Key Takeaways & Executive Findings
- •• Blood cells, including leukocyte subsets, erythrocytes, and platelets, regulate bone metabolism through cytokine secretion, inflammatory modulation, and growth factor release, impacting osteoporosis pathogenesis. • Blood cell-derived biomarkers offer promising tools for early osteoporosis screening and diagnosis, with gene regulation and proteomics enhancing their potential. • Emerging therapeutic strategies targeting blood cells, such as immune intervention and stem cell-based approaches, provide novel avenues for osteoporosis treatment. • Technological advances like CRISPR-Cas9 and single-cell analysis are expected to overcome current limitations and enable precise blood cell-based therapies for osteoporosis.
Abstract
BACKGROUND: Osteoporosis is a systemic bone metabolic disease characterized by deterioration of bone microstructure and increased bone fragility. Blood is not only a medium of bone metabolism, but also a major factor in the regulation of bone metabolism. The traditional theory of "osteogenesis-osteoclast" is difficult to fully explain its complex pathogenesis, but bone immunology reveals the core role of the interaction between the immune system and bone, and the effects of blood cells in osteoporosis have become a research hotspot. OBJECTIVE: To summarize the mechanism of action of blood cells in osteoporosis and evaluate its potential for related biomarkers and emerging therapeutic approaches. METHODS: A systematic literature search was conducted in CNKI, Wanfang, PubMed, and Web of Science databases using Chinese and English search terms including "blood cells, osteoporosis, biomarkers, bone metabolism, neutrophils, macrophages, bone marrow mesenchymal stem cells". A total of 65 articles were included for review. RESULTS AND CONCLUSION: Blood cells influence the occurrence and development of osteoporosis through mechanisms such as inflammation, immune response, and metabolic regulation. Blood cell-based biomarkers can serve as indicators for early screening of osteoporosis and provide effective targets for diagnosis and treatment. With advances in CRISPR-Cas9 gene editing, single-cell technology, and novel monoclonal antibody development, blood cells are expected to play an important role in the treatment of osteoporosis.
1. Introduction
Osteoporosis is a systemic bone disease characterized by low bone mass and deterioration of bone microarchitecture, leading to increased bone fragility and susceptibility to fractures [1]. It primarily results from an imbalance between osteoblast-mediated bone formation and osteoclast-mediated bone resorption (Figure 1). Based on etiology, osteoporosis is classified into primary and secondary types; primary includes postmenopausal (type I), senile (type II), and idiopathic osteoporosis, while secondary arises from other diseases or factors [2]. Epidemiological data indicate a 32.6% prevalence of osteoporosis in postmenopausal women [3], and among adults over 50 years, approximately 10.2% are affected, with projections rising to 13.6% by 2030 [4].
Recent research has revealed that blood cells not only participate in systemic immune responses but also play crucial roles in the pathogenesis and progression of osteoporosis by secreting cytokines, modulating inflammatory responses, and influencing bone cell activity. For instance, T and B cells regulate osteoclast formation and activity via cytokines; monocytes and macrophages modulate osteoclast differentiation; neutrophils release pro-inflammatory factors under inflammatory conditions, promoting osteoporosis; and erythrocyte and platelet indices serve as early screening tools. Blood cell-based biomarkers hold significant promise for elucidating the mechanisms of osteoporosis, yet their precise roles remain incompletely understood, necessitating further experimental validation to assess their potential as diagnostic tools or therapeutic targets. Investigating emerging therapeutic strategies related to blood cell biomarkers is of great importance. This review aims to summarize the roles of blood cells in osteoporosis, providing a basis for understanding its mechanisms and developing treatments.
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Hu Yingnan, Shi Wanwan, Wang Datao (2026). Blood cells and the occurrence and progression of osteoporosis: biomarkers and emerging therapeutic strategies. Chinese Journal of Tissue Engineering Research. https://doi.org/10.12307/2026.21422
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Frequently Asked Questions
What is the role of blood cells in osteoporosis?
Blood cells, including leukocytes, erythrocytes, and platelets, regulate bone metabolism through cytokine secretion, inflammatory modulation, and growth factor release. They influence osteoblast and osteoclast activity, thereby contributing to the pathogenesis and progression of osteoporosis.
How can blood cell biomarkers be used for osteoporosis diagnosis?
Blood cell biomarkers, such as specific immune cell subsets and platelet indices, can serve as indicators for early screening and diagnosis of osteoporosis. Advances in gene regulation and proteomics enhance their diagnostic potential.
What are the emerging therapeutic strategies targeting blood cells for osteoporosis?
Emerging strategies include immune intervention, stem cell-based therapies, and the use of exosomes. Additionally, CRISPR-Cas9 gene editing and monoclonal antibodies are being explored to modulate blood cell functions for therapeutic benefit.
What are the current challenges in blood cell-based therapies for osteoporosis?
Challenges include the complexity of osteoporosis pathophysiology, technical limitations in CRISPR-Cas9 editing of hematopoietic stem cells (e.g., differentiation efficiency and specificity), and the need for synergistic combination with existing drugs.
What is the significance of bone immunology in osteoporosis research?
Bone immunology reveals the core role of the immune system in bone metabolism, highlighting the interaction between immune cells and bone cells. This perspective helps explain the complex pathogenesis of osteoporosis beyond the traditional 'osteogenesis-osteoclast' imbalance.
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