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Oral antiresorptive therapy

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Abstract

Oral antiresorptive agents play a pivotal role in the management of osteoporosis. This paper discusses the effects and potential future role of newer agents such as ibandronate. Alternative dosing schedules and routes of administration have become available and may improve fracture protection, compliance, and tolerability for the long term treatment of a chronic condition such as osteoporosis. Increasingly these agents are being used to reduce bone loss in other diseases associated with high risk for osteoporosis such as organ transplantation and cystic fibrosis. Such studies may act as prototypes for the extended use of this class of drugs in other chronic inflammatory disease states. The innovative, yet disappointing results from combining an antiresorptive agent (alendronate) with the anabolic effects of teriparatide is also discussed. The major problem that remains is the lack of direct comparison between the agents in terms of fracture endpoints.

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References and Recommended Reading

  1. Fleisch H: Bisphosphonates: mechanism of action. Endocr Rev 1998, 19:80–100.

    Article  PubMed  CAS  Google Scholar 

  2. Papapoulos SE: Ibandronate: a potent new bisphosphonate in the management of postmenopausal osteoporosis. Int J Clin Pract 2003, 57:417–422.

    PubMed  CAS  Google Scholar 

  3. McClung MR, Wasnich RD, Recker R, et al.: Oral daily ibandronate prevents bone loss in early postmenopausal women without osteoporosis. J Bone Miner Res 2004, 19:11–18.

    Article  PubMed  CAS  Google Scholar 

  4. Tanko LB, McClung MR, Schimmer RC, et al.: The efficacy of 48-week ibandronate treatment in postmenopausal osteoporosis when taken 30 versus 60 minutes before breakfast. Bone 2003, 32:421–426.

    Article  PubMed  CAS  Google Scholar 

  5. Schnitzer T, Bone HG, Crepaldi G, et al.: Therapeutic equivalence of alendronate 70 mg once-weekly and alendronate 10mg daily in the treatment of osteoporosis. Aging Clin Exp Res 2000, 12:1–12.

    CAS  Google Scholar 

  6. Brown JP, Kendler DL, McClung MR, et al.: The efficacy and tolerability of risedronate once a week for the treatment of postmenopausal osteoporosis. Calcif Tissue Int 2002, 71:103–111.

    Article  PubMed  CAS  Google Scholar 

  7. Tanko LB, Mouritzen U, Lehmann HJ, et al.: Oral ibandronate: changes in markers of bone turnover during adequately dosed continuous and weekly therapy and during different suboptimally dosed treatment regimens. Bone 2003, 32:687–693.

    Article  PubMed  CAS  Google Scholar 

  8. Bagger YZ, Tanko LB, Alexandersen P, et al.: Alendronate has residual effect on bone mass in postmenopausal Danish women up to 7 years after treatment withdrawal. Bone 2003, 33:301–307.

    Article  PubMed  CAS  Google Scholar 

  9. Sornay-Rendu E, Garnero P, Munoz F, et al.: Effect of withdrawal of hormone replacement therapy on bone mass and bone turnover: the OFELY study. Bone 2003, 33:159–166.

    Article  PubMed  CAS  Google Scholar 

  10. Greenspan SL, Resnick NM, Parker RA: Combination therapy with hormone replacement and alendronate for prevention of bone loss in elderly women. A randomized controlled trial. JAMA 2003, 289:2525–2533.

    Article  PubMed  CAS  Google Scholar 

  11. Hochberg MC, Greenspan S, Wasnich RD, et al.: Changes in bone density and turnover explain the reductions in incidence of non-vertebral fractures that occur during treatment with antiresorptive agents. J Clin Endocrinol Metab 2002, 87:1586–1592.

    Article  PubMed  CAS  Google Scholar 

  12. Cummings SR, Karpf DB, Harris F, et al.: Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med 2002, 112:281–289.

    Article  PubMed  CAS  Google Scholar 

  13. Bone HG, Hosking D, Devogelaer J-P, et al.: Ten years experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 2004, 350:1189–1199. Continuous treatment over 10 years resulted in a sustained increase in BMD and maintenance of a stable reduction in bone turnover. Stopping treatment after 5 years results in a stable BMD at the spine but a decline at the hip. Protection from fractures seems preserved by this length of treatment.

    Article  PubMed  CAS  Google Scholar 

  14. Liberman UA, Weiss SR, Broll J, et al.: Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 1995, 333:1437–1443.

    Article  PubMed  CAS  Google Scholar 

  15. Harris ST, Watts NB, Genant HK, et al.: Effects of risedronate treatment on vertebral and non-vertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. J Am Med Assoc 1999, 282:1344–1352.

    Article  CAS  Google Scholar 

  16. Reginster J-Y, Minne H, Sorensen OH, et al.: Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporosis Int 2000, 11:83–91.

    Article  CAS  Google Scholar 

  17. McClung MR, Geusens P, Miller PD, et al.: Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med 2001, 344:333–340.

    Article  PubMed  CAS  Google Scholar 

  18. Sorensen OH, Crawford GM, Mulder H, et al.: Long-term efficacy of risedronate: a 5 year placebo-controlled clinical experience. Bone 2003, 32:120–126.

    Article  PubMed  CAS  Google Scholar 

  19. Miller PD, Watts NB, Licata AA, et al.: Cyclial etidronate in the treatment of postmenopausal osteoporosis: efficacy and safety after 7 years of treatment. Am J Med 1997, 103:468–478.

    Article  PubMed  CAS  Google Scholar 

  20. Strewler GJ: Decimal point-osteoporosis therapy at the 10-year mark. N Engl J Med 2004, 350:1172–1174.

    Article  PubMed  CAS  Google Scholar 

  21. Eastell R, Adachi J, Harper K, et al.: The effects of raloxifene on incident vertebral fractures in postmenopausal women with osteoporosis: 4-year results from the MORE trial. J Bone Miner Res 2000, 15(Suppl 1):S229.

    Google Scholar 

  22. Ettinger B, Black DM, Mitlak BH, et al.: Reduction in vertebral fracture risk in post-menopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999, 282:637–645.

    Article  PubMed  CAS  Google Scholar 

  23. National Osteoporosis Foundation: Analyses of the effectiveness and cost of screening and treatment strategies for osteoporosis: a basis for development of practice guidelines. Osteoporos Int 1998, 8(Suppl 4):1–88.

    Google Scholar 

  24. Kanis JA, Black D, Cooper C, et al.: On behalf of the International Osteoporosis Foundation and the National Osteoporosis Foundation, USA. A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int 2002, 13:527–536.

    Article  PubMed  CAS  Google Scholar 

  25. Hanson J: Standardization of proximal femur BMD measurements. International Committee for Standards in Bone Measurement. Osteoporos Int 1997, 7:500–501.

    Article  PubMed  CAS  Google Scholar 

  26. Kanis JA, Johnell O, Black DM, et al.: Effect of raloxifene on the risk of new vertebral fracture in postmenopausal women with osteopenia or osteoporosis: a re-analysis of the Multiple Outcomes of Raloxifene Evaluation trial. Bone 2003, 33:293–300.

    Article  PubMed  CAS  Google Scholar 

  27. Cummings SR, Black DM, Thompson DE, et al.: Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. J Am Med Assoc 1998, 280:2077–2082.

    Article  CAS  Google Scholar 

  28. Harris ST, Watts NB, Genant HK, et al.: For the Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Effects of risedronate treatment on vertebral and non-vertbral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 1999, 282:1344–1352.

    Article  PubMed  CAS  Google Scholar 

  29. Reginster J, Minne HW, Sorensen OH, et al.: For the Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporos Int 2000, 11:83–91.

    Article  PubMed  CAS  Google Scholar 

  30. Black DM, Thompson DE, Bauer DC, et al.: For the FIT Research Group. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. J Clin Endocrinol Metab 2000, 85:4118–4124.

    Article  PubMed  CAS  Google Scholar 

  31. Maricic M, Adachi JD, Sarkar S, et al.: Early effects of raloxifene on clinical vertebral fractures at 12 months in postmenopausal women with osteoporosis. Arch Intern Med 2002, 162:1140–1143.

    Article  PubMed  CAS  Google Scholar 

  32. Black DM, Greenspan SL, Ensrud KE, et al.: The effect of parathyroid hormone alone or in combination in postmenopausal osteoporosis. N Engl J Med 2003, 349:1207–1215. The combination of PTH and alendronate leads to larger gains in BMD than alendronate alone but PTH alone is the optimal approach. The gain in bone size at the hip with PTH, which is probably important in its antifracture effect, is impaired or lost by the addition of alendronate.

    Article  PubMed  CAS  Google Scholar 

  33. Dempster DW, Cosman F, Kurland ES, et al.: Effects of daily treatment with parathyroid hormone on bone microarchitecture and turnover in patients with osteoporosis: a paired biopsy study. J Bone Miner Res 2001, 16:1846–1853.

    Article  PubMed  CAS  Google Scholar 

  34. Finkelstein JS, Hayes A, Hunzelman JL, et al.: Effect of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 2003, 349:1216–1226.

    Article  PubMed  CAS  Google Scholar 

  35. Lindsay R, Nieves J, Formica C, et al.: Randomized controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis. Lancet 1997, 350:550–555.

    Article  PubMed  CAS  Google Scholar 

  36. Marie PJ, Amman P, Boivin G, Rey C: Mechanism of action and therapeutic potential of strontium in bone. Calcif Tissue Int 2001, 69:121–129.

    Article  PubMed  CAS  Google Scholar 

  37. Meunier PJ, Slosman DO, Delmas PD, et al.: Strontium ranelate: dose dependent effect in established postmenopausal vertebra osteoporosis-a 2 year randomized placebo controlled trial. J Clin Endocrinol Metab 2002, 87:2060–2066.

    Article  PubMed  CAS  Google Scholar 

  38. Meunier PJ, Roux C, Seeman E, et al.: The effects of strontium ranelate on the risk of vertebral fractures in women with postmenopausal osteoporosis. N Engl J Med 2004, 350:459–468. A new class of bone active drug with the ability to uncouple bone turnover in favor of a net gain. The element currently missing is more data on the effect on non-spine fractures that will be a critical determinant of its place in the treatment for osteoporosis.

    Article  PubMed  CAS  Google Scholar 

  39. Silvermann SL: Management of corticosteroid induced osteoporosis: a clinician’s perspective. Calcif Tissue Int 1992, 50:101–103.

    Article  Google Scholar 

  40. Herrala J, Puolijoki H, Liippo KO, et al.: Clodronate is effective in preventing corticosteroid-induced bone loss among asthatic patients. Bone 1998, 22:577–582.

    Article  PubMed  CAS  Google Scholar 

  41. Frediani B, Falsetti P, Baldi F, et al.: Effects of 4-year treatment with once-weekly clodronate on prevention of corticosteroidinduced bone loss and fractures in patients with arthritis: evaluation with dual-energy x-ray absorptiometry and quantitative ultrasound. Bone 2003, 33:575–581.

    Article  PubMed  CAS  Google Scholar 

  42. Sambrook PN, Birmingham J, Kelly PJ, et al.: Prevention of corticosteroid osteoporosis: a comparison of calcium, calcitriol and calcitonin. N Engl J Med 1993, 328:1747–1752.

    Article  PubMed  CAS  Google Scholar 

  43. Aris RM, Stevens A, Ontjes DA, et al.: Adverse alterations in bone metabolism are associated with lung infection in adults with cystic fibrosis. Am J Respir Crit Care 2000, 162:1674–1678.

    CAS  Google Scholar 

  44. Aris RM, Lester GE, Caminiti M, et al.: Efficacy of alendronate in adults with cystic fibrosis with low bone density. Am J Respir Crit Care Med 2004, 169:77–82.

    Article  PubMed  Google Scholar 

  45. Leidig-Bruckner G, Hosch S, Dodidou P, et al.: Frequency and predictors of osteoporotic fractures after cardiac or liver transplantation: a follow-up study. Lancet 2001, 357:342–347.

    Article  PubMed  CAS  Google Scholar 

  46. Shane E, Addesso V, Namerow PB, et al.: Alendronate versus calcitriol for the prevention of bone loss after cardiac transplantation. N Engl J Med 2004, 350:767–777.

    Article  PubMed  CAS  Google Scholar 

  47. Downs RWJ, Bell NH, Ettinger MP, et al.: Comparison of alendronate and intranasal calcitonin for treatment of osteoporosis in postmenopausal women. J Clin Endocrinol Metab 2000, 85:1783–1788.

    Article  PubMed  CAS  Google Scholar 

  48. Hosking D, Adami S, Felsenberg D, et al.: Comparison of change in bone resorption and bone mineral density with once-weekly alendronate and daily risedronate: a randomized placebo controlled study. Curr Med Res Opin 2003, 19:383–394.

    Article  PubMed  CAS  Google Scholar 

  49. Lufkin EG, Sarkar S, Kulkarni PM, et al.: Antiresorptive treatment of postmenopausal osteoporosis: review of randomised clinical studies and rationale for the Evista alendronate comparison (EVA) trial. Curr Med Res Opin 2004, 20:351–357. This is the first comparative study of two drugs known to be effective against osteoporotic fractures (raloxifene and alendronate) with fracture as a primary endpoint. Studying both drugs in one population should overcome many of the problems inherent in comparing overall safety and efficacy. Results from this study should provide evidence of the relative clinical utility of these two agents.

    Article  PubMed  CAS  Google Scholar 

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Pande, I., Hosking, D.J. Oral antiresorptive therapy. Curr Osteoporos Rep 2, 116–122 (2004). https://doi.org/10.1007/s11914-996-0010-9

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  • DOI: https://doi.org/10.1007/s11914-996-0010-9

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