The Impact of Bisphosphonates on the Osteoclast Cells of Osteogenesis Imperfecta Patients
Vandana Dhiman1, Anshita Aggarwal2, Sanjay Kumar Bhadada2, Naresh Sachdeva2, Nirmal Raj Gopinathan3 and D. K. Dhawan1  

1Department of Biophysics, Panjab University, Chandigarh, India, 2Departments of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 3Departments of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Corresponding Author E-mail: bhadadask@rediffmail.com

Abstract: Bisphosphonates (BPs) are widely used for treatment of  osteogenesis imperfecta (OI). However, prolonged use may be associated with suppression of bone turnover, the exact molecular mechanism of which is poorly understood. The objective of this study was to evaluate the effect of zoledronic acid (ZOL) on precursor osteoclasts by studying caspase 3 activity. Total 15 children participated in the study (n = 10 OI patients ,n= 5  controls).  Out of the 10 OI children, 5 had received a cumulative dose of <30 mg and 5 received ≥ 30 mg of ZOL. Isolated mononuclear cells were studied for caspase 3 activity from all study participants. The mean age of study participants was 7 ±1.5 years. Six of them had OI type IV, two had type III and two had types I & II each. Radiographs showed “zebra stripe sign” and dense metaphyses; suggestive of acquired osteosclerosis. Bone turnover markers (PINP and Ctx) were suppressed in all OI patients compared to controls. Caspase-3 activity was significantly increased in precursor osteoclasts cells at higher doses of BPs (>30 mg). Overzealous use of ZOL in OI suppresses bone turnover markers (P1NP, CTX) causes osteosclerosis and increased expression of caspase 3 activity in precursor osteoclasts which results in adynamic bone.

Keywords: Osteogenesis Imperfecta; Fracture; Bone Mass; Zebra Lines; Precursor Osteoclast Cells; Bisphosphonates; Apoptosis

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