Volume 5 Issue 12, December 2009

Researchers have identified a new molecular pathway for the regulation of bone and energy metabolism that challenges the conventional view of the role of leptin in bone turnover.

Adipocytokines are usually regarded as signaling molecules that originate from and act within the adipose tissue. However, recent data show that adipocytokines, especially adiponectin, exert various functions throughout the organism that are neither unambiguously protective nor solely harmful.

In the late 1990s, bone cell biologists predicted inhibition of RANKL as an important therapeutic target for osteoporosis. The theory has now been confirmed by two studies showing that denosumab reduces fracture risk. This success for translational research should be tempered by awareness of the need for long-term monitoring for adverse effects.

Two randomized controlled trials have shown no significant differences in outcome between vertebroplasty and a sham procedure in patients with back pain and vertebral fracture. What conclusions can be drawn from these results?

New research shows that intensive bisphosphonate therapy for Paget disease of bone has no beneficial effect on quality of life, bone pain or clinical complications compared with symptomatic management. What are the implications of these findings on the management of patients with Paget disease?

The immune and skeletal systems share several molecules, including cells, cytokines, transcription factors, signaling molecules and membrane receptors. In rheumatoid arthritis, the synovium is a site of active interplay between immune cells and bone cells, in which, as outlined in this Review, osteoclasts are stimulated by cytokines and molecules, such as receptor activator of nuclear factor κB ligand, to mediate structural damage.

Evidence is mounting that biologic agents used to treat rheumatoid arthritis and other inflammatory rheumatic diseases exert substantial effects not only on underlying inflammation but also on the vasculature. This article reviews the available evidence on the effects of infliximab, adalimumab, etanercept and rituximab on atherosclerosis and cardiovascular disease risk.

Bone tissue engineering involves the development of viable bone substitutes that restore and maintain the function of bone tissue. In this article, the authors provide an overview of the rapidly progressing field of bone tissue engineering, describing the various approaches at the level of the scaffold, cells, and growth factors, and identifying the advantages and limitations of each approach.

Musculoskeletal ultrasonography is emerging as a potentially useful tool for the assessment and management of patients with rheumatoid arthritis. In this Review, Dr. Andrew Brown describes the diverse applications and advantages of this imaging modality in the diagnosis, treatment and monitoring of rheumatoid arthritis in the clinic.

Septic costochondritis is a rare presentation that is usually seen in intravenous drug users, patients with diabetes or those receiving long-term hemodialysis. In this Case Study, the authors describe the diagnosis and management of this condition in a previously healthy patient without any of the established risk factors.

B-cell-depletion therapy emerged as a new therapeutic option for systemic lupus erythematosus (SLE) about a decade ago. Promising results from several open-label studies, with respect to efficacy and safety, were marred by the failure of two large, randomized controlled studies of rituximab to meet their endpoints. Rather than writing off B-cell depletion, might we eventually be able to accept it as a useful approach for treating SLE?