An in-depth investigation of NAs-induced osteoporosis adverse events: a real-world, network toxicology and molecular docking analysis

BackgroundNucleoside and nucleotide analogs are one of the mainstays of treatment for chronic hepatitis B, but their effects on bone density are highly controversial.MethodsIn this study, four pharmacovigilance analysis methods and Bonferroni-corrected p-values were used to analyze the FDA Adverse E...

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Main Authors: Jingkai Di, Shuang Wang, Lujia Liu, Likun Qi, Zijian Guo, Yingda Qin, Chuan Xiang
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-07-01
Series:Frontiers in Medicine
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Online Access:https://www.frontiersin.org/articles/10.3389/fmed.2025.1605024/full
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author Jingkai Di
Jingkai Di
Shuang Wang
Lujia Liu
Likun Qi
Zijian Guo
Yingda Qin
Chuan Xiang
author_facet Jingkai Di
Jingkai Di
Shuang Wang
Lujia Liu
Likun Qi
Zijian Guo
Yingda Qin
Chuan Xiang
author_sort Jingkai Di
collection DOAJ
description BackgroundNucleoside and nucleotide analogs are one of the mainstays of treatment for chronic hepatitis B, but their effects on bone density are highly controversial.MethodsIn this study, four pharmacovigilance analysis methods and Bonferroni-corrected p-values were used to analyze the FDA Adverse Event Reporting System database to investigate the relationship between adefovir and tenofovir and osteoporosine-related adverse events. In addition, the biological pathways and target proteins were studied by network toxicology and molecular docking techniques.ResultsAdefovir showed signs of adverse skeletal events at the two PT levels of OSTEOPOROSIS and BONE DENSITY DECREASED, while tenofovir showed signs of adverse skeletal events at the five PT levels of BONE DENSITY DECREASED, BONE LOSS, OSTEOPENIA, OSTEOPOROSIS and OSTEOPOROTIC FRACTURE. Furthermore, at the overall SMQ level, positive signals of adverse skeletal events were also valid. Subgroup analysis showed that adefovir was more likely to cause osteoporosis in the elderly and women, while tenofovir exhibited the opposite trend. Furthermore, GO and KEGG analyses indicated that both drugs may jointly promote osteoporosis through pathways such as cell migration, G protein-coupled receptor and Toll-like receptor signaling pathways. Molecular docking technology further reveals that the two drugs can produce pathological effects by binding to osteoporosis-related genes such as ADORA1 and JAK1.ConclusionThis study comprehensively reported the risk and mechanisms of osteoporosis caused by the clinical use of NAs drugs, and provided more detailed recommendations for clinical improvement and prevention of adverse events.
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spelling doaj-art-c2c57c6f66a6411cab47aab11e4dfe602025-08-20T03:16:10ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-07-011210.3389/fmed.2025.16050241605024An in-depth investigation of NAs-induced osteoporosis adverse events: a real-world, network toxicology and molecular docking analysisJingkai Di0Jingkai Di1Shuang Wang2Lujia Liu3Likun Qi4Zijian Guo5Yingda Qin6Chuan Xiang7Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, ChinaShanxi Provincial Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, ChinaDepartment of Gastroenterology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, ChinaSchool of Stomatology of Shanxi Medical University, Taiyuan, ChinaSchool of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, ChinaSchool of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, ChinaSchool of Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi, ChinaDepartment of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan, ChinaBackgroundNucleoside and nucleotide analogs are one of the mainstays of treatment for chronic hepatitis B, but their effects on bone density are highly controversial.MethodsIn this study, four pharmacovigilance analysis methods and Bonferroni-corrected p-values were used to analyze the FDA Adverse Event Reporting System database to investigate the relationship between adefovir and tenofovir and osteoporosine-related adverse events. In addition, the biological pathways and target proteins were studied by network toxicology and molecular docking techniques.ResultsAdefovir showed signs of adverse skeletal events at the two PT levels of OSTEOPOROSIS and BONE DENSITY DECREASED, while tenofovir showed signs of adverse skeletal events at the five PT levels of BONE DENSITY DECREASED, BONE LOSS, OSTEOPENIA, OSTEOPOROSIS and OSTEOPOROTIC FRACTURE. Furthermore, at the overall SMQ level, positive signals of adverse skeletal events were also valid. Subgroup analysis showed that adefovir was more likely to cause osteoporosis in the elderly and women, while tenofovir exhibited the opposite trend. Furthermore, GO and KEGG analyses indicated that both drugs may jointly promote osteoporosis through pathways such as cell migration, G protein-coupled receptor and Toll-like receptor signaling pathways. Molecular docking technology further reveals that the two drugs can produce pathological effects by binding to osteoporosis-related genes such as ADORA1 and JAK1.ConclusionThis study comprehensively reported the risk and mechanisms of osteoporosis caused by the clinical use of NAs drugs, and provided more detailed recommendations for clinical improvement and prevention of adverse events.https://www.frontiersin.org/articles/10.3389/fmed.2025.1605024/fulladefovirtenofovirosteoporosisG protein-coupled receptorIL-17
spellingShingle Jingkai Di
Jingkai Di
Shuang Wang
Lujia Liu
Likun Qi
Zijian Guo
Yingda Qin
Chuan Xiang
An in-depth investigation of NAs-induced osteoporosis adverse events: a real-world, network toxicology and molecular docking analysis
Frontiers in Medicine
adefovir
tenofovir
osteoporosis
G protein-coupled receptor
IL-17
title An in-depth investigation of NAs-induced osteoporosis adverse events: a real-world, network toxicology and molecular docking analysis
title_full An in-depth investigation of NAs-induced osteoporosis adverse events: a real-world, network toxicology and molecular docking analysis
title_fullStr An in-depth investigation of NAs-induced osteoporosis adverse events: a real-world, network toxicology and molecular docking analysis
title_full_unstemmed An in-depth investigation of NAs-induced osteoporosis adverse events: a real-world, network toxicology and molecular docking analysis
title_short An in-depth investigation of NAs-induced osteoporosis adverse events: a real-world, network toxicology and molecular docking analysis
title_sort in depth investigation of nas induced osteoporosis adverse events a real world network toxicology and molecular docking analysis
topic adefovir
tenofovir
osteoporosis
G protein-coupled receptor
IL-17
url https://www.frontiersin.org/articles/10.3389/fmed.2025.1605024/full
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