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Anabolic agents: what is beyond osteoporosis?

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Abstract

Osteoporosis is a common skeletal disorder characterized by low bone mass, which leads to reduced bone strength and an increased risk of fractures. Anabolic agents have been shown to improve bone mass and decrease fracture risk in osteoporosis patients by directly stimulating osteoblasts to produce new bone. Currently, two anabolic agents are available in the USA: recombinantly produced teriparatide (TPTD), which is the fully active (1–34) amino active sequence of human parathyroid hormone (PTH), and abaloparatide (APTD), a synthetic analog of parathyroid hormone-related peptide (PTHrP). At present, both agents are approved only for treatment of patients with osteoporosis at high risk of fracture. Nonetheless, their anabolic properties have led to off-label application in additional settings which include spine fusion, osteonecrosis of the jaw, arthroplasty, and fracture healing. In this article, we summarize available scientific literature regarding the efficacy, effectiveness, and safety of TPTD in these off-label settings.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA

    Y. Liu, A. E. Levack, E. Marty, O. Or, B. P. Samuels, M. Redko & J. M. Lane

  2. Department of Orthopedic Surgery, Hadassah Medical Center, 91120, Jerusalem, Israel

    O. Or

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Dr. Joseph Lane is a co-principal investigator for a trial of teriparatide and pelvic fracture (NIH: 1U01AR069869-01). Ashley E. Levack is supported by NIH T32 AR007281. Yi Liu, Eric Marty, Omer Or, Blossom P. Samuels, and Mariya Redko declare that they have no conflict of interest.

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Liu, Y., Levack, A.E., Marty, E. et al. Anabolic agents: what is beyond osteoporosis?. Osteoporos Int 29, 1009–1022 (2018). https://doi.org/10.1007/s00198-018-4507-8

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