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中华老年骨科与康复电子杂志 ›› 2026, Vol. 12 ›› Issue (03) : 180 -187. doi: 10.3877/cma.j.issn.2096-0263.2026.03.008

综述

铁死亡在骨质疏松机制与治疗中的研究进展
包文斌1, 安晨璐2, 常青1, 李强1, 赵建民1,()   
  1. 1010000 呼和浩特,内蒙古医科大学附属医院骨科
    2010000 呼和浩特,内蒙古医科大学
  • 收稿日期:2025-11-25 出版日期:2026-06-05
  • 通信作者: 赵建民
  • 基金资助:
    内蒙古自治区自然科学基金(No:2021ZD0014)

Research progress of ferroptosis in the mechanism and treatment of osteoporosis

Wenbin Bao1, Chenlu An2, Qing Chang1, Qiang Li1, Jianmin Zhao1,()   

  1. 1Department of Orthopaedics, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, China
    2Inner Mongolia Medical University, Hohhot, 010000, China
  • Received:2025-11-25 Published:2026-06-05
  • Corresponding author: Jianmin Zhao
引用本文:

包文斌, 安晨璐, 常青, 李强, 赵建民. 铁死亡在骨质疏松机制与治疗中的研究进展[J/OL]. 中华老年骨科与康复电子杂志, 2026, 12(03): 180-187.

Wenbin Bao, Chenlu An, Qing Chang, Qiang Li, Jianmin Zhao. Research progress of ferroptosis in the mechanism and treatment of osteoporosis[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2026, 12(03): 180-187.

骨质疏松症(OP)是老年人常见疾病,以骨强度下降、骨密度降低、骨折风险增加为特征。它主要是由于骨重建不平衡引起的,即破骨细胞引起的骨吸收超过了骨合成。铁死亡是一种铁依赖性,脂质过氧化引起的调节性细胞死亡模式,细胞内二价铁离子(Fe2+)通过氧化还原反应产生大量铁依赖性活性氧,促使脂质过氧化导致细胞死亡。目前,铁死亡在OP发生发展中的作用与详细机制尚未完全阐明。铁死亡可能通过谷胱甘肽过氧化物酶4(GPX4),铁超载和脂质过氧化等途径影响成骨及破骨细胞加速OP进展,本综述基于铁死亡理论进一步探讨其在OP发生机制中的作用和潜在治疗靶点,以期为OP诊疗及药物研发提供新策略和方向。

Osteoporosis (OP) is a common disease in the elderly, which is characterized by decreased bone strength, decreased bone mineral density and increased risk of fracture. It is mainly caused by the imbalance of bone remodeling, that is, bone resorption caused by osteoclasts exceeds bone synthesis. Ferroptosis is an iron-dependent regulatory cell death mode caused by lipid peroxidation. Intracellular divalent iron ions (Fe2+) produce a large number of iron-dependent reactive oxygen species through REDOX reactions, which promote lipid peroxidation and lead to cell death. At present, the role and detailed mechanism of ferroptosis in the development of OP have not been fully elucidated. Ferroptosis may be mediated by glutathione peroxidase 4(GPX4), iron overload and lipid peroxidation affect osteoblasts and osteoclasts to accelerate the progression of OP. Based on the theory of ferroptosis, this review further discusses the role of ferroptosis in the development of OP and potential therapeutic targets, in order to provide new strategies and directions for the diagnosis and treatment of OP and drug research and development.

图1 铁代谢紊乱与骨质疏松症
图2 铁死亡与成骨、破骨细胞
表1 不同类型骨质疏松关键机制与干预策略
骨质疏松类型 核心病理机制与铁死亡的关系 关键分子/信号通路 干预策略与潜在药物
绝经后骨质疏松症 雌激素缺乏+铁过载→氧化应激→成骨细胞铁死亡。铁死亡通过激活破骨细胞加剧骨流失。 核心轴:GPX4(关键酶,受雌激素调节)、SLC7A11/GSH
调控通路:KEAP1/NRF2/HMOX1、PI3K/Akt(circRNA/miR轴)
纳米材料:包被DFO/咖啡酸的纳米球
天然化合物:女贞子(Nrf2/HO-1)、知母-黄柏
靶向基因:PTEN,SIRT1等
糖皮质激素诱导的骨质疏松症 GC长期使用→直接/间接诱导成骨细胞铁死亡。铁死亡是其骨质流失的关键驱动因素。 保护性通路:Nrf2/GPX4、PI3K/AKT/mTOR
细胞通讯:外泌体介导的保护作用
天然产物:秦皮素(Fraxin,激活Nrf2/GPX4)
内源性激素:褪黑素(MT,激活PI3K/AKT/mTOR),即使启动后仍有效
外泌体疗法:血管内皮/内皮祖细胞来源的外泌体(抑制铁自噬)
糖尿病性骨质疏松症 高糖环境→多条信号通路紊乱→诱导成骨细胞铁死亡。 诱导通路:HIF1α、METTL3/ASK1-p38
保护通路:Nrf2/GPX4、AMPK/SIRT1、HO-1、PCBP1(促进铁蛋白表达)
维生素D:Eldecalcitol(ED- 71,激活HIF1α)
天然产物:地黄苷(Pol)、灰毡毛忍冬皂苷(AVI)、姜黄素
纳米递送:四面体框架核酸(tFNA)递送姜黄素
其他类型骨质疏松症 吸烟(SROP):烟草毒素积累→诱导BMSC铁死亡和铁自噬。
年龄相关性:衰老相关应激→成骨细胞铁死亡。
SROP关键因子:铁自噬、ROS相关通路
年龄相关关键因子:ATF3(骨细胞铁死亡驱动因子)
SROP:骨靶向工程外泌体递送姜黄素
年龄相关:维生素D受体激活(Nrf2/GPX4)、抑制ATF3
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