Description
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Introduction: Bisphosphonate is prescribed to treat excessive bone resorption in osteoporotic patients. However, its use is associated with potential adverse effects such as medication-related osteonecrosis of the jaw, prompting the introduction of the drug holiday concept in patients before dentoalveolar surgery. Furthermore, discontinuation of bisphosphonate has been studied in vivo, human and animal models. However, it is not known whether this approach could affect bone cells in vitro. Therefore, the objective of this study was to investigate the potential effects of bisphosphonate discontinuation on pre-osteoblast and osteoblast activities in vitro. Methodology: Pre-osteoblasts (MC3T3) and osteoblasts were treated with bisphosphonate (alendronate) at concentrations 1, 5, and 10 µM. Then, alendronate was withdrawn at different time points. Negative control was untreated cells (0 µM), while positive control was cells incubated with alendronate throughout the experiment. Cell viability, cell adhesion, cell cytoskeleton, mineralization, and gene expressions were investigated. Results: Pre-osteoblasts and osteoblasts showed a decrease in cell viability after treatment with 5-10 μM alendronate for 4 days or longer. Two days of alendronate discontinuation significantly increased cell viability compared with positive control. However, these levels did not reach the levels of the negative control. Bone nodule formation was reduced by alendronate. Discontinuation of alendronate regained bone nodule formation. Longer discontinuation periods were more effective in recovering nodule formation compared to shorter periods. The addition of alendronate resulted in an increase in the percentage of dead cells; this decreased when alendronate was withdrawn. Alendronate affected cell cytoskeleton by disassembling actin stress fiber. Also, the number of cell adhesion and cell morphological parameters were impacted by alendronate. Discontinuation of alendronate restored cell adhesion and these parameters. Overall, the highest improvement after alendronate discontinuation was seen at 10 µM. However, alendronate treatment and discontinuation did not affect osteoblast gene expressions. Conclusion: Discontinuation of alendronate help recover the negative effects of the drug on cell viability, cell adhesion, and mineralization via restoring cell cytoskeleton. Our data suggested the benefits of the drug holiday and/or intermittent strategies for alendronate administration at the cellular level. (2024-06-25)
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