A theoretical medical approach that could help reduce the amount of bone loss during osteomyelitis

Question

I got a question from a textbook <<Seeley's Anatomy & Physiology Twelfth Edition>> that does not have an answer at the back of the book (only odd numbered questions do have an answer and this question is even):

In addition to targeting the bacteria for death, what is one theoretical medical approach that could help reduce the amount of bone loss during osteomyelitis?

I found a paper that suggests 3 methods:

1. Antibiotics targeting the bacteria (but that is targeting the bacteria for death
2. Surgical debridement of dead tissue (including sequestrum) or biofilm produced by the bacteria
3. Hyperbaric oxygen treatment, which puts patient in a high pressure pure oxygen environment will result in immunomodulation, reduction in pro-inflammatory mediators. This is helpful because bone loss in osteomyelitis is also caused largely by host's inflammatory chemical damaging the bone.

Another paper only suggest antibiotics and surgical methods. I look through a few other and there seemed to be no other methods to help reduce bone loss during osteomyelitis.

However, i am not sure if there is any other ways to reduce bone loss during osteomyelitis. Please help me by suggesting other methods that i may have missed out.

Thank you

Answer 1

You could address bone metabolism.

Bone contains osteoclasts and osteoblasts. Osteoclasts break down and resorb bone. Osteoblasts lay down new bone.

If osteoclasts are inhibited, bone resorbtion is inhibited. This is how bisphosphates and RANK-ligand inhibitors work. Both categories of drug are used to inhibit bone loss due to cancer or to osteoporosis. In theory, these drugs could inhibit bone loss due to osteomyelitis also.

If osteoblasts are stimulated, they will lay down more new bone. Bone Morphogentic Protein stimulates osteoblasts and has been used clinically to accelerate and augment orthopedic surgeries. In theory, BMP could stimulate osteoblasts associated with infected bone to lay down new bone and counter bone loss.