Bone metabolism and the development of denosumab: a narrative review

The bone of human body provides many basic functions, including normal bone metabolism. Bone plays an important role in maintaining physiological homeostasis of the body. The balance between osteolysis and osteogenesis is important in bone metabolism. This process reflects the osteoblast and osteolytic cell function of coordination. RANKL/RANK/OPG pathway plays a central regulatory role in normal bone remodeling. RANKL/RANK/OPG regulates the axis of Bone, which is an important way to influence bone formation and dynamic equilibrium. In the process of tumor osteolytic bone metastasis and giant cell tumor (GCT) of bone, the expression of RANKL increases, which leads to excessive bone resorption. Denosumab can specifically block RANKL, thereby inhibiting the activity of osteoclasts and blocking the development of disease. Skeletal-related event (SRE) caused by bone metastases not only reduce patients' physical function and quality of life, but also increase the risk of death. How to optimize the management of bone metastasis and relieve the pain caused by bone metastasis has become a hot spot in the field of cancer. Based on a series of clinical studies, Denosumab has been approved by the U. S. Food and Drug Administration for osteoporosis, solid tumor bone metastasis, GCT of bone, malignant tumor hypercalcemia and other fields. In China, Denosumab was indicated to treat GCT of bone, as well as SRE caused by solid tumor bone metastases and multiple myeloma.