Sadegh Baradaran-Mahdavi - Clinical Scientist resident, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
Roya Kelishadi - Professor of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

Osteoporosis is characterized by low bone mass and increased susceptibility to fragility bone fractures due to alterations in bone micro-architecture. It is mostly observed in the elderly and in post-menopausal women. In osteoporosis, the bone remodeling process, alters in favor of bone resorption and causes the clinical presentation of the disease. The role of genetic profile in bone phenotype and disease-related fracturein osteoporosis is well-documented. However, it is proposed that less than 10% of observed variance in bone mineral density, could be related to genetic factors.With respect to developmental origins of osteoporosis, emerging evidence has been focused on the interaction of environmental and genetic factorsfrom antenatal period to adulthood. This interaction may be modulated, in part by epigenetic mechanisms including DNA methylation, histone modifications and microRNAs (miRNAs). Experimental and observational studies represented different aspects of epigenetic mechanisms involved in bone cell differentiation and bone homeostasis. While, conventional techniques such as dual-energy x-ray absorptiometry (DEXA) or medications such as oral or parenteral bisphosphonates are still being applied for diagnosis and treatment of osteoporosis respectively, identifying the epigenetic biomarkers may offer promising personalized diagnostic techniques or therapies. The alterations in miRNAs and DNA methylation patterns have been associated with osteoporosis onset and progression in many studies. However, the robust research is scare in this field and sensitivity or specificity of any biomarker as well as the potential of applying new treatments based on genetic/epigenetic pathways, needs to be thoroughly investigated in the future. The present review considers the available evidence of epigenetic of osteoporosis with a special focus on the most recent studies proposing new biomarkers to diagnose or prognosticate the disease or investigating potential genetic/epigenetic based treatments for this multifactorial condition in the clinical setting.

Osteoporosis,Epigenetics, Biomarkers, DNA methylation, miRNAs, Histone modifications