Patogénesis de la osteoporosis: papel de los estrógenos
DOI:
https://doi.org/10.18597/rcog.477Palabras clave:
menopausia, osteoporosis, estrógenos, patogénesisResumen
Introducción: la osteoporosis es una enfermedad en la que la pérdida de fortaleza ósea conduce a fracturas por fragilidad. Las fracturas de cadera tienen alta morbilidad y mortalidad, igualmente existen resultados similares para las fracturas vertebrales. La prevalencia creciente y los tremendos costos de este desorden resaltan la importancia de desarrollar nuevos tratamientos, por ello identificar los mecanismos moleculares que controlan la masa ósea es de suma importancia.
La resorción ósea por los osteoclastos se acopla con la formación por los osteoblastos, proceso equilibrado que remodela y adapta el esqueleto. La fragilidad ósea es consecuencia de una adaptación fallida. Durante la menopausia, la remodelación del hueso pierde su equilibrio y se produce pérdida ósea.
La deficiencia de estrógenos conduce a un aumento global en producción de IL-7, en parte a través de disminución en TGF-ß y aumento de IGF-1, lo que lleva a activación de células T. Las células T activadas liberan IFN-g, el cual incrementa la presentación antigénica.
La deficiencia de estrógenos también amplifica la activación de células T y la osteoclastogénesis, regulando a la baja las vías antioxidantes. El aumento resultante en los oxidantes estimula la presentación antigénica y la producción de TNF por los osteoclastos maduros. El efecto combinado de IFN-g y oxidantes promueve la liberación de los factores osteoclastogénicos RANKL y TNF.
El TNF estimula la producción de RANKL y MCSF por células pluripotenciales y osteoblastos, incrementando la producción de estos últimos. TNF e IL-7 alteran la formación ósea a través de efectos represivos directos en los osteoblastos.
Biografía del autor/a
Oswaldo Rincón-Sierra
Ivonne Díaz-Yamal
Luis Ernesto Pérez-Agudelo
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