There is growing evidence that inflammation may be one of the causal factors of osteoporosis. Several cytokines such as IL-1, IL-6, RANKL, OPG, and M-CSF were implicated in the pathogenesis of osteoporosis. These cytokines are important determinants of osteoclast differentiation and its bone resorptive activity. Anticytokine therapy using cytokine antagonists such as IL-receptor antagonist and TNF-binding protein was able to suppress the activity of the respective cytokines and prevent bone loss. Several animal studies have shown that vitamin E in the forms of palm-derived tocotrienol and α-tocopherol may prevent osteoporosis in rat models by suppressing IL-1 and IL-6. Free radicals are known to activate transcription factor NFκB which leads to the production of bone resorbing cytokines. Vitamin E, a potent antioxidant, may be able to neutralise free radicals before they could activate NFκB, therefore suppressing cytokine production and osteoporosis. Vitamin E has also been shown to inhibit COX-2, the enzyme involved in inflammatory reactions. Of the two types of vitamin E studied, tocotrienol seemed to be better than tocopherol in terms of its ability to suppress bone-resorbing cytokines. 1. Introduction Osteoporosis is a bone disease, characterized by low bone mass and increased risk of fractures [1]. It is well accepted that osteoporosis can be caused by various endocrine, metabolic, and mechanical factors. However, recently, there are opinions that there may be an inflammatory component in the etiology of osteoporosis [2, 3]. There is plenty of evidence linking inflammation to osteoporosis. Epidemiological studies have identified higher incidence of osteoporosis in various inflammatory conditions such as ankylosing spondylitis, rheumatoid arthritis, and systemic lupus erythematosus [4–7]. This association was also observed clinically whereby the degree of osteoporosis was equivalent to the extent of inflammation. If the inflammation was systemic, bone loss will occur at all skeletal sites, whereas if the inflammation was only restricted to a site, bone loss will only occur locally at that site of inflammation [3]. Elderly patients are more prone to osteoporosis, and this was believed to be connected to the elevated production of proinflammatory cytokines with aging [8, 9]. The occurrence of inflammation is indicated by the presence of inflammatory markers such as cytokines and C-reactive protein. Biochemical studies have demonstrated elevation of proinflammatory cytokines TNF-α and IL-6 in arthritic disease such as gouty arthritis, rheumatoid
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