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Clinical Orthopaedics and Related Research®

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01-08-2011 | Symposium: Bone Quality: From Bench to Bedside

Anabolic Agents and Bone Quality

Authors: Tarek Sibai, MD, Elise F. Morgan, PhD, Thomas A. Einhorn, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2011

Abstract

Background

The definition of bone quality is evolving particularly from the perspective of anabolic agents that can enhance not only bone mineral density but also bone microarchitecture, composition, morphology, amount of microdamage, and remodeling dynamics.

Questions/purposes

This review summarizes the molecular pathways and physiologic effects of current and potential anabolic drugs.

Methods

From a MEDLINE search (1996–2010), articles were identified by the search terms “bone quality” (1851 articles), “anabolic agent” (5044 articles), “PTH or parathyroid hormone” (32,229 articles), “strontium” or “strontium ranelate” (283 articles), “prostaglandin” (77,539 articles), and “statin” or “statins” (14,233 articles). The search strategy included combining each with the phrase “bone quality.” Another more limited search aimed at finding more novel potential agents.

Results

Parathyroid hormone is the only US Food and Drug Administration-approved bone anabolic agent in the United States and has been the most extensively studied in in vitro animal and human trials. Strontium ranelate is approved in Europe but has not undergone Food and Drug Administration trials in the United States. All the studies on prostaglandin agonists have used in vivo animal models and there are no human trials examining prostaglandin agonist effects. The advantages of statins include the long-established advantages and safety profile, but they are limited by their bioavailability in bone. Other potential pathways include proline-rich tyrosine kinase 2 (PYK2) and sclerostin (SOST) inhibition, among others.

Conclusions

The ongoing research to enhance the anabolic potential of current agents, identify new agents, and develop better delivery systems will greatly enhance the management of bone quality-related injuries and diseases in the future.

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Title: Anabolic Agents and Bone Quality
Authors: Tarek Sibai, MD
Elise F. Morgan, PhD
Thomas A. Einhorn, MD
Publication date: 01-08-2011
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 8/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-010-1722-9

At a glance: The STEP trials

Springer Medicine

Anabolic Agents and Bone Quality

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

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