Antiresorptive therapies for osteoporosis: a clinical overview

Abstract

Antiresorptive therapies are used to increase bone strength in individuals with osteoporosis and include five principal classes of agents: bisphosphonates, estrogens, selective estrogen receptor modulators (SERMs), calcitonin and monoclonal antibodies such as denosumab. However, no head-to-head studies have compared different antiresorptive agents using fracture as an end point. Bisphosphonates, which have proven antifracture efficacy and a good safety profile, are the most widely used first-line antiresorptive therapy and are recommended for patients with osteoporosis, a prior fragility fracture or osteopenia, as well as individuals with a high risk of fracture. Denosumab, which also has good antifracture efficacy, is another possible first-line therapy, although long-term safety data are lacking. However, no single antiresorptive therapy is currently appropriate for all patients or clearly superior to other therapies. Antiresorptive agents such as estrogens, SERMs (in postmenopausal women) and calcitonin are considered to be second-line agents that are appropriate in special circumstances. Clinicians should determine the most appropriate pharmacological therapy after a careful assessment of the risk:benefit profiles of these drugs in each patient. In addition, patients should receive a detailed explanation of the treatment goals, so that the therapeutic benefit can be maximized through good compliance and persistence.

Osteocyte-Intrinsic TGF-β Signaling Regulates Bone Quality through Perilacunar/Canalicular Remodeling

“…Current therapeutics can improve 70% of trabecular fractures but only 20–40% of cortical bone fractures, which is precisely where PLR dysregulation is most profound (Ahmed et al, 2015; Chen and Sambrook, 2011; Rivadeneira and Mäkitie, 2016). A combination of systems analysis of GWAS data from clinical cohorts, along with functional in vivo and in vitro studies, can shed light on new molecular targets to control bone fragility and expand the pool of genetic markers needed for fracture risk assessment and prevention.…”

Antiresorptive Therapies for Osteoporosis

“…Because the most popular formulation of this medicine is a nasal spray, some of the more common side effects are at the site of administration, like sneezing and rhinitis. 6 There have been many large, randomized, controlled trials proving fracture efficacy with these drugs. Once a drug has been proven to reduce fractures, the US Food and Drug Administration (FDA) allows "bridging" studies, using bone density as endpoint, for other populations.…”

“…There are currently 5 classes of antiresorptive agents approved for use: bisphosphonates, monoclonal antibodies against receptor activator of nuclear factor-kB ligand (RANKL), selective estrogen receptor modulators (SERMs), estrogens, and calcitonin ( Table 1). 6 There is abundant evidence demonstrating the efficacy of antiresorptives in preventing fractures, especially in postmenopausal women. We currently have only 1 anabolic therapeutic agent, teriparatide, which is usually reserved for patients with severe osteoporosis or at a high risk of fracture.…”

Polycan, a β-glucan from Aureobasidium pullulans SM-2001, mitigates ovariectomy-induced osteoporosis in rats

“…At present, anti-resorptive agents, including biophosphonate, estrogen and calcitonin, are widely used (5); however, there is a requirement for highly effective resorptive inhibitors with improved safety and efficacy profiles. Anabolic agents, which are able to stimulate bone formation, are less well-known (6); however, trials to develop anabolic agents have been conducted, and have improved current understanding of the mechanisms underlying osteoblast differentiation and bone formation (7).…”