The effect of antiresorptives on bone quality

Area of Science:

• Osteoporosis Research
• Pharmacology
• Bone Biology

Background:

• Current antiresorptive therapies for osteoporosis include bisphosphonates, estrogen replacement, raloxifene, and denosumab.
• The initial therapeutic goal was that inhibiting bone resorption would allow bone formation to correct defects.
• However, bone density increases explain only a small part of the antifracture benefits of these treatments.

Purpose of the Study:

• To investigate the antifracture benefits of antiresorptive medications derived from improvements in bone quality.
• To understand the mechanisms by which antiresorptive agents prevent fractures.

Main Methods:

• A comprehensive literature search was conducted using a software program (Refman™) on an archive of nearly 30,000 articles.
• Approximately 250 publications were identified, with 69 ultimately cited in the review.
• The study involved a systematic review of existing research on antiresorptive therapies.

Main Results:

• Antiresorptive agents are not primarily anabolic; they increase bone density modestly by reducing bone remodeling space.
• The majority of their efficacy stems from suppressing excessive bone remodeling, the primary driver of osteoporosis.
• All evaluated antiresorptive therapies demonstrate improvements in specific aspects of bone quality.

Conclusions:

• Antiresorptive therapy reduces fracture risk by enhancing bone quality, halting bone tissue removal, and preserving bone microarchitecture.
• These therapies may also improve the intrinsic material properties of bone tissue.
• Findings can aid clinicians in selecting patients for antiresorptive therapy, particularly by identifying cases not driven by excessive bone remodeling.