Combination therapy has the potential to revolutionize fracture prevention in osteoporosis

Osteoporosis is a disease in which bone tissue breaks down faster than it forms, gradually weakening bone structure and leading to fractures. Although the disease is well known, Dominique Pioletti, head of the Biomechanical Orthopaedics Laboratory at the EPFL School of Engineering, emphasizes that the economic and social consequences of osteoporosis fractures are often underestimated.

“In the absence of effective preventive measures, about 40% of women in their 50s experience at least one serious osteoporotic fracture; in men, the figure is about 20%,” he says. – What’s more, people often don’t realize the seriousness of the condition. In elderly people with femoral neck fractures in the hip region, the mortality rate within a year of fracture is 20%, and more than half of those affected are never able to return to pre-fracture activities.

A diagnosis of osteoporosis is usually accompanied by treatment with systemic drugs that work by either reducing the rate of resorption of old bone tissue (anti-catabolism) or speeding up the production of new bone tissue (anabolism). But both treatments can take up to a year to have an effect, and in the meantime patients become prone to fractures.

Pioletti and colleagues have developed an injectable hydrogel to rapidly increase bone density locally. The team, in collaboration with Vincent Stadelmann of the Schultes Clinic, Zurich, recently reported a new therapy that combines hydrogel injections with traditional systemic drugs. The results, published in the journal Bone, show a four- to fivefold increase in bone density in the paws of rats that had previously shown bone loss.

In this work, scientists have demonstrated for the first time that a combination therapy involving systemic drug delivery and local injection of a novel hydrogel provides a rapid increase in bone density and therefore could revolutionize fracture prevention in osteoporosis.

Enhancing synthesis and preventing fracture

Most current treatments for osteoporosis are systemic, and the few topical treatments available are in the form of pastes that harden into a cement-like substance. An easily injectable hydrogel developed at EPFL is composed of hyaluronic acid and hydroxyapatite nanoparticles and mimics the natural minerals in bone.

The results of the study showed that self-administered injections of the hydrogel significantly increased bone density by two to three times, independent of the use of systemic therapy. However, the strongest effect was observed in animals receiving systemic anabolic treatment (parathyroid hormone) and hydrogel mixed with the anti-catabolic drug zoledronate: at the injection site, bone density increased almost 4.8-fold in just 2-4 weeks.

The results of this study suggest that injectable hydrogels with local delivery of anti-catabolic drugs may complement systemic anti-catabolic treatment or systemic anabolic treatment to promote bone strength by rapidly increasing bone density locally.

The team of scientists is now awaiting regulatory approval to conduct a human clinical trial.

The researchers hope that such a trial will allow them to demonstrate the benefits of the hydrogel in cases where patients require a rapid increase in bone density, such as for implant support in conditions of bone weakness. The researchers then plan to use the findings to develop a therapy to prevent osteoporosis-induced fractures.

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Published: 29.01.2025

Updated: 29.01.2025

Medical author, Medical editor:

Stepan Yuk

Medical expert:

PhD. Olexandr Voznyak