From the Guidelines
Bone formation and antiresorptive therapy are crucial in managing osteoporosis. The process of bone formation involves the accrual of bone mineral density (BMD) through the use of bone-forming agents, such as abaloparatide, which has been shown to be effective in increasing BMD in men with osteoporosis 1.
Antiresorptive Therapy
Antiresorptive therapy, on the other hand, aims to inhibit bone breakdown by reducing osteoclastic activity. This can be achieved through the use of oral anti-resorptive agents, such as bisphosphonates, which are recommended as first-line agents in men at high risk of fracture 1.
- Bisphosphonates: These include medications like alendronate (70 mg once per week), risedronate (35 mg once per week), and ibandronate (150 mg once per month) 1.
- Denosumab: This is another antiresorptive agent that has been shown to reduce the risk of fracture, but its discontinuation may lead to an increased risk of vertebral fractures 1.
Bone Formation and Resorption
The homeostatic process of bone formation and resorption involves a continuous cycle of bone matrix and mineral resorption (osteoclastic activity) and bone formation (osteoblastic activity) 1.
- Osteoclastic activity: This process is enhanced by hormone deprivation states, glucocorticoids, and other clinical factors, leading to bone loss and increased fracture risk 1.
- Osteoblastic activity: This process can be promoted through the use of bone-forming agents, such as abaloparatide, to increase BMD and reduce fracture risk 1. In summary, the process of bone formation and antiresorptive therapy involves the use of bone-forming agents and antiresorptive agents to promote bone health and reduce fracture risk in individuals with osteoporosis.
From the Research
Bone Formation Process
- Bone formation is a complex process that involves the dynamic interaction of bone cells, including osteoblasts and osteoclasts 2, 3
- Osteoblasts are responsible for bone formation, while osteoclasts are involved in bone resorption 4, 5
- The balance between bone formation and resorption is crucial for maintaining bone health and preventing osteoporosis 2, 6
Antiresorptive Therapy
- Antiresorptive therapy is a treatment approach that aims to reduce bone resorption and prevent fractures in patients with osteoporosis 2, 4, 5, 3, 6
- Antiresorptive agents, such as bisphosphonates, selective estrogen receptor modulators (SERMs), and denosumab, work by inhibiting osteoclast activity and reducing bone resorption 4, 5, 3, 6
- Antiresorptive therapy can improve bone quality by reducing the removal of bone tissue and preserving the microarchitecture of bone 4
Types of Antiresorptive Agents
- Bisphosphonates are a class of antiresorptive agents that bind to hydroxyapatite crystals on the bone surface, inhibiting bone resorption and preventing fractures 4, 3, 6
- Denosumab is a monoclonal antibody that inhibits osteoclastogenesis and reduces bone resorption by hindering the interaction between RANKL and RANK 5, 3, 6
- Selective estrogen receptor modulators (SERMs) are a class of antiresorptive agents that maintain the bone-protective effects of estrogen while avoiding its associated adverse side effects 3
Treatment Approach
- Bone-forming therapy should be followed by antiresorptive treatment with a bisphosphonate or denosumab to maintain bone health and prevent fractures 2
- The choice of antiresorptive agent depends on the individual patient's needs and medical history 4, 5, 3, 6
- Antiresorptive therapy can be used in combination with other treatments, such as hormone replacement therapy and calcitonin, to achieve optimal results 6