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

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

The Effect of Antiresorptives on Bone Quality

Authors: Robert R. Recker, MD, Laura Armas, MD

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

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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.
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Metadata
Title
The Effect of Antiresorptives on Bone Quality
Authors
Robert R. Recker, MD
Laura Armas, 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/s11999-011-1909-8

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