decreased bone quality, and modifications in bone microarchitecture. However, the pivotal role of the immune system in osteoporosis was initially sidelined in the pathophysiology of osteoporosis but has gained much attention in recent years. Current discoveries have highlighted the existence of a vast network of communication between bone and the immune system in the maintenance of bone homeostasis. Moreover, it is observed that the majority of first-line therapies currently used to treat osteoporosis have immunomodulatory potential thereby preventing bone resorption by regulating the “Immunoporotic axis.” Therefore, these findings would potentially lead to a dramatic shift in the treatment modalities for the management of inflammatory bone loss observed in osteoporosis. To emphasize the crucial role of the immune system in the pathology of osteoporosis, our group coined the term “Immunoporosis” in 2018. In this chapter, we will comprehensively review the pivotal role of the immune system in the pathophysiology of osteoporosis. Furthermore, we will discuss several novel immunomodulatory strategies that can be exploited for the management and prevention of osteoporosis.