Alendronate and omeprazole in combination reduce angiogenic and growth signals from osteoblasts

Tormod B Krüger; Bente B Herlofson; Aina M Lian; Unni Syversen; Janne E Reseland

doi:10.1016/j.bonr.2021.100750

Alendronate and omeprazole in combination reduce angiogenic and growth signals from osteoblasts

Bone Rep. 2021 Jan 26:14:100750. doi: 10.1016/j.bonr.2021.100750. eCollection 2021 Jun.

Authors

Tormod B Krüger¹, Bente B Herlofson¹, Aina M Lian², Unni Syversen^{2

3

4}, Janne E Reseland²

Affiliations

¹ Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Norway.
² Clinical Oral Research Laboratory, Faculty of Dentistry, University of Oslo, Norway.
³ Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, 7491 Trondheim, Norway.
⁴ Department of Endocrinology, Clinic of Medicine, St. Olavs University Hospital, 7491 Trondheim, Norway.

Abstract

Objective: Due to gastrointestinal side effects of oral bisphosphonates (BPs), proton pump inhibitors (PPIs) are often prescribed. PPIs may enhance the risk of osteonecrosis of the jaw, a rare side effect of BPs. Therefore, the objective of this study was to evaluate the effects of the oral BP alendronate (ALN) and the PPI omeprazole (OME) alone and in combination on primary human osteoblasts and gingival fibroblasts in vitro.

Methods: Human gingival fibroblasts and normal human osteoblasts were incubated with either 5 μM of ALN or 1 μM of OME, or ALN + OME for 1, 3, 7 or 14 days. Effect on viability was evaluated by the lactate dehydrogenase activity in the medium and on proliferation by quantifying 3H-thymidin incorporation. Multianalyte profiling of proteins in cell culture media was performed using the Luminex 200TM system to assess the effect on selected bone markers and cytokines.

Results: The proliferation of osteoblasts and fibroblasts was reduced upon exposure to ALN + OME. ALN induced an early, temporary rise in markers of inflammation, and OME and ALN + OME promoted a transient decline. An initial increase in IL-13 occurred after exposure to all three options, whereas ALN + OME promoted IL-8 release after 7 days. OME and ALN + OME promoted a transient reduction in vascular endothelial growth factor (VEGF) from osteoblasts, whereas ALN and ALN + OME induced a late rise in VEGF from fibroblasts. Osteoprotegerin release was enhanced by ALN and suppressed by OME and ALN + OME.

Conclusions: ALN + OME seemed to exaggerate the negative effects of each drug alone on human osteoblasts and gingival fibroblasts. The anti-proliferative effects, modulation of inflammation and impairment of angiogenesis, may induce unfavorable conditions in periodontal tissue facilitating development of osteonecrosis.

Keywords: Alendronate; Bisphosphonates; Bone repair; Omeprazole; Osteonecrosis; Proton pump inhibitors.