Current and emerging osteoporosis pharmacotherapy for women: state of the art therapies for preventing bone loss

Abstract

Introduction: Pharmacological options to address the imbalance between bone resorption and accrual in osteoporosis include anti-resorptive and osteoanabolic agents. Unique biologic pathways such as Wnt/-catenin pathway have been targeted in the quest for new emerging therapeutic strategies. Areas Covered: This review aims to provide an overview of existing pharmacotherapy for osteoporosis in women and explore state-of-the-art and emerging therapies to prevent bone loss, with an emphasis on the mechanism of action, indications and side effects. Expert Opinion: Bisphosphonates appear to be a reliable and cost-effective option, whereas denosumab has introduced a simpler dosing regimen and may achieve a linear increase in BMD with no plateau being observed, along with continuous anti-fracture efficacy. Selective estrogen receptor modulators (SERMs) are synthetic non-steroidal agents which have varying estrogen agonist and antagonist activities in different tissues and antifracture efficacy. Abaloparatide, a parathyroid-hormone-related peptide (PTHrP)-analogue, approved by the FDA in April 2017, constitutes the first new anabolic osteoporosis drug in the US for nearly 15 years and has also proven its anti-fracture efficacy. Romosozumab, a sclerostin inhibitor, which induces bone formation and suppresses bone resorption, has also been developed and shown anti-fracture efficacy; however, concerns have arisen with regard to increased cardiovascular risk.

The Cross-Talk Between Gut Microbiota and Lungs in Common Lung Diseases

“…In another study, lower levels of Dialister, Enterobacter, Escherichia-Shigella, Fecalibacterium, and Kluyvera but higher levels of Veillonella, Bacteroides, and Fusobacterium compared to that of the controls were found . The correlations between the relative abundance of the above-mentioned bacterial genera and systemic inflammation-related markers including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (Fontalis et al, 2019), and lymphocyte-tomonocyte ratio (LMR) were analyzed. The results showed that Enterobacter and Escherichia-Shigella, were correlated positively with serum NLR level, while Dialister was negatively correlated with contents of PLR and NLR in the serum.…”

Grade 1 Vertebral Fractures Identified by Densitometric Lateral Spine Imaging Predict Incident Major Osteoporotic Fracture Independently of Clinical Risk Factors and Bone Mineral Density in Older Women

“…(2,4,5) Osteoporosis medications are particularly effective in reducing the risk of VFs in postmenopausal women, and it is therefore of utmost importance that VFs come to clinical attention. (8,9) Spine imaging is required for the diagnosis of VF and the clinical challenge is to identify and diagnose the asymptomatic two-thirds of individuals with VF, (10) in addition to detect VFs not reported correctly by the radiologist. (11) Vertebral fracture assessment (VFA) is a well-established and validated method for detecting VFs from lateral spine imaging (LSI) with dual-energy X-ray absorptiometry (DXA).…”

The emerging role of IMD 0354 on bone homeostasis by suppressing osteoclastogenesis and bone resorption, but without affecting bone formation

“…For instance, bisphosphonates can markedly inhibit bone resorption and are very efficient at reducing osteoclast numbers and activity, while they also profoundly decrease bone formation 22 . Moreover, lasofoxifene belongs to selective estrogen receptor modulators (SERMS) downmodulating the activity of osteoclasts in a transforming growth factor-β3-dependent manner leading to reduced bone resorption 23 , while it is associated with an approximately two fold increased risk of deep vein thrombosis 24 . As a selective IKK-β inhibitor, IMD 0354 downregulates IκB phosphorylation and blocks NF-κB P65 nuclear translocation.…”