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Bone Biology and Anabolic Therapies for Bone: Current Status and Future Prospects

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초록

Bone is continuously remodelled at many sites asynchronously throughout the skeleton,with bone formation and resorption balanced at these sites to retain bone structure. Negative balance resulting in bone loss and osteoporosis, with consequent fractures,has mainly been prevented or treated by anti-resorptive drugs that inhibit osteoclastformation and/or activity, with new prospects now of anabolic treatments that restorebone that has been lost. The anabolic effectiveness of parathyroid hormone has beenestablished, and an exciting new prospect is presented of neutralising antibody againstthe osteocyte protein, sclerostin. The cellular actions of these two anabolic treatmentsdiffer, and the mechanisms will need to be kept in mind in devising their best use. Onpresent evidence it seems likely that treatment with either of these anabolic agents willneed to be followed by anti-resorptive treatment in order to maintain bone that hasbeen restored. No matter how effective anabolic therapies for the skeleton become, itseems highly likely that there will be a continuing need for safe, effective anti-resorptivedrugs.

Abstract

Bone is continuously remodelled at many sites asynchronously throughout the skeleton,with bone formation and resorption balanced at these sites to retain bone structure. Negative balance resulting in bone loss and osteoporosis, with consequent fractures,has mainly been prevented or treated by anti-resorptive drugs that inhibit osteoclastformation and/or activity, with new prospects now of anabolic treatments that restorebone that has been lost. The anabolic effectiveness of parathyroid hormone has beenestablished, and an exciting new prospect is presented of neutralising antibody againstthe osteocyte protein, sclerostin. The cellular actions of these two anabolic treatmentsdiffer, and the mechanisms will need to be kept in mind in devising their best use. Onpresent evidence it seems likely that treatment with either of these anabolic agents willneed to be followed by anti-resorptive treatment in order to maintain bone that hasbeen restored. No matter how effective anabolic therapies for the skeleton become, itseems highly likely that there will be a continuing need for safe, effective anti-resorptivedrugs.

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