Advances in Osteoporosis Therapy: Focus on Osteoanabolic Agents, Secondary Fracture Prevention, and Perioperative Bone Health

Abstract

Purpose of Review This review summarizes recently published data and other developments around osteoanabolic osteoporosis therapies in patients with very high fracture risk, including those undergoing bone-related surgery. Recent Findings Two osteoanabolic agents, abaloparatide and romosozumab, were recently approved for treatment of patients with osteoporosis at high fracture risk. These agents, along with teriparatide, are valuable for primary and secondary fracture prevention. Orthopedic surgeons are well positioned to facilitate secondary fracture prevention via referrals to fracture liaison services or other bone health specialist colleagues. This review aims to help surgeons understand how to identify patients with sufficiently high fracture risk to warrant consideration of osteoanabolic therapy. Recent evidence around the perioperative use and potential benefits of osteoanabolic agents in fracture healing and other orthopedic settings (e.g., spinal fusion and arthroplasty) in individuals with osteoporosis is also discussed. Summary Osteoanabolic agents should be considered for patients with osteoporosis at very high fracture risk, including those with prior osteoporotic fractures and those with poor bone health who are undergoing bone-related surgery.

The Analysis Study of Osteoporosis and Fracture Risk : A Ten Years Systematic Review

“…7 Kostenuik's study highlights the importance of prevention in osteoporosis, highlighting the potential benefits of osteoanabolic agents in reducing fracture risk in patients at high risk. 16 Schini's research highlights FRAX as a globally leading tool for fracture risk assessment, with its utility in costeffectiveness and efficient population screening. The tool's new FRAXplus website allows for modification of probability, and the second version is under development.…”

“…20 An ASBMR task force on secondary fracture prevention advises that osteoanabolics are appropriate initial therapies for individuals with vertebral fractures. 16 Updated CPGs from NAMS advise that vertebral or hip fracture history is sufficient to diagnose osteoporosis, regardless of BMD or other risk factors. Updated ESCEO/IOF CPGs recommend osteoanabolics for patients at high risk of fracture and advise that women over 65 years old with an osteoporotic fracture history can be considered for treatment without BMD testing.…”

“…Updated ESCEO/IOF CPGs recommend osteoanabolics for patients at high risk of fracture and advise that women over 65 years old with an osteoporotic fracture history can be considered for treatment without BMD testing. 16,21 Osteoanabolic therapy is recommended as first-line therapy for patients with VHFxR by multiple organizations and experts, with no evident controversy or dissent. 16 Postmenopausal osteoporosis treatment options have increased significantly in the past 20 years, but no Cochrane-type reviews or meta-analyses have been conducted recently.…”

Bones and guts – Why the microbiome matters

“…Anti-resorptive agents are associated with many side effects and ultimately do not increase survival [26] . Their osteoanabolic counterparts – medications designed to facilitate bone growth by either activating parathyroid receptors or inhibiting sclerositin, a Wnt signaling antagonist – are administered clinically; however these agents too have severe side effects including hypercalcemia, osteonecrosis of the jaw, and cardiovascular events [70] . Notably, supplementation with bacteria and SCFAs, such as Lactobacillus and its metabolite butyrate, may serve as a potential therapy for both cancer in bone and associated pain.…”

Comparison of osteoanabolic agents (teriparatide and romosozumab) with bisphosphonates in prevention of subsequent vertebral fractures in patients treated for osteoporotic vertebral fracture for 12 months: An observational cohort study

“…Currently, osteoanabolic agents, teriparatide (TPTD) or romosozmab (Romo), are being used more frequently as first-line treatments for patients with a very high risk of fracture. ( Kostenuik et al, 2023 ), but there is no evidence on their effects on domino OVF. This study aimed to evaluate the effects of osteoanabolic agents, including TPTD and Romo, on subsequent domino OVF, bony union, and progression of vertebral collapse (VC) after initial OVF.…”