What is bone remodelling?
Bone remodelling is the lifelong, coupled process by which osteoclasts resorb and osteoblasts replace bone. This page defines the process, its molecular regulators, and the research models used to study it.
What is bone remodelling?
Bone remodelling is the continuous, coupled process by which mature bone tissue is resorbed by osteoclasts and subsequently replaced by osteoblasts, maintaining skeletal integrity and mineral homeostasis throughout life. It is distinct from bone modelling, which changes bone shape during growth. Synonyms include bone turnover and bone renewal. The process is regulated by the RANK/RANKL/OPG signalling axis and by the Wnt/β-catenin pathway, whose inhibitor sclerostin is a therapeutic target in osteoporosis [2].
Osteoporosis, a systemic skeletal disorder affecting approximately 10% of individuals over 50 years of age, is characterised by increased risk of fragility fractures and is a major source of morbidity, mortality, and healthcare burden worldwide [2]. Approved pharmacological therapies for osteoporosis include anabolic agents that stimulate osteoblast-mediated bone formation (teriparatide, abaloparatide), antiresorptive agents that inhibit osteoclast-driven bone resorption (bisphosphonates, denosumab), and dual-action agents such as romosozumab, which through sclerostin inhibition simultaneously increases bone formation and decreases bone resorption [2].
Research Studies
Vitamin K status and bone strength, geometry and microarchitecture
A prospective cross-sectional case-control study enrolled 108 patients undergoing arthroplasty (hip-fracture, n = 63; non-fracture, n = 45) and collected bone biopsies and blood specimens intraoperatively. The study examined the incremental contribution of six pathway-specific nutritional biomarkers, including circulating biomarkers reflecting vitamin K, one-carbon metabolism, and antioxidant nutrients (vitamins E and C). The authors noted that the contribution of specific nutritional biomarkers to skeletal fragility remains poorly understood, in part because most studies include participants with metabolic conditions that obscure nutrient-specific effects [1].
MicroRNA markers and therapeutic response to romosozumab and abaloparatide in postmenopausal osteoporosis
A registered clinical study investigates microRNA and markers of therapeutic response to romosozumab and abaloparatide in postmenopausal osteoporosis. The study context notes that osteoporosis affects approximately 10% of individuals over 50 years of age and that approved therapies include anabolic agents (teriparatide, abaloparatide), antiresorptive agents (bisphosphonates, denosumab), and the dual-action agent romosozumab, which acts through sclerostin inhibition [2].
Parathyroid hormone combined with xenograft in maxillary sinus augmentation
A clinical study investigated the effect of combining parathyroid hormone (PTH) with bovine-derived bone graft in maxillary sinus augmentation. The authors stated that there is limited information available about the effect of PTH on maxillary sinus augmentation to achieve a clear understanding of PTH's efficacy in bone regeneration and bone remodelling through radiological, clinical, biomarker, histological and histomorphometric assessment. Objectives included evaluation of bone density at planned implant sites using cone beam computed tomography (CBCT) and histomorphometric examination of maxillary sinus bone to measure bone trabeculae, connective tissue, osteoblast, and osteocyte after healing 4 months after the procedure [3].
Comparison of bone remodelling markers across therapeutic classes
The table below summarises the therapeutic classes and their principal effects on bone remodelling as described in the evidence.
| Therapeutic class | Example agents | Principal effect on remodelling |
|---|---|---|
| Anabolic | Teriparatide, abaloparatide | Stimulate osteoblast-mediated bone formation [2] |
| Antiresorptive | Bisphosphonates, denosumab | Inhibit osteoclast-driven bone resorption [2] |
| Dual-action | Romosozumab | Through sclerostin inhibition, simultaneously increases bone formation and decreases bone resorption [2] |
Biomarkers of vitamin K status and skeletal fragility
The arthroplasty study measured circulating biomarkers reflecting vitamin K status alongside one-carbon metabolism and antioxidant nutrients (vitamins E and C) in 108 patients. The design allowed examination of the incremental contribution of six pathway-specific nutritional biomarkers to skeletal fragility, with bone biopsies and blood specimens collected intraoperatively [1].
Histomorphometric assessment of bone remodelling in sinus augmentation
In the maxillary sinus augmentation study, histomorphometric examination of maxillary sinus bone was planned to measure bone trabeculae, connective tissue, osteoblast, and osteocyte populations after healing 4 months after the procedure. Bone density at planned implant sites was evaluated using CBCT [3].
MicroRNA as markers of therapeutic response in osteoporosis
The registered study of romosozumab and abaloparatide in postmenopausal osteoporosis examines microRNA and markers of therapeutic response. The study background notes that osteoporosis is characterised by increased risk of fragility fractures and that a range of pharmacological therapies has been approved with demonstrated efficacy in reducing fracture risk [2].
Parathyroid hormone and bone regeneration in maxillary sinus augmentation
The maxillary sinus augmentation study aimed to investigate the beneficial effect of combining PTH with bovine-derived bone graft. The authors noted limited information about the effect of PTH on maxillary sinus augmentation and sought a clear understanding of PTH's efficacy in bone regeneration and bone remodelling through radiological, clinical, biomarker, histological and histomorphometric assessment [3].
If you are reading this for personal health reasons
The materials and compounds discussed on this page are sold for laboratory research use only. We do not provide dosing, medical guidance, or recommendations for personal use. Anyone considering a compound for themselves should speak to a licensed clinician.
Sources
- [1] Vitamin K Status and Skeletal Fragility: Differential Associations of Osteocalcin Carboxylation States with Bone Strength, Geometry and Microarchitecture. https://europepmc.org/article/PMC/PMC13516068
- [2] MicroRNA and Markers and Therapeutic Response to Romosozumab and Abaloparatide in Postmenopausal Osteoporosis. https://clinicaltrials.gov/study/NCT07616401
- [3] Radiographical, Histomorphometrical and Biomarker Analysis After Maxillary Sinus Augmentation Utilizing Xenograft Particulate Bone Graft Mixed With Parathyroid Hormone. https://clinicaltrials.gov/study/NCT07459075