Anabolic Therapy and Optimal Treatment Sequences for Patients With Osteoporosis at High Risk for Fracture |
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| Institution: | 1. From the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.;1. University of New Mexico Health Sciences Center, Department of Internal Medicine, Division of Endocrinology;2. University of New Mexico Health Sciences Center, Department of Pharmaceutical Sciences, Albuquerque, New Mexico.;1. Regional Bone and Clinical Research Centers, Helen Hayes Hospital, West Haverstraw, NY 10993, United States of America;2. Department of Medicine, Columbia University, New York, NY 10032, United States of America;3. Department of Epidemiology, Columbia University, New York, NY 10032, United States of America;4. Department of Pathology and Cell Biology, Columbia University, New York, NY 10032, United States of America;1. Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Christian-Albrechts-Universität zu Kiel, Kiel, Germany;2. GSI, Darmstadt, Germany;3. Institut und Poliklinik für Diagnostische Radiologie, Uniklinik Köln, Germany;4. Amgen Inc., Thousand Oaks, CA, USA |
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| Abstract: | Objective: Provide an update regarding anabolic medications for osteoporosis, which are often considered to be the last resort for patients with osteoporosis, after multiple fractures have already occurred and other medications have already been administered.Methods: Literature review and discussion.Results: Recent pivotal trial data for anabolic agents and randomized trials comparing anabolic and antiresorptive medications suggest that three anabolic agents (teriparatide, abaloparatide, and romosozumab) reduce nonvertebral and vertebral fractures faster and to a greater extent than potent antiresorptive treatments. Furthermore, bone density accrual is maximized when patients are given anabolic agents first, followed by potent antiresorptive therapy. Since total hip bone density during or after osteoporosis treatment has emerged as an excellent surrogate for future fracture risk, attaining a greater hip bone mineral density is a treatment goal for high-risk osteoporosis patients.Conclusion: This review defines the highest-risk patients and summarizes the rationale for the evolving role of anabolic therapy in the management of postmenopausal women at high risk for fracture.Abbreviations: ACTIVE = Abaloparatide Comparator Trial in Vertebral Endpoints; ARCH = Active Controlled Fracture Study in Postmenopausal Women with Osteoporosis at High Risk; BMD = bone mineral density; FRAME = Fracture Study in Postmenopausal Women with Osteoporosis; FRAX = Fracture Risk Assessment Tool; PTH = parathyroid hormone; TBS = trabecular bone score |
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