Reduced bone modeling and unbalanced bone remodeling : Targets for antiresorptive and anabolic therapy

Book chapter


Ramchand, Sabashini and Seeman, Ego. (2020). Reduced bone modeling and unbalanced bone remodeling : Targets for antiresorptive and anabolic therapy. In In Stern, Paula H. (Ed.). Bone regulators and osteoporosis therapy pp. 423-450 Springer Nature Switzerland AG. https://doi.org/10.1007/164_2020_354
AuthorsRamchand, Sabashini and Seeman, Ego
EditorsStern, Paula H.
Abstract

Bone loss during advancing age is the net result of reduced modeling-based bone formation upon the outer (periosteal) envelope and unbalanced remodeling by basic multicellular units (BMUs) upon the three (intracortical, endocortical, and trabecular) components of the inner (endosteal) bone envelope. Each BMU deposits less bone than resorbed, reducing total bone volume and deteriorating the microstructure of the diminished residual bone volume.

Antiresorptive agents like bisphosphonates reduce, but do not abolish, the rate of bone remodeling – fewer BMUs remodel, “turn over,” the volume of bone. Residual unbalanced remodeling continues to slowly reduce total bone volume and deteriorate bone microstructure. By contrast, denosumab virtually abolishes remodeling so the decrease in bone volume and the deterioration in microstructure cease. The less remodeled matrix remains, leaving more time to complete the slow process of secondary mineralization which reduces the heterogeneity of matrix mineralization and allows it to become glycosylated, changes that may make the smaller and microstructurally deteriorated bone volume more brittle. Neither class of antiresorptive restores bone volume or its microstructure, despite increases in bone mineral density misleadingly suggesting otherwise. Nevertheless, these agents reduce vertebral and hip fractures by 50–60% but only reduce nonvertebral fractures by 20–30%.

Restoring bone volume, microstructure, and material composition, “curing” bone fragility, may be partly achieved using anabolic therapy. Teriparatide, and probably abaloparatide, produce mainly remodeling-based bone formation by acting on BMUs existing in their resorption, reversal, or formation phase at the time of treatment and by promoting bone formation in newly initiated BMUs. Romosozumab produces modeling-based bone formation almost exclusively and decreases the surface extent of bone resorption. All three anabolic agents reduce vertebral fracture risk relative to untreated controls; parathyroid hormone 1-34 and romosozumab reduce vertebral fracture risk more greatly than risedronate or alendronate, respectively. Evidence for nonvertebral or hip fracture risk reduction relative to untreated or antiresorptive-treated controls is lacking or inconsistent. Only one study suggests sequential romosozumab followed by alendronate reduces vertebral, nonvertebral, and hip fracture risk compared to continuous alendronate alone. Whether combined antiresorptive and anabolic therapy result in superior fracture risk reduction than monotherapy is untested.

Keywordsanabolic; antiresorptives; bone mineral density; fracture; osteoporosis
Page range423-450
Year2020
Book titleBone regulators and osteoporosis therapy
PublisherSpringer Nature Switzerland AG
Place of publicationCham, Switzerland
SeriesHandbook of experimental pharmacology ; volume 262
ISBN9783030573775
9783030573782
ISSN0171-2004
1865-0325
Digital Object Identifier (DOI)https://doi.org/10.1007/164_2020_354
Scopus EID2-s2.0-85097004414
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Online31 Mar 2020
Print2020
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Deposited12 Apr 2022
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A. Michael Parfitt: Enlightened scholar and revered mentor: May 10, 1930-May 18, 2015
Manolagas, Stavros C., Compston, Juliet, Rao, Sudhaker and Seeman, Ego. (2015). A. Michael Parfitt: Enlightened scholar and revered mentor: May 10, 1930-May 18, 2015. Journal of Bone and Mineral Research. 30(8), pp. 1349 - 1355. https://doi.org/10.1002/jbmr.2576
Co-administration of antiresorptive and anabolic agents: A missed opportunity
Seeman, Ego and Martin, T. John. (2015). Co-administration of antiresorptive and anabolic agents: A missed opportunity. Journal of Bone and Mineral Research. 30(5), pp. 753 - 764. https://doi.org/10.1002/jbmr.2496
The ABC of writing a grant proposal
Seeman, Ego. (2015). The ABC of writing a grant proposal. Osteoporosis International. 26(6), pp. 1665 - 1666. https://doi.org/10.1007/s00198-015-3085-2
Growth and age-related abnormalities in cortical structure and fracture risk
Seeman, Ego. (2015). Growth and age-related abnormalities in cortical structure and fracture risk. Endocrinology and Metabolism. 30(4), pp. 419 - 428. https://doi.org/10.3803/EnM.2015.30.4.419
High-resolution in vivo imaging of bone and joints: a window to microarchitecture
Geusens, P., Geusens, P., Chapurlat, Roland D., Chapurlat, Roland D., Schett, G., Ghasem-Zadeh, Ali, Ghasem-Zadeh, Ali, Seeman, Ego, De Jong, J. and Van Den Bergh, J.. (2014). High-resolution in vivo imaging of bone and joints: a window to microarchitecture. Nature Reviews Rheumatology. 10(5), pp. 304 - 313. https://doi.org/10.1038/nrrheum.2014.23
A new method of segmentation of compact-appearing, transitional and trabecular compartments and quantification of cortical porosity from high resolution peripheral quantitative computed tomographic images
Zebaze, Roger M., Ghasem-Zadeh, Ali, Mbala, A. and Seeman, Ego. (2013). A new method of segmentation of compact-appearing, transitional and trabecular compartments and quantification of cortical porosity from high resolution peripheral quantitative computed tomographic images. Bone. 54(1), pp. 8 - 20. https://doi.org/10.1016/j.bone.2013.01.007
Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy
Chiang, Cherie Ying, Zebaze, Roger M.D., Ghasem-Zadeh, Ali, Iuliano-Burns, Sandra, Hardidge, Andrew and Seeman, Ego. (2013). Teriparatide improves bone quality and healing of atypical femoral fractures associated with bisphosphonate therapy. Bone. 52(1), pp. 360 - 365. https://doi.org/10.1016/j.bone.2012.10.006
Predictors of new and severe vertebral fractures: Results from the HoRIZoN Pivotal Fracture Trial
Wustrack, R., Seeman, Ego, Bucci-Rechtweg, C. and Burch, S.. (2012). Predictors of new and severe vertebral fractures: Results from the HoRIZoN Pivotal Fracture Trial. Osteoporosis International. 23(1), pp. 53 - 58. https://doi.org/10.1007/s00198-011-1664-4
The effect of acute exercise on undercarboxylated osteocalcin in obese men
Levinger, Itamar, Zebaze, Roger M., Jeru, G., Hare, David L., Selig, Steve and Seeman, Ego. (2011). The effect of acute exercise on undercarboxylated osteocalcin in obese men. Osteoporosis International. 22(5), pp. 1621 - 1626. https://doi.org/10.1007/s00198-010-1370-7
Teriparatide therapy for osteonecrosis of the jaw REPLY
Cheung, Ada S. and Seeman, Ego. (2011). Teriparatide therapy for osteonecrosis of the jaw REPLY. New England Journal of Medicine. 364, pp. 1081 - 1082. https://doi.org/10.1056/NEJMc1100730
Festschrift to honor Professor Pierre D. Delmas
Seeman, E., Lindsay, R. and Kanis, J. A.. (2009). Festschrift to honor Professor Pierre D. Delmas. Osteoporosis International. 20(Supplement 3), pp. S231 - S233. https://doi.org/10.1007/s00198-008-0811-z
Bone fragility in men - Where are we?
Seeman, Ego, Bianchi, Georges, Khosla, Sundeep, Kanis, John and Orwoll, E. (2006). Bone fragility in men - Where are we? Osteoporosis International. 17(11), pp. 1577 - 1583. https://doi.org/10.1007/s00198-006-0160-8