Journal List > J Rheum Dis > v.19(1) > 1064011

Chung: Current and Upcoming Treatments for Osteoporosis

Abstract

Osteoporosis is a common senile disease that results in fragility fractures. With an ageing population, the medical and socioeconomic effect of osteoporosis, particularly postmenopausal osteoporosis, will increase further. Currently, good anti-fracture data supports many available anti-resorptive and anabolic drugs including bisphosphonates, selective estrogen receptor modulators, and recombinant human parathyroid hormones. Calcium and vitamin D are also essential treatments for the prevention and treatment of osteoporosis. Although, bisphosphonate is the cornerstone of osteoporosis treatment and is considered as the first line of therapy, their duration of therapy and long-term safety is under question. Novel agents, particularly denosumab, inhibitors of cathepsin K, andanabolic agents that act on Wnt signaling, will increase the therapeutic options for clinicians in the coming years.

Figures and Tables

Figure 1
The World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX): South Korea Version (http://www.shef.ac.uk/FRAX).
jrd-19-4-g001

References

1. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992. 2:285–289.
2. The Korea Institute for Health and Social Affairs and the Korea Centers for Disease Control and Prevention. The fourth Korea National Health and Nutrition Examination Survey (KNHANES). 2008.
3. Kang HY, Yang KH, Kim YN, Moon SH, Choi WJ, Kang DR, et al. Incidence and mortality of hip fracture among the elderly population in South Korea: a population-based study using the national health insurance claims data. BMC Public Health. 2010. 10:230.
4. National Osteoporosis Foundation. Clinician's guide to prevent and treatment of osteoporosis. 2010. Washington, DC, USA: National Osteoporosis Foundation.
5. World Health Organization. FRAX WHO Fracture Risk Assessment Tool. 2008. Geneva, Switzerland: World Health Organization.
6. The Korean Society of the Bone Metabolism. Physician's guide for diagnosis & treatment of osteoporosis. 2008. Seoul, South Korea: The Korean Society of the Bone Metabolism.
7. Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, et al. Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. BMJ. 2008. 336:262–266.
8. Bolland MJ, Avenell A, Baron JA, Grey A, MacLennan GS, Gamble GD, et al. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010. 341:c3691.
9. Nordin BE, Lewis JR, Daly RM, Horowitz J, Metcalfe A, Lange K, et al. The calcium scare--what would Austin Bradford Hill have thought? Osteoporos Int. 2011. 22:3073–3077.
10. Korea Women's Health and Osteoporosis Foundation. Korean Society of Osteoporosis. Korean Society of Gynecologic Endocrinology. Calcium and Vitamin D Recommendation. 2010.
11. Lips P, Hosking D, Lippuner K, Norquist JM, Wehren L, Maalouf G, et al. The prevalence of vitamin D inadequacy amongst women with osteoporosis: an international epidemiological investigation. J Intern Med. 2006. 260:245–254.
12. Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, et al. Vitamin D insufficiency in Korea--a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab. 2011. 96:643–651.
13. Eastell R, Walsh JS, Watts NB, Siris E. Bisphosphonates for postmenopausal osteoporosis. Bone. 2011. 49:82–88.
14. Weinstein RS. Glucocorticoid-Induced Bone Disease. N Engl J Med. 2011. 365:62–70.
15. Favus MJ. Bisphosphonates for osteoporosis. N Engl J Med. 2010. 363:2027–2035.
16. Ruggiero SL, Dodson TB, Assael LA, Landesberg R, Marx RE, Mehrotra B. American Association of Oral and Maxillofacial Surgeons. American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaws--2009 update. J Oral Maxillofac Surg. 2009. 67:5 Suppl. 2–12.
17. Shane E, Burr D, Ebeling PR, Abrahamsen B, Adler RA, Brown TD, et al. American Society for Bone and Mineral Research. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010. 25:2267–2294.
18. Bone HG, Hosking D, Devogelaer JP, Tucci JR, Emkey RD, Tonino RP, et al. Alendronate Phase III Osteoporosis Treatment Study Group. Ten years' experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med. 2004. 350:1189–1199.
19. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002. 288:321–333.
20. The Writing Group for the PEPI. Effects of hormone therapy on bone mineral density: results from the postmenopausal estrogen/progestin interventions (PEPI) trial. JAMA. 1996. 276:1389–1396.
21. Cummings SR, Ettinger B, Delmas PD, Kenemans P, Stathopoulos V, Verweij P, et al. LIFT Trial Investigators. The effects of tibolone in older postmenopausal women. N Engl J Med. 2008. 359:697–708.
22. Modelska K, Cummings S. Tibolone for postmenopausal women: systematic review of randomized trials. J Clin Endocrinol Metab. 2002. 87:16–23.
23. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, et al. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA. 1999. 282:637–645.
24. Silverman SL. New selective estrogen receptor modulators (SERMs) in development. Curr Osteoporos Rep. 2010. 8:151–153.
25. Chesnut CH 3rd, Silverman S, Andriano K, Genant H, Gimona A, Harris S, et al. PROOF Study Group. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. Am J Med. 2000. 109:267–276.
26. Lyritis GP, Tsakalakos N, Magiasis B, Karachalios T, Yiatzides A, Tsekoura M. Analgesic effect of salmon calcitonin in osteoporotic vertebral fractures: a double-blind placebo-controlled clinical study. Calcif Tissue Int. 1991. 49:369–372.
27. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001. 344:1434–1441.
28. Greenspan SL, Bone HG, Ettinger MP, Hanley DA, Lindsay R, Zanchetta JR, et al. Treatment of Osteoporosis with Parathyroid Hormone Study Group. Effect of recombinant human parathyroid hormone (1-84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann Intern Med. 2007. 146:326–339.
29. Saag KG, Shane E, Boonen S, Marín F, Donley DW, Taylor KA, et al. Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl J Med. 2007. 357:2028–2039.
30. Brewer L, Williams D, Moore A. Current and future treatment options in osteoporosis. Eur J Clin Pharmacol. 2011. 67:321–331.
31. Ishizuya T. Therapeutic agents for disorders of bone and calcium metabolism: Weekly subcutaneous injection of teriparatide. Clin Calcium. 2011. 21:17–24.
32. Lewiecki EM. Denosumab: an investigational drug for the management of postmenopausal osteoporosis. Biologics. 2008. 2:645–653.
33. Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, Siddhanti S, Christiansen C, et al. FREEDOM Trial. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009. 361:756–765.
34. Rachner TD, Khosla S, Hofbauer LC. Osteoporosis: now and the future. Lancet. 2011. 377:1276–1287.
35. Kendler DL, McClung MR, Freemantle N, Lillestol M, Moffett AH, Borenstein J, et al. DAPS Investigators. Adherence, preference, and satisfaction of postmenopausal women taking denosumab or alendronate. Osteoporos Int. 2011. 22:1725–1735.
36. Bone HG, McClung MR, Roux C, Recker RR, Eisman JA, Verbruggen N, et al. Odanacatib, a cathepsin-K inhibitor for osteoporosis: a two-year study in postmenopausal women with low bone density. J Bone Miner Res. 2010. 25:937–947.
TOOLS
Similar articles