The effect of antiresorptives on bone quality

Robert R. Recker, Laura Armas

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Currently, antiresorptive therapy in the treatment and prevention of osteoporosis includes bisphosphonates, estrogen replacement, selective estrogen receptor modulators (raloxifene), and denosumab (a human antibody that inactivates RANKL). The original paradigm driving the development of antiresorptive therapy was that inhibition of bone resorption would allow bone formation to continue and correct the defect. However, it is now clear increases in bone density account for little of the antifracture effect of these treatments. Questions/purposes: We examined the antifracture benefit of antiresorptives deriving from bone quality changes. Methods: We searched the archive of nearly 30,000 articles accumulated over more than 40 years in our research center library using a software program (Refman™). Approximately 250 publications were identified in locating the 69 cited here. Results: The findings document antiresorptive agents are not primarily anabolic. All cause a modest increase in bone density due to a reduction in the bone remodeling space; however, the majority of their efficacy is due to suppression of the primary cause of osteoporosis, ie, excessive bone remodeling not driven by mechanical need. All of them improve some element(s) of bone quality. Conclusions: Antiresorptive therapy reduces risk of fracture by improving bone quality through halting removal of bone tissue and the resultant destruction of microarchitecture of bone and, perhaps to some extent, by improving the intrinsic material properties of bone tissue. Information presented here may help clinicians to improve selection of patients for antiresorptive therapy by avoiding them in cases clearly not due to excessive bone remodeling.

Original languageEnglish
Pages (from-to)2207-2214
Number of pages8
JournalClinical Orthopaedics and Related Research
Volume469
Issue number8
DOIs
StatePublished - Aug 2011

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Bone and Bones
Bone Remodeling
Bone Density
Osteoporosis
Therapeutics
Bone Density Conservation Agents
Selective Estrogen Receptor Modulators
Estrogen Replacement Therapy
Bone Fractures
Diphosphonates
Bone Resorption
Osteogenesis
Patient Selection
Libraries
Publications
Software
Antibodies
Research

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine

Cite this

The effect of antiresorptives on bone quality. / Recker, Robert R.; Armas, Laura.

In: Clinical Orthopaedics and Related Research, Vol. 469, No. 8, 08.2011, p. 2207-2214.

Research output: Contribution to journalArticle

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