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Osteoporosis Therapeutics 2020

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Bone Regulators and Osteoporosis Therapy

Part of the book series: Handbook of Experimental Pharmacology ((HEP,volume 262))

Abstract

Numerous safe and efficient drug therapies are currently available to decrease risk of low trauma fractures in patients with osteoporosis including postmenopausal, male, and secondary osteoporosis. In this chapter, we give first an overview of the most important outcomes regarding fracture risk reduction, change in bone mineral density (BMD by DXA) and/or bone markers of the phase III clinical studies of well-established therapies (such as Bisphosphonates, Denosumab or Teriparatide) and also novel therapies (such as Romosozumab or Abaloparatide) and highlight their mechanisms of action at bone tissue/material level. The latter understanding is not only essential for the choice of drug, duration and discontinuation of treatment but also for the interpretation of the clinical outcomes (in particular of eventual changes in BMD) after drug administration. In the second part of this chapter, we focus on the management of different forms of osteoporosis and give a review of the respective current guidelines for treatment. Adverse effects of treatment such as atypical femoral fractures, osteonecrosis of the jaw or influence of fracture healing are considered also in this context.

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Abbreviations

AFFs:

Atypical femoral fractures

ALN:

Alendronate

BMD:

Bone mineral density

BMDD:

Bone mineralization density distribution

BPs:

Bisphosphonates

BSUs:

Bone structural units

CTX:

Carboxy-terminal collagen crosslinks (CTX)

DXA:

Dual-energy X-ray absorptiometry

FRAX:

Fracture Risk Assessment Tool

GCs:

Glucocorticoids

GIOP:

Glucocorticoid-induced osteoporosis

HRT:

Hormone replacement therapy

ONJ:

Osteonecrosis of the jaw

PINP:

Procollagen I N-terminal propeptide

PTH:

Parathyroid hormone

PTHrP:

Parathyroid hormone-related protein

RIS:

Risedronate

SERMs:

Selective estrogen receptor modulators

TBS:

Trabecular bone score

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  1. Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Med. Dept. Hanusch Hospital, Vienna, Austria

    Roland Kocijan, Klaus Klaushofer & Barbara M. Misof

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    Paula H. Stern

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Kocijan, R., Klaushofer, K., Misof, B.M. (2020). Osteoporosis Therapeutics 2020. In: Stern, P.H. (eds) Bone Regulators and Osteoporosis Therapy. Handbook of Experimental Pharmacology, vol 262. Springer, Cham. https://doi.org/10.1007/164_2020_373

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