Increased bone resorption precedes increased bone formation in the ovariectomized rat

This study describes an increase in biochemical and histomorphometric markers of bone resorption prior to increased bone formation and trabecular bone loss in the ovariectomized rat. Six-month-old, female Sprague Dawley rats were either sham operated or ovariectomized (Ovx) and killed at 0, 6, 9, 15, 18, 21, and 42 days postOperation when femora were collected and trabecular bone volume (BV/TV) was determined from von Kossa silver-stained sections using the Quantimet 520 image analysis system in the distal region. A number of these sections were also examined unstained for fluorochrome labels, and stained for acid phosphatase to detect osteoclast-like cells (ACP surface). At 18 days postoperation, lumbar vertebrae were examined. Blood and urine specimens were analyzed for bone-related biochemical variables. ACP surface was significantly greater in Ovx rats compared with sham at 6 days postoperation (mean ACP surface (%TS) ± SEM: sham 36.4 ± 1.9; Ovx 40.3 ± 1.2,P < 0.05) as was urinary hydroxyproline excretion. Serum osteocalcin and alkaline phosphatase activity were not elevated in Ovx rats compared with Sham until 9 days postoperation. Mineral apposition rate (MAR) was increased at 12 days after ovariectomy (mean MAR (Μm/day) ± SEM: sham 0.85 ± 0.06; Ovx 1.23 ± 0.06,P < 0.05). Trabecular bone volume (BV/TV) at a specific site in the metaphyseal-diaphyseal core area was significantly lower at 15 days postoperation (mean (%) ± SEM: Sham 7.40 ± 1.23, Ovx 4.25 0 0.65,P < 0.05). There was no difference in lumbar vertebral BV/TV between the two groups at 18 days postoperation, however, ACP surface was elevated in the Ovx rats (P < 0.05). A systemic increase in bone resorption at 6 days postovariectomy precedes increased formation whereas the length of time required for the dissolution of trabeculae postoperation is determined locally.     

Osteoclast recruitment and modulation by calcium deficiency,fasting, and calcium supplementation in the rat

In the rat, 1 week of a calcium-deficient diet will recruit large numbers of osteoclasts to long bone endosteal surfaces. Subsequent calcium supplementation causes the osteoclasts to disappear in 1–3 days but as little as 3 hours of calcium supplementation reduces the extent of their ruffled borders. To test the hypothesis that at some point there is an irreversible inhibition of osteoclasts, male, weanling, calcium-deficient, SD rats were given various amounts of calcium-containing diet followed by a 12-hour fast. No changes in seven morphological indices of osteoclast activity were found. The hypothesis that the fast had reversed the effects of the calcium diet was supported by a second experiment indicating that no inhibition threshold had been reached. Another experiment showed differences in the degree of osteoclast inhibition with different amounts of calcium supplementation, again without evidence of a threshold. These experiments raised two questions: (1) Will fasting recruit osteoclasts in calcium-replete rats? and (2) Is osteoclast recruitment facilitated by the presence of postosteoclasts? The results of experiments testing these hypotheses support the conclusion that fasting and calcium deficiency maintain plasma calcium levels by different mechanisms, and post-osteoclasts are not available for reactivation. It is concluded that inhibition of osteoclasts by dietary calcium is a graded phenomenon, and when osteoclasts have lost contact with the bone surface they are unavailable for reactivation; a threshold has been reached.     

Cancellous bone resorption in the proximal ilium of the ovariectomized rat

Summary Bone histomorphometry was performed on the proximal ilium of mature Sprague-Dawley rats following ovariectomy, and these rats were compared with sham-operated controls. Bone volume per unit tissue volume (BV/TV), osteoid surface, and the depth and extent of eroded cavities were measured in animals killed at intervals after operation. The rate of bone loss and the mean osteoid surface in the proximal ilium of the ovariectomized rats was significantly greater than that of the control rats over a 210-day postoperative period. The eroded surface and mean trabecular thickness in the proximal ilium of the ovariectomized rats were not significantly different from that of the control rats, and therefore failed to explain the difference in the rate of bone loss. The distribution of the depths of trabecular eroded cavities in the ilium of ovariectomized rats was different from that in the control rats. The loss of trabecular bone mass in the proximal ilium of ovariectomized, mature rats appeared due to increased activity of individual osteoclasts, rather than to increased osteoclast numbers and thinning of trabeculae.     

Minocycline prevents the decrease in bone mineral density and trabecular bone in ovariectomized aged rats

In the current study, we examined the effects of minocycline, on the osteopenia of ovariectomized aged rats. Old female rats were randomly divided into five groups: sham, ovariectomized control and ovariectomized treated with minocycline, 17β-estradiol, or both agents. Bone samples were collected 8 wk after the treatment. Ovariectomy reduced bone mineral density of the whole femur and at the condylar, distal metaphyseal and head-neck-trochanter regions 10%–19% and the loss of bone density was prevented by treatment with minocycline or 17β-estradiol. Histomorphometric analysis of distal femur showed ovariectomy reduced the trabecular bone area, the trabecular bone number, trabecular bone thickness and increased the trabecular bone separation. The microanatomic structure of trabecular bone also showed that the number of nodes, node to node, cortical to node, node to free end was reduced by ovariectomy. Treatment with minocycline attenuated the effect of ovariectomy on trabecular bone in aged animals. In contrast, cortical bone was not affected by ovariectomy or minocycline treatment. The effect of minocycline on bone turnover was also examined. Minocycline increased osteoid surface, mineralizing surface, mineral apposition rate, bone formation rate and reduced eroded surface. We have therefore concluded that the modest increase in bone mineral density and the improvement in the trabecular bone status noted in minocycline treated ovariectomized aged rats is likely due to an increase in bone formation coupled with a decrease in bone resorption.     

Rapid increase in fraction of cardiac output to bone in experimental calcium deficiency

The fractional redistribution of cardiac output to bone in dietary calcium deficiency was studied in the immature rat, utilizing the⁸⁶Rb method of Sapirstein. The results of the study indicated that there was a rapid and significant increase in the fraction of cardiac output to the femurs of the calcium-deficient rats relative to the control population. The increase in cardiac output fraction to bone occurred during the same general time period in which significant changes in the density, dry weight and ash content were detected. The increased fraction of the cardiac output to the femur in the calcium-deficient rats returned to normal after nine days, in spite of continuation of the calcium-deficient diet.From the Department of Radiology, Yale University School of Medicine. Supported by USPHS Grants AM-09664, GM-01152, AM-09429 and CA-06519.     

The effects of tamoxifen on the osteopenia induced by sciatic neurotomy in the rat: A histomorphometric study

Summary The effects of a 3-week treatment with the nonsteroidal “antiestrogen” tamoxifen were determined on cortical and trabecular bone mass of the tibiae of growing male rats that had undergone unilateral sciatic neurotomy (USN). USN resulted in decreases in cortical area (−11.3%), cross-sectional area (−8.4%), and periosteal bone formation rate (−32.6%) in cortical bone, indicating that the disuse osteopenia results in a decrease in bone formation in cortical bone. USN significantly reduced the amount of trabecular bone in our metaphyseal sampling site (−75%), markedly increasing the amount of bone surface lined by osteoclasts (+65%) without affecting the surface lined by osteoblasts. These results suggest that trabecular bone disuse osteopenia is due, at least in part, to increased bone resorption. Tamoxifen treatment significantly reduced the loss of trabecular bone, restoring resorbing surface length to the control (sham-operated) animal levels. Tamoxifen treatment of sham-operated animals increased trabecular bone area and surface by 35.7% (±10.5) and 41.8% (±7.8), respectively, and reduced resorbing surface by 21.5% (±11.6) compared with sham-operated placebo-treated rats. Tamoxifen had no significant effect on cortical bone parameters in the sham-operated group. The results indicate that tamoxifen is able to reduce the trabecular bone loss that results from USN, but has no effect on cortical bone disuse osteopenia, or on trabecular bone formation. Moreover, tamoxifen treatment of control (intact) animals inhibited the normal levels of bone resorption occurring in these rapidly growing animals.     

Bone particles disturb new bone formation on the interface of the titanium implant after reaming of the marrow cavity

Histomorphometric studies were conducted in rats to determine whether bone particles would disturb new bone formation on the interface of titanium implants inserted after reaming of the marrow cavity. In eighty 10-week-old female Wistar rats, smooth-surfaced titanium alloy implants were inserted bilaterally into the marrow cavity after reaming in the distal femur. There were three experimental groups: in the irrigated femora, sterile saline was flushed through the medullary canal; in the particle femora, autologous bone particles were inserted into the intramedullary cavity; and in the reamed femora, the implant was inserted without procedures after reaming. The rats were sacrificed at one, two, four or eight weeks postoperatively, and Villanueva bone staining was applied for histomorphometric studies. The bone volume of new bone on the interface of the implant in the irrigated femora was greater than that in the particle or the reamed femora throughout the study period. The results suggest that clearance of bone particles by irrigation after reaming of the marrow cavity significantly facilitates new bone formation on the interface of implants by one week. The findings also suggest the potential clinical application of total canal irrigation prior to insertion of cementless femoral components as well as cemented prosthesis.     

Juxtaarticular bone loss in experimental inflammatory arthritis

The osteopenia associated with experimental inflammatory arthritis was studied by a histomorphometric method that exphasized net changes in bone composition. Juxtaarticular trabecular bone volume and turnover were studied in the carrageenan injection model of inflammatory arthritis of the mature rabbit knee. Trabecular bone volume was studied by histomorphometry of the femoral condyles and confirmed by photodensitometry on standard macroradiographs. Osteogenesis was studied by imaging of calcein fluorochrome-labeled newly formed bone in undecalcified histological sections. A significant net loss of cancellous bone (approximately 20%) occurred over 49 days in both the medial and the lateral femoral condyle in the arthritis group compared with normal controls. Total osteogenesis was increased fourfold and it was calculated that an even greater increase in total bone resorption was responsible for the negative bone balance. There is evidence that the periarticular bone loss of human rheumatoid arthritis is also associated with increased bone turnover. Quantitative studies of the kinetics of bone remodeling in inflammatory arthritis will provide the basis for therapeutic attempts to prevent or reverse arthritis-induced bone loss. Fracture risk in inflammatory arthritis may be increased not only by osteopenia, but additionally by the presence of a large proportion of newly formed (and presumably less mineralized) bone.     

The relationship between calcium accumulation in osteoclast mitochondrial granules and bone resorption

In the process of bone resorption, calcium is considered to be transported within vesicles in osteoclasts and eventually released. We studied the ultramicromorphology of calcium (Ca) transport in osteoclasts by preparing samples of osteoclasts collected from rat femurs in which calcium was maximally preserved and subjected them to high-pressure quick-freezing and freeze-substitution. We then examined the localization of calcium by Electron Energy Loss Spectroscopy (EELS). The structures of cell membranes were preserved, suggesting the suitability of this high-pressure quick-freezing and freeze-substitution technique.Osteoclast mitochondria adjacent to the ruffled border were rich in mitochondrial granules and contained a large amount of Ca. In contrast, mitochondria in the basolateral region contained few granules. Moreover, by an osteoclast-culturing experiment, differences in the morphology of mitochondrial granules were noted between culturing on a dentin slice and that on a gold plate, i.e., few mitochondrial granules were noted in osteoclasts cultured on a non-dentin plate.These findings suggest an association between the morphology of mitochondrial granules in osteoclasts and bone resorption as well as a new transport route for Ca resorbed by osteoclasts. We propose that Ca accumulates in mitochondria granules to prevent increased Ca concentration in cytoplasm of osteoclasts during bone resorption.     

Comparison of the effects of calcium loading with calcium citrate or calcium carbonate on bone turnover in postmenopausal women

Calcium supplementation is known to increase bone mineral density and decrease fractures, but the relative efficacy of different forms of calcium supplementation is not established. We compared the effects of calcium carbonate and calcium citrate on markers of bone resorption in older postmenopausal women in an open-labeled crossover study. Forty women were randomized to receive 1000 mg/day of either calcium citrate or calcium carbonate for 12 weeks, followed by a 2-week washout without calcium supplements and 12 weeks treatment with the alternate calcium supplement. All women received vitamin D (900 IU/day). Thirty-four women (25 Caucasian, nine Hispanic) completed the study. No significant differences in the decrease in parathyroid hormone (PTH) or bone specific alkaline phosphatase or the increase in urinary calcium/creatinine were detected between the two treatments. However, calcium citrate supplementation decreased the collagen cross-link resorption markers, urinary N-telopeptide (–30%), C-telopeptide (–31%), free deoxypyridinoline (19%) and serum N-telopeptide (–8%), compared to no significant change following calcium carbonate supplementation (+2%, +3%, +2% and +2%, respectively; P<0.05). Calcium citrate decreased markers of bone resorption significantly more than calcium carbonate in postmenopausal women, although no differences in their effects in calcium excretion or PTH were detected.     

Relationship between serum intact parathyroid hormone concentrations and bone remodeling in type I osteoporosis: Evidence that skeletal sensitivity is increased

To define the role of parathyroid gland function in the pathophysiology of bone loss in type I (postmenopausal) osteoporosis, we measured serum intact parathyroid hormone (PTH) concentration by immunoradiometric assay (IRMA) and by multisite immunochemiluminometric assay (ICMA) in 63 postmenopausal osteoporotic women (PMOp) with vertebral compression fractures and in 75 age-comparable postmenopausal normal women (PMNl). Also, tetracycline-based histomorphometric indices in cancellous bone were assessed in iliac biopsy samples from 61 PMOp and 28 PMNl women. Serum PTH concentrations by IRMA were similar in PMOp and PMNl (medians, 3.92 and 3.77 pmol/l; NS) but were significantly lower in PMOp by the more sensitive ICMA (medians, 2.82 and 3.14 pmol/l;P<0.01). By multiple linear regression analysis, serum PTH was directly related (P<0.001) to activation frequency, bone resorption rate, bone formation rate, and the calculated rate of bone loss. For each unit (pmol/l) increase in serum PTH by ICMA, activation frequency increased by 1.3%/year more (P=0.01), bone resorption rate increased by 3.9%/year more (P=0.003), and the rate of cancellous bone loss was 2.8% greater (P= 0.0003) in the PMOp women compared with the PMNl women. Concentrations of serum estradiol, but not serum estrone, had a weak opposing effect to PTH, especially for bone formation rate. These data suggest that in PMOp the bone has increased sensitivity to the biologic effects of PTH. This may represent one of the fundamental pathophysiologic defects in PMOp and, in the setting of estrogen deficiency, may explain, in part, their greater rate of bone loss.     

The bisphosphonate ibandronate,given daily as well as discontinuously,decreases bone resorption and increases calcium retention as assessed by45ca kinetics in the intact rat

The new bisphosphonate ibandronate was given at various doses and regimens to normal growing rats, and its effect on calcium metabolism investigated by means of⁴⁵Ca kinetics. The bisphosphonate began to inhibit bone resorption at a dose of 0.1 µg P/kg, given daily. At higher doses intestinal calcium absorption, calciuria and calcium balance were also increased, calcemia being decreased. There was no difference in effect when the same amount of compound was given either daily for 10 days or all at once. Furthermore, the effect of a high dose of 100 µg P/kg was present 1 month after a single administration, whereas a dose 10 times lower was no longer effective. These results suggest that ibandronate may be effective in humans for decreasing bone resorption and increasing calcium balance in osteoporosis, when given either daily or discontinuously.With the technical assistance of I. Tschudi.     

Combined magnetic fields increased net calcium flux in bone cells

Low energy electromagnetic fields (EMF) exhibit a large number of biological effects. A major issue to be determined is “What is the lowest threshold of detection in which cells can respond to an EMF?” In these studies we demonstrate that a low-amplitude combined magnetic field (CMF) which induces a maximum potential gradient of 10^-5 V/m is capable of increasing net calcium flux in human osteoblast-like cells. The increase in net calcium flux was frequency dependent, with a peak in the 15.3–16.3 Hz range with an apparent bandwidth of approximately 1 Hz. A model that characterizes the thermal noise limit indicates that nonspherical cell shape, resonant type dynamics, and signal averaging may all play a role in the transduction of lowamplitude EMF effects in biological systems.     

Acute effects of nasal salmon calcitonin on calcium and bone metabolism

Summary Effects of a single dose of 200 IU of nasal salmon calcitonin (SCT) on calcium metabolism and biochemical markers of bone turnover were investigated in 12 healthy male volunteers in a randomized, placebo-controlled, crossover design. The nasal spray was given in the morning, and subsequently blood and urine samples were collected for 26 hours. There was a significant decrease in serum ionized calcium with a nadir 4 hours after administration of nasal SCT accompanied by a significant increase in serum parathyroid hormone (P = 0.01) and serum calcitriol (P = 0.04). Nasal SCT did not reduce urinary hydroxyproline/creatinine. Urinary deoxypyridinoline/creatinine was lowered significantly 2 hours after administration of nasal SCT and throughout the first 24 hours, but remained unchanged for the last 2 hours. On a 24-hour basis, urinary deoxypyridinoline/creatinine decreased from 14.1 (3.5) nmol/mmol to 11.7 (3.2) nmol/mmol after nasal SCT (P = 0.04). Nasal SCT did not change the serum levels of alkaline phosphatase, osteocalcin, and the carboxyterminal propeptide of type 1 procollagen. The results indicate that nasal SCT given as a single dose provokes a modest decrease in bone resorption lasting several hours, but leaves bone formation unaffected.     

Mineral loss in cortical and trabecular bone during high-dose prednisone treatment

Summary To evaluate the effect of prednisone and triple treatment (sodium fluoride, calcium, and vitamin D) on trabecular and cortical bone serial bone mineral content (BMC) measurements were made at a metaphyseal (BMC_D) and diaphyseal (BMC_P) site on the forearm on 31 consecutive and previously bone-healthy patients scheduled for at least 24 weeks high-dose prednisone treatment. The patients were randomized into two further treatment groups: group I (n=16) received prednisone plus triple treatment and group II (n=15) received only prednisone. The two groups were similar with regard to age, sex, prednisone dose, and initial BMC. During 24 weeks treatment, BMC_D (partially representing trabecular bone) and BMC_P (mainly representing cortical bone) fell significantly and similarly, demonstrating that there is no preventive effect on bone mineral loss on the triple regimen. The BMC fall after 12 weeks was significantly more pronounced for metaphyseal (partially trabecular) than for diaphyseal (cortical) bone, whereas the values did not differ significantly after 24 weeks; this indicates a greater sensitivity to the hormone treatment of trabecular bone. In the entire group, the fall in BMC correlated positively with individual prednisone dose, significant at the diaphyseal site (r=0.39,P<0.05), but not at the metaphyseal site (r=0.31, P=0.08). It is concluded that corticosteroid-induced osteopenia is a diffuse bone disease which affects trabecular as well as cortical bone, suggesting that BMC measured on the forearm reflects changes in bone mineral at other locations.     

The anabolic effect of human PTH (1–34) on bone formation is blunted when bone resorption is inhibited by the bisphosphonate tiludronate—is activated resorption a prerequisite for the in vivo effect of PTH on formation in a remodeling system?

Parathyroid hormone (PTH) and its (1-34) fragment are stimulators of bone turnover that have an anabolic effect increasing trabecular bone mass when administered intermittently by daily subcutaneous injections. Its clinical use in osteoporosis, however, has been limited by the concomitant increased bone resorption and deleterious effect on cortical bone. To evaluate if a treatment combining PTH and a potent inhibitor of bone resorption would retain the anabolic effect of PTH without increasing bone resorption, we analyzed the effects of PTH (1–34) (500 IU/d) with or without the bisphosphonate tiludronate (1 mg/kg per day) for 3 months on biochemical and histological indices of bone turnover in old female sheep, an animal model which has a slow bone remodeling activity that resembles the one of elderly women. As expected, PTH (1-34) induced a significant increase of urinary pyridinoline and hydroxyproline (reflecting bone resorption), and of serum osteocalcin and alkaline phosphatase (reflecting bone formation), that were consistent with an increase of resorption and tetracycline-based formation of bone measured on iliac crest biopsy. In contrast, all biochemical and histological indices of bone turnover were decreased in sheep receiving tiludronate, a potent inhibitor of bone resorption. Surprisingly, in the combined therapy group, biochemical and histological indices of both resorption and formation did not differ from the control groups. Thus, the model of old sheep, which closely resembles the situation in old human, shows that the anabolic effect of PTH on bone is not maintained when PTH is coadministered with a bisphosphonate, in marked contrast to results noted in the growing rat. Because bisphosphonates are selective inhibitors of osteoclastic bone resorption that do not directly affect osteoblastic bone formation in vivo, these data suggest that the activation of bone resorption may be a prerequisite for the anabolic effect of PTH. Although tiludronate was the only bisphosphonate tested, our data also suggest that a combined PTH-bisphosphonate therapy is not a valid strategy for osteoporotic patients. Combination regimens of anabolic and antiresorptive agents may not be effective and should be tested in an appropriate animal model before clinical trials in osteoporotic patients are undertaken.     

Removal of tibial marrow induces increased formation of bone and cartilage in rat mandibular condyle

Summary The present paper reports alterations in osteogenesis recorded in mandibular condyles 3–18 days after the removal of marrow tissue from tibial bones. Computerized histomorphometric evaluation of undecalcified condyles revealed a considerable increase in the thickness of condylar cartilage, in particular, the zone of provisional calcification. Measurements of the subcartilaginous trabecular bone suggested an increase in the number of osteoblasts and in their activity. The systemic enhancement of osteogenesis may be initiated by circulating factors released at the affected limb during regeneration of the marrow.     

Treatment of denervation/disuse osteoporosis in the rat with a capacitively coupled electrical signal: effects on bone formation and bone resorption

Utilizing a sciatic neurectomy model of disuse osteoporosis, the effects on rates of bone formation and bone resorption were examined when a capacitively coupled electrical signal was applied to the denervated tibia in the rat. It was found that a low-voltage, symmetrical sine wave, 60-kHz, capacitively coupled signal had no significant effect on the amount of bone resorption occurring in denervated right tibiae in rats previously labeled with [3H]tetracycline. This was true whether the signal was applied while osteoporosis was developing (prevention of osteoporosis) or after it had been established (treatment of osteoporosis). If a similar capacitively coupled signal was applied to rats in which osteoporosis was well established, and the rats were labeled with [3H]tetracycline daily during a 12-day treatment period, it was found that there was statistically significant enhancement of the amount of new bone formation (increased [3H]tetracycline incorporation) in the tibiae that received the signal as compared with that of the controls. These results indicate that prevention or amelioration of disuse osteoporosis that occurs with a capacitively coupled electrical signal is due not to a change in the rate of bone resorption, but to an increase in the rate of bone formation.     

Reduction in dynamic indices of cancellous bone formation in rat tail vertebrae after caudal neurectomy

We have previously noted that a relatively large load (150 N) is required to induce a strain on the cortex of rat vertebrae similar to that induced on weight-bearing bones by normal mechanical usage. It seems unlikely that the musculature of the tail normally imposes loads of this magnitude, and this suggests that the quantity of bone in caudal vertebrae is maintained at a higher level than would be expected for the mechanical environment to which it is exposed. This high bone mass could represent a genetically determined minimum, or could be maintained through increased sensitivity to mechanical stimuli. To distinguish between these two possibilities, we denervated the tails of 13-week-old rats by neurectomy at L6, and assessed the response of the caudal vertebrae to mechanical disuse. We found that caudal neurectomy caused a reduction in the cancellous bone formation rate in the eighth caudal vertebrae to 12% of that seen in sham-operated animals. The cancellous bone formation rate in the thoracic vertebrae of neurectomized rats, which are not mechanically disused by caudal neurectomy, was not significantly reduced. This suggests that the cancellous bone formation rate in vertebrae is maintained by substantially less intense mechanical environments than those prevailing in weight-bearing bones, raising the possibility that bones may differ in their sensitivity to mechanical strain.     

Vitamin K2 inhibits glucocorticoid-induced bone loss partly by preventing the reduction of osteoprotegerin (OPG)

We have recently demonstrated that glucocorticoid (GC) suppresses bone formation and enhances bone resorption, with resultant bone loss. This altered bone turnover is not due to the action of parathyroid hormone (PTH), but appears to be related to the suppression of osteoprotegerin (OPG). As vitamin K2 (menatetrenone) has been used for the treatment of osteoporosis, the present study was carried out to evaluate the effect of vitamin K2 on GC-induced bone loss. Twenty patients with chronic glomerulonephritis treated with GC for the first time were chosen for this study. Ten patients received GC alone (group A) and the other 10 patients each received 15 mg of vitamin K2 per day in addition to GC (group B). Markers of bone metabolism, including serum OPG, osteocalcin (OC), bone-specific alkaline phosphatase activity (BAP), PTH, tartrate-resistant acid phosphatase (TRAP), and bone mineral density (BMD), were measured before and during the treatment. OPG was significantly decreased in group A (P < 0.001), while no significant change was seen in group B. TRAP was markedly increased in both groups, more particularly in group A (P < 0.01). PTH was decreased in group A, but was increased in group B. OC was decreased at month 1 but subsequently increased until month 12 in both groups. BAP had decreased at month 3 in group A (P < 0.05), but not in group B. BMD of the lumbar spine was significantly reduced after 6 months (P < 0.01), and 12 months (P < 0.001) of treatment in group A, whereas there was no remarkable change in group B. The present study demonstrated that the inhibition exerted by vitamin K2 of the reduction in OPG induced by GC may, at least in part, play a role in the prevention and treatment of GC-induced bone loss.