Impact of Treatments for Postmenopausal Osteoporosis (Bisphosphonates, Parathyroid Hormone, Strontium Ranelate, and Denosumab) on Bone Quality: A Systematic Review
- 26 September 2010
- journal article
- review article
- Published by Springer Science and Business Media LLC in Calcified Tissue International
- Vol. 87 (6), 469-484
- https://doi.org/10.1007/s00223-010-9420-x
Abstract
The objective of this systematic review was to examine the influence of treatments for postmenopausal osteoporosis (parathyroid hormone [PTH], bisphosphonates, strontium ranelate, and denosumab) on bone quality and discuss the clinical implications. Most bone-quality data for PTH is from teriparatide. Teriparatide results in a rapid increase in bone-formation markers, followed by increases in bone-resorption markers, opening an "anabolic window," a period of time when PTH is maximally anabolic. Teriparatide reverses the structural damage seen in osteoporosis and restores the structure of trabecular bone. It has a positive effect on cortical bone, and any early increases in cortical porosity appear to be offset by increases in cortical thickness and diameter. Bisphosphonates are antiresorptive agents which reduce bone turnover, improve trabecular microarchitecture, and mineralization. Concerns have been raised that the prolonged antiresorptive action of bisphosphonates may lead to failure to repair microdamage, resulting in microcracks and atypical fragility. Strontium ranelate is thought to have a mixed mode of action, increasing bone formation and decreasing bone resorption. Strontium ranelate improves cortical thickness, trabecular number, and connectivity, with no change in cortical porosity. Denosumab exerts rapid, marked, and sustained effects on bone resorption, resulting in falls in the markers of bone turnover. Evidence from bone-quality studies suggests that treatment-naive women, aged 60-65 years, with very low BMD T scores may benefit from PTH as primary therapy to improve bone substrate and build bone. Post-PTH treatment with bisphosphonates will maintain improvements in bone quality and reduce the risk of fracture.Keywords
This publication has 82 references indexed in Scilit:
- Mineralization density distribution of postmenopausal osteoporotic bone is restored to normal after long-term alendronate treatment: qBEI and sSAXS data from the fracture intervention trial long-term extension (FLEX)Journal of Bone and Mineral Research, 2010
- Bisphosphonate Associated Osteonecrosis of the JawThe Journal of Rheumatology, 2009
- Effects of Alendronate on the Proliferation and Osteogenic Differentiation of MG-63 CellsJournal of International Medical Research, 2009
- Severely Suppressed Bone Turnover and Atypical Skeletal FragilityJournal of Clinical Endocrinology & Metabolism, 2008
- An emerging pattern of subtrochanteric stress fractures: A long-term complication of alendronate therapy?Injury, 2008
- Low bone mineral density is associated with bone microdamage accumulation in postmenopausal women with osteoporosisBone, 2007
- Increases in BMD Correlate With Improvements in Bone Microarchitecture With Teriparatide Treatment in Postmenopausal Women With OsteoporosisJournal of Bone and Mineral Research, 2007
- Severely Suppressed Bone Turnover: A Potential Complication of Alendronate TherapyJournal of Clinical Endocrinology & Metabolism, 2005
- Bone Mineral Density Thresholds for Pharmacological Intervention to Prevent FracturesArchives of Internal Medicine, 2004
- Changes in bone mineral density explain little of the reduction in vertebral or nonvertebral fracture risk with anti-resorptive therapyBone, 2004