Drugs Used in the Treatment of Metabolic Bone Disease

Abstract

Osteoporosis is the most important metabolic bone disease and places an increasing burden on the healthcare system. The condition can be prevented by the early introduction of hormone replacement therapy. The role of bisphosphonates in achieving the same result is being actively explored. The attraction of preventing bone loss is that it preserves the micro-architecture of bone, and therefore its mechanical integrity. The great problem of treating the established condition is that substantial bone loss is accompanied by architectural disintegration. Replacing lost bone may not necessarily restore mechanical integrity and protect against fractures. The management of Paget's disease has been quite revolutionised by the introduction of the bisphosphonates. The condition is a result of a primary increase in osteoclastic bone resorption which can be corrected by bisphosphonates, with considerable symptomatic improvement. The increasing potency and safety margin of the newer agents has meant that the threshold for treatment has fallen. There is now potential for long term control of bone turnover with the hope of preventing late complications. Hypercalcaemia of malignancy is usually the result of both increased bone destruction and decreased urinary calcium excretion. These two components of hypercalcaemia demand different approaches to management. The general availability of an ever-expanding range of increasingly potent bisphosphonates has resulted in a dramatic improvement in the treatment of increased bone resorption associated with malignancy. Many types of tumour, either directly or indirectly, compromise the ability of the kidney to eliminate a calcium load derived from increased bone destruction. Calcitonin is the only agent which is currently available to counter this process.

Hypercalcemia in pregnancy – a multifaceted challenge: case reports and literature review

“…Calcitonin is usually well tolerated and acts rapidly (4–6 h), but it has limited effect (maximum calcium decrease of 0.3–0.5 mmol/L) and is associated with tachyphylaxis after 48 h of use 27. Calcitonin does not cross the placenta and is considered safe for the mother and fetus 2.…”

Intracellular expression of human calcitonin (hCT) gene in the methylotrophic yeast, Pichia pastoris

“…Calcitonin is one of the most effective reagents for osteoporosis with antalgic activities (Munos et al, 2004). It is believed that salmon calcitonin can inhibit bone resorption, reduce bone mass loss and relieve bone pain (Patel et al, 1993). But oral or nasal administration of salmon calcitonin can cause many side effects in osteoporosis patients.…”

Bisphosphonates and the Treatment of Bone Disease in the Elderly

“…[70] Bisphosphonates have replaced calcitonin as the treatment of choice, giving better response rate, more prolonged remission and none of the secondary resistance seen in up to a fifth of those treated with calcitonin. [52,71] Dose-related responses rapidly control both the presenting disease and relapses. Because the drug persists in the body, remissions can last for many months or years.…”