Open AccessBone anabolics in osteoporosis: Actuality and perspectives
Author(s) -
A Montagnani
Publication year - 2014
Publication title -
world journal of orthopedics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.76
H-Index - 43
ISSN - 2218-5836
DOI - 10.5312/wjo.v5.i3.247
Subject(s) - sclerostin , medicine , osteoporosis , bone remodeling , bone resorption , denosumab , bone formation , endocrinology , parathyroid hormone , anabolism , anabolic agents , teriparatide , wnt signaling pathway , bone mineral , signal transduction , calcium , chemistry , biochemistry
Vertebral and nonvertebral fractures prevention is the main goal for osteoporosis therapy by inhibiting bone resorption and/or stimulating bone formation. Antiresorptive drugs decrease the activation frequency, thereby determining a secondary decrease in bone formation rate and a low bone turnover. Bisphosphonates are today's mainstay among antiresorptive treatment of osteoporosis. Also, oral selective estrogen receptor modulators and recently denosumab have a negative effect on bone turnover. Agents active on bone formation are considered a better perspective in the treatment of severe osteoporosis. Recombinant-human parathyroid hormone (PTH) has showed to increase bone formation and significantly decrease vertebral fractures in severe patients, but with a modest effect on nonvertebral fractures. The study of Wnt signaling pathway, that induces prevalently an osteoblastic activity, opens large possibilities to antagonists of Wnt-inhibitors, such as sclerostin antibodies and dickkopf-1 antagonists, with potential effects not only on trabecular bone but also on cortical bone.