Combination of anabolic and antiresorptive agents for the treatment of osteoporosis

Anabolic drugs have recently widened therapeutic options in osteoporosis treatment, as they influence processes associated with bone formation to a greater extent and earlier than bone reabsortion. They positively affect a number of skeletal properties besides bone density, as intermittent administration of parathyroid hormone (PTH) results in an increase in the number and activity of osteoblasts leading to an increase in bone mass and improvement in skeletal architecture at both the trabecular and cortical bone. Human recombinant parathyroid hormone (hrPTH 1-84) and human recombinant PTH peptide 1-34 (teriparatide) belong to this group. The objective of this paper is to review PTH actions, benefits and adverse effects, action on biochemical markers, combination therapy with antiresorptive agents, impact of antiresorptive therapy prior to anabolic treatment, sequential treatment, and effect on glucocorticoid-induced osteoporosis.

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Bisphosphonates in Orthopedics: Evidence-based Review of Indications and Adverse Effects

Journal of Postgraduate Medicine Education and Research ◽

10.5005/jp-journals-10028-1197 ◽

2016 ◽

Vol 50 (2) ◽

pp. 75-85 ◽

Cited By ~ 2

Author(s):

Nitesh Gahlot ◽

Uttam Chand Saini

Keyword(s):

Adverse Effects ◽

Metastatic Bone Disease ◽

Evidence Based ◽

Important Class ◽

Pharmacokinetics And Pharmacodynamics ◽

Potent Effect ◽

Treatment Of Osteoporosis ◽

Antiresorptive Agents ◽

Orthopedic Applications ◽

Pediatric Disorders

ABSTRACT Bisphosphonates (BPs) are clinically the most important class of antiresorptive agents available to treat diseases characterized by osteoclast-mediated bone resorption. These agents have a potent effect on the skeleton and are in common use for treatment of osteoporosis, Paget's disease, and metastatic bone disease in adults as well as in the treatment of pediatric disorders, such as osteogenesis imperfecta, Perthes’ disease, and fibrous dysplasia. Although initial investigations had demonstrated an acceptable safety profile of bisphosphonate drugs, but recently this has been questioned by some authors. In this article, we review the chemistry, pharmacokinetics, and pharmacodynamics of these agents in brief and the orthopedic applications as well as adverse effects in detail. How to cite this article Aggarwal S, Gahlot N, Saini UC, Dhillon MS. Bisphosphonates in Orthopedics: Evidencebased Review of Indications and Adverse Effects. J Postgrad Med Edu Res 2016;50(2):75-85.

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Prevention and Treatment of Osteoporosis: Efficacy of Combination of Hormone Replacement Therapy with Other Antiresorptive Agents

Journal of Clinical Densitometry ◽

10.1385/jcd:3:2:187 ◽

2000 ◽

Vol 3 (2) ◽

pp. 187-201 ◽

Cited By ~ 36

Author(s):

Sunil J. Wimalawansa

Keyword(s):

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Hormone Replacement ◽

Treatment Of Osteoporosis ◽

Antiresorptive Agents ◽

Prevention And Treatment

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Role of novel antiresorptive agents for the prevention and treatment of osteoporosis

Acta Endocrinologica ◽

10.1530/eje.0.1390018 ◽

1998 ◽

pp. 18-19

Author(s):

CA Meier

Keyword(s):

Treatment Of Osteoporosis ◽

Antiresorptive Agents ◽

Prevention And Treatment

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Therapy of Osteoporosis in Men with Teriparatide

Journal of Osteoporosis ◽

10.4061/2011/463675 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 9

Author(s):

Natalie E. Cusano ◽

Aline G. Costa ◽

Barbara C. Silva ◽

John P. Bilezikian

Keyword(s):

Therapeutic Option ◽

The United States ◽

Treatment Of Osteoporosis ◽

Beneficial Effects ◽

Nonvertebral Fractures ◽

Duration Of Therapy ◽

Good Safety Profile ◽

Antiresorptive Agents ◽

Osteoporosis In Men ◽

Antiresorptive Drug

Osteoanabolic therapy is an attractive therapeutic option for men with osteoporosis because it directly stimulates bone formation, an action not shared by any antiresorptive drug. Teriparatide (recombinant human PTH(1-34)) and PTH(1-84) are available in many countries but PTH(1-84) is not available in the United States. Only teriparatide is approved for the treatment of osteoporosis in men. It is also indicated in glucocorticoid-induced osteoporosis. Teriparatide is associated with major gains in bone density at the lumbar spine and, to a lesser extent, in the hip regions. Vertebral and nonvertebral fractures are reduced in postmenopausal women treated with teriparatide. Fracture reduction data in men are less secure because the number of study subjects is small and the studies have not been powered to document this endpoint. Nevertheless, observational data in men suggest a reduction in vertebral fractures with teriparatide. Attempts to show further beneficial effects of teriparatide in combination with antiresorptive agents have not been demonstrated yet to be superior to monotherapy with teriparatide alone. The duration of therapy with teriparatide is limited to 2 years. Thereafter, it is necessary to treat with an antiresorptive drug to maintain, and perhaps increase, densitometric gains. Teriparatide is well tolerated with a good safety profile.

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Inhibition of Osteoclast Differentiation and Bone Resorption by N-Methylpyrrolidone

Journal of Biological Chemistry ◽

10.1074/jbc.m111.223297 ◽

2011 ◽

Vol 286 (27) ◽

pp. 24458-24466 ◽

Cited By ~ 37

Author(s):

Chafik Ghayor ◽

Rita M. Correro ◽

Katrin Lange ◽

Lindsay S. Karfeld-Sulzer ◽

Klaus W. Grätz ◽

...

Keyword(s):

Acid Phosphatase ◽

Bone Resorption ◽

Osteoclast Differentiation ◽

Cathepsin K ◽

Bone Diseases ◽

Tartrate Resistant Acid Phosphatase ◽

Treatment Of Osteoporosis ◽

Multinucleated Cells ◽

Antiresorptive Agents ◽

Actin Rings

Regulation of RANKL (receptor activator of nuclear factor κB ligand)-induced osteoclast differentiation is of current interest in the development of antiresorptive agents. Osteoclasts are multinucleated cells that play a crucial role in bone resorption. In this study, we investigated the effects of N-methylpyrrolidone (NMP) on the regulation of RANKL-induced osteoclastogenesis. NMP inhibited RANKL-induced tartrate-resistant acid phosphatase activity and the formation of tartrate-resistant acid phosphatase-positive multinucleated cells. The RANKL-induced expression of NFATc1 (nuclear factor of activated T cells, cytoplasmic 1) and c-Fos, which are key transcription factors for osteoclastogenesis, was also reduced by treatment with NMP. Furthermore, NMP induced disruption of the actin rings and decreased the mRNAs of cathepsin K and MMP-9 (matrix metalloproteinase-9), both involved in bone resorption. Taken together, these results suggest that NMP inhibits osteoclast differentiation and attenuates bone resorption. Therefore, NMP could prove useful for the treatment of osteoporosis or other bone diseases associated with excessive bone resorption.

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SYMPOSIUM PRESS RELEASE “KEY FACTORS OF SUCCESSIN THE TREATMENT OF OSTEOPOROSIS. TREATMENT TO THE GOAL. ’’held at the VIII All-Russian Congress of Osteoporosis in Kazan, September 10, 2016

Osteoporosis and Bone Diseases ◽

10.14341/osteo2016341-45 ◽

2016 ◽

Vol 19 (3) ◽

pp. 41-45

Author(s):

Keyword(s):

Metabolic Diseases ◽

Systemic Disease ◽

Osteoporosis Treatment ◽

Fracture Prevention ◽

Satellite Symposium ◽

Low Bone Mass ◽

Key Factors ◽

Treatment Of Osteoporosis ◽

Antiresorptive Agents ◽

Increased Risk

Osteoporosis - is a systemic disease characterized by low bone mass, microarchitectural violation of its structure that leads to an increased risk of fractures. Currently, the method of finding the optimal therapy for osteoporosisis given special attention. In Kazan, September 9, 2016 in the framework of the Russian Congress on Osteoporosis, osteoarthritis and other metabolic diseases of the skeleton was heldAmgen satellite symposium. The event included reports of Russian and foreign experts, dedicated to practical issues of the treatment of osteoporosis and fracture prevention with the particular emphaseson the benefits of using modern antiresorptive agents.

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