Two of the most common complications in systemic mastocytosis (SM) are osteoporosis and fractures. According to a review recently published in Osteoporosis International, controlling SM itself is the best way of protecting bone health in people with the disease.
SM is caused by the abnormal accumulation of mast cells in different organs. When mast cells accumulate in the bones, it can cause problems with bone mineral density.
Bone disease can take on many forms in SM, including osteopenia (reduced bone density), osteolytic lesions (areas of destroyed bone tissue) and osteosclerosis (abnormal hardening of bone tissue). Common risk factors for fragility fractures in patients with SM include advanced age, male sex and lower hip bone mineral density.
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Research is expanding our understanding of the molecular processes in SM that are linked to bone disease. The infiltration and activation of mast cells, alongside the release of inflammatory mediators like histamines, creates an environment conducive to bone loss and other effects that weaken the bone tissue. This raises the risk of fractures from even minimal trauma.
“Therefore, controlling mast cell activity and proliferation might be the best way to prevent SM-related skeletal complications,” the review’s authors wrote.
The most frequently prescribed first-line therapies in SM-associated osteoporosis are antiresorptive therapies, such as bisphosphonates and denosumab. Bisphosphonates have a long history of strengthening bone mineral density, reducing pain in osteopenia and lowering the risk of falls.
Scientists have suggested that adding interferon (a protein that helps the immune system) to bisphosphonates can suppress mast cell activity, lower tryptase levels and generally improve bone density compared with the use of bisphosphonates alone.
However, the authors suggested the best strategy for dealing with SM-associated bone diseases is to prevent them from developing in the first place, which can be achieved by controlling the proliferation and activation of mast cells. They suggest the best approach to dealing with bone disease in SM is to treat the disease as a whole, which will have a downstream effect on preserving bone integrity and protecting against fractures.
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