Abstract
This chapter discusses drug therapy used to reduce fracture risk by influencing the material and structural properties of bone. Bone loss is slow before menopause because remodelling is slow. Bone loss accelerates after menopause because remodelling rate increases, reducing bone mineral density (BMD) and bones material rigidity. Anti-resorptive drugs reduce the rate of bone remodelling. Reconstruction the skeleton requires anabolic therapy. Parathyroid hormone (PTH) given intermittently increases bone formation on the endosteal surface increasing both cortical and trabecular thickness. Strontium ranelate reduces vertebral and non-vertebral fractures. The rate of bone remodelling does not appear to be reduced. There may be a reduction the depth of bone resorption while allowing bone formation to continue but remains uncertain.
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References
Black DM, Greenspan SL, Ensrud KE, the PTH Study Investigators (2003) The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med 349:1207–1215
Cosman F, Nieves J, Zion M, Woelfert L, Luckey M, Lindsay R (2005) Daily and cyclic parathyroid hormone in women receiving alendronate. N Engl J Med 353(6):566–575
Currey JD (2002) Bones: structure and mechanics. Princeton University Press, Princeton, New Jersey, pp 1–380
Delmas PD (2002) Treatment of postmenopausal osteoporosis. Lancet 359:2018–2026
Ettinger B, San Martin J, Crans G, Pavo I (2004) Differential effects of teriparatide on BMD after treatment with raloxifene or alendronate. J Bone Miner Res 19:745–751
Finkelstein JS, Hayes A, Hunzelman JL, Wyland JJ, Lee H, Neer RM (2003) The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 349:1216–1226
Komatsubara S, Mori S, Mashiba T, Ito M, Li J, Kaji Y, Akiyama T, Miyamoto K, Cao Y, Kawanishi J, Norimatsu H (2003) Long-term treatment of incadronate disodium accumulates microdamage but improves the trabecular bone microarchitecture in dog vertebra. J Bone Miner Res 18:512–520
Lips P, Courpron P. Meunier PJ (1978) Mean wall thickness of trabecular bone packets in the human iliac crest: changes with age. Calcif Tissue Res 10:13–17
Manolagas SC (2000) Birth and death of bone cells: basic regulatory mechanisms and implications for the pathogenesis and treatment of osteoporosis. Endocr Rev 21:115–137
Mashiba T, Hirano T, Turner CH, Forwood MR, Johnston CC, Burr DB (2000) Suppressed bone turnover by bisphosphonates increases microdamage accumulation and reduces some biomechanical properties in dog rib. J Bone Miner Res 15:613–620
Meunier PJ, Slosman D, Delmas PD, Sebert JL, Brandi ML, Albanese C, Lorenc R, Pors-Nielsen S, De Vernejoul MC, Roces A, Reginster JY (2002) Strontium ranelate: dose-dependent effects in established post-menopausal vertebral osteoporosis. The Stratos 2-year randomized placebo controlled trial. J Clin Endocrinol Metab 87:2060–2066
Meunier PJ, Roux C, Seeman E (2004) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 350:459–468
Neer RM, Arnaud CD, Zanchette JR (2001) Effect of parathyroid hormone (1–134) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441
Odvina CV, Zerwekh JE, Rao DS, Maaloof N, Gottschalk FA, Pak CYC (2005) Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 1294–1301
Parfitt AM (1980) Morphological basis of bone mineral measurements: transient and steady state effects of treatment in osteoporosis. Mineral Electrolyte Metab 4:273–287
Parfitt AM (1996) Skeletal heterogeneity and the purposes of bone remodelling: implications for the understanding of osteoporosis. In: Marcus R, Feldman D, Kelsey J (eds) Osteoporosis. Academic Press, San Diego, pp 315–339
Reginster JY, Seeman E, De Vernejoul (2005) Strontium ranelate reduced the risk of nonvertebral fractures in postmenopausal women with osteoporosis TROPOS study. Strontium ranelate reduces the risk of non-vertebral fractures in post-menopausal women with osteoporosis: Treatment of Peripheral Osteoporosis (TROPOS) Study. J Clin Endosc Metab 90:2816–2822
Seeman E (2003) Periosteal bone formation: a neglected determinant of bone strength. N Engl J Med 349:320–323
Van der Linden JC, Homminga J, Verhaar JAN, Weinans H (2001) Mechanical consequences of bone loss in cancellous bone. J Bone Miner Res 16:457–465
Whyte MP, Wenkert D, Clements KL, McAlister WH, Mumm S (2003) Brief report: bisphosphonate-induced osteopetrosis. N Engl J Med 349:457–463
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Seeman, E. (2007). Material and Structural Basis of Bone Fragility: A Rational Approach to Therapy. In: Qin, L., Genant, H.K., Griffith, J.F., Leung, K.S. (eds) Advanced Bioimaging Technologies in Assessment of the Quality of Bone and Scaffold Materials. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-45456-4_23
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DOI: https://doi.org/10.1007/978-3-540-45456-4_23
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