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The Effect of Antiresorptives on Bone Quality

  • Symposium: Bone Quality: From Bench to Bedside
  • Published:
Clinical Orthopaedics and Related Research®

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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Authors and Affiliations

  1. Osteoporosis Research Center, Creighton University, 601 N 30th Street #5766, Omaha, NE, 68131, USA

    Robert R. Recker MD & Laura Armas MD

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  1. Robert R. Recker MD
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  2. Laura Armas MD
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Correspondence to Robert R. Recker MD.

Additional information

Robert R. Recker is a paid consultant for Merck & Co, Inc (Whitehouse Station, NJ); Eli Lilly and Co (Indianapolis, IN); Pfizer, Inc (Princeton, NJ); The Proctor & Gamble Co (Cincinnati, OH); Amgen Inc (Thousand Oaks, CA); Roche USA (Indianapolis, IN); GlaxoSmithKline, Inc (Research Triangle Park, NC); and Novartis Corp (East Hanover, NJ) and has received grant/research support from Merck & Co, Inc; Eli Lilly and Co; Wyeth (Madison, NJ); The Proctor & Gamble Co; Amgen Inc; Roche USA; GlaxoSmithKline, Inc; Novartis Corp; and Sanofi-Aventis US (Bridgewater, NJ) through grants to his institution.

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Recker, R.R., Armas, L. The Effect of Antiresorptives on Bone Quality. Clin Orthop Relat Res 469, 2207–2214 (2011). https://doi.org/10.1007/s11999-011-1909-8

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