Clinical Orthopaedics and Related Research®

, Volume 469, Issue 8, pp 2215–2224 | Cite as

Anabolic Agents and Bone Quality

  • Tarek Sibai
  • Elise F. Morgan
  • Thomas A. Einhorn
Symposium: Bone Quality: From Bench to Bedside
First Online:

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.

Keywords

Bone Mineral Density Fracture Risk Carpal Tunnel Syndrome Fracture Healing Teriparatide 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Notes

Acknowledgment

We thank John Wiley & Sons, Inc, for their permission to use published material for our images in the article.

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Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Tarek Sibai
    • 1
  • Elise F. Morgan
    • 2
  • Thomas A. Einhorn
    • 1
  1. 1.Department of Orthopaedic SurgeryBoston University Medical CenterBostonUSA
  2. 2.Department of Mechanical EngineeringBoston UniversityBostonUSA

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