Comparative effects of antiresorptive agents on bone mineral density and bone turnover in postmenopausal women

Abstract

Postmenopausal osteoporosis is a common clinical entity; its complications represent a significant burden to society. In recent years the choice of therapies available for the treatment of postmenopausal osteoporosis has increased dramatically. There are a number of antiresorptive agents currently available including hormone replacement therapy (HRT), selective estrogen receptor modulators (SERMs), bisphosphonates, and dual action bone agents. It is difficult to truly compare these therapies given the lack of direct head-to head studies. The efficacy of antiresorptive therapies can be assessed in a number of ways including measurement of bone mineral density (BMD), assessment of bone turnover markers, and fracture reduction. Other important factors include ease of administration and consequent patient compliance. This article reviews the currently available antiresorptive agents and their effects on the above outcome measures.

Effects of genistein aglycone in osteoporotic, ovariectomized rats: a comparison with alendronate, raloxifene and oestradiol

“…Drugs that interfere with steps in the resorptive pathway resulting in bone loss (antiresorptive agents) ( Jordan et al ., 2006 ) or that amplify or mimic steps in the anabolic pathway to build new and improved skeletons (anabolic or bone‐forming agents) are specifically recommended to treat bone loss ( Canalis et al ., 2007 ). Safe anabolic agents are needed to build bone, restoring both bone structure and strength, rather than just prevention or slower progression of bone fragility, as occurs with current antiresorptive agents.…”

“…Oestrogen replacement therapy, SERMs (that is, raloxifene hydrochloride) and bisphosphonates (that is, alendronate) are widely used to oppose accelerated bone resorption in senile or postmenopausal osteopaenia/osteoporosis. All of these treatments predominantly exert antiresorptive effects by inhibiting, through several different mechanisms, the activity of osteoclasts ( Jordan et al ., 2006 ) rather than promoting osteoblast activity. Increasing clinical evidence suggests a role for genistein aglycone in the treatment of postmenopausal bone loss ( Morabito et al ., 2002 ; Marini et al ., 2007 , 2008 ); however, proof of efficacy in the treatment of established osteoporosis is still lacking ( Tempfer et al ., 2007 ).…”

Increased release and activity of matrix metalloproteinase‐9 in patients with mandibuloacral dysplasia type A, a rare premature ageing syndrome

“…Bone resorption in culturederived osteoclasts is inhibited by three resorption Increased level of MMP-9 in MADA disease inhibitors: calcitonin, alendronate and an integrin antagonist (70). Bisphosphonates, for example form the mainstay of current therapy for a wide range of human bone diseases, including osteoporosis, rheumatoid arthritis, metastatic bone cancer and hypercalcaemia (71,72). In this context, the availability of a disease-specific osteoclastic marker is considered to be required for a proper clinical trial using this class of drugs.…”

The clinical utility of bone marker measurements in osteoporosis

“…BTMs on the other hand show a substantial and more immediate global effect, they measure both bone formation and resorption rate and can classify patients into low or high remodelling groups. Osteoporosis treatments such as bisphosphonates, strontium ranelate, denosumab, hormone replacement therapy (HRT) and selective estrogen receptor moderators (SERMs) act by reducing BTM levels by forty to sixty percent within three to six months [88]. Thus one use of BTMs is to give an early indication of the success of the treatment.…”