Osteoanabolic therapy for osteoporosis in women

Abstract

Therapy to activate bone formation is required to reverse and restore the damaged bone architecture found in women with postmenopausal osteoporosis. The osteoanabolic drugs include teriparatide, which has been available for several years, and abaloparatide and romosozumab, novel osteoanabolic drugs that have become available more recently. By stimulating bone formation, these drugs produce greater increases in bone mass and bone strength, and they do so more quickly compared to the commonly used anti-remodeling (also called antiresorptive) drugs such as bisphosphonates. In head-to-head trials, teriparatide and romosozumab reduce fracture risk more effectively than do oral bisphosphonates in women with osteoporosis and high fracture risk. Osteoanabolic drugs have little role in the prevention of bone loss during early menopause, but they have an important place in the treatment of women at very high risk of fracture or who remain at high fracture risk after a course of bisphosphonate therapy. Primarily because of the high cost of the drugs, these therapies are initiated by specialists rather than primary-care physicians in most countries. This review will present the evidence for efficacy and safety of these drugs so that clinicians may discern their appropriate use when caring for postmenopausal women with osteoporosis.

女性骨质疏松症的骨合成代谢疗法 摘要

逆转和恢复绝经后骨质疏松症女性中发现的骨结构受损需要骨形成激活治疗。骨合成代谢药物包括已上市数年的特立帕肽, 以及最近上市的新型骨合成代谢药物阿巴洛肽和罗莫索单抗。通过刺激骨形成, 这些药物增加骨量和骨强度效果更强, 并且与常用的抗重塑（也称为抗吸收）药物如双膦酸盐相比, 它们增加得更快。在头对头试验中, 特立帕肽和罗莫索单抗比口服双膦酸盐更有效地降低骨质疏松和高骨折风险女性的骨折风险。骨合成代谢药物在预防绝经早期的骨丢失方面几乎没有作用, 但是它们在治疗具有异常高骨折风险或在一个疗程的双膦酸盐治疗后仍然具有高骨折风险的女性中具有重要地位。主要是因为药物成本高, 在大多数国家, 这些疗法是由专家而不是初级保健医生提倡的。该综述将提供这些药物的有效性和安全性的证据, 以便临床医生在护理绝经后骨质疏松症女性时可以辨别它们的适当用途。

Keywords:

• Osteoanabolic
• teriparatide
• abaloparatide
• romosozumab
• sequence
• osteoporosis

Potential conflict of interest

M. R. McClung currently receives consulting fees and honorarium from Amgen, and honorarium for speaking from Alexion. He has previously received honorarium from Radius Health and grant support from Amgen, Aventis, Lilly, Merck, Novartis, Pfizer, Procter & Gamble and Roche. He is a member of the Board of Trustees of the International Osteoporosis Foundation and the North American Menopause Society. A. L. Clark receives funding from Ms Medicine as a member of Provider Executive Group.

Source of funding

No funding was received for the writing of this article. The authors alone are responsible for the content and writing of the article.