The failure rate for fracture fixation in patients with
osteoporosis has been estimated to be 10–25%. An agent that improves bone
repair, fracture healing, and fixation of surgical hardware would be beneficial
in the management of fractures. A consensus statement released by the European
Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO)
addressed fracture healing with current and emerging osteoporosis therapy.
The ESCEO concluded that bisphosphonates (Actonel, Actonel+Ca, Aredia,
Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa) and raloxifene (Evista) did not impair
fracture healing.
Preclinical studies and several case reports suggested that strontium ranelate might enhance fracture
healing.
Studies with teriparatide (Forteo) had mixed results,
but overall were consistent with a beneficial effect on fracture healing.
Clinical trials with
denosumab (Prolia) have shown no adverse effects on fracture healing.
Sclerostin monoclonal antibody therapy has been shown to
enhance fracture healing in rats and cynomolgus monkeys. Although several phase II studies to investigate the effects of
romosozumab (an antisclerostin therapy) on fracture healing in humans have been
conducted [ClinicalTrials.gov identifiers: NCT00907296, NCT01081678], there is currently no ongoing effort to
pursue regulatory approval of this agent for acceleration of fracture healing.
You will note that,
among the current therapies, only strontium ranelate, which is not available in
the USA or Canada, and teriparatide may enhance fracture healing. I believe
strontium citrate has the same beneficial effect on fracture healing because it
is the strontium that increases bone mineral density and improves bone
microarchitecture.
Role of Sclerostin in Bone and Cartilage and Its Potential
as a Therapeutic Target in Bone Diseases, E. Michael Lewiecki, MD, FACP, FACE, Ther
Adv Musculoskel Dis. 2014;6(2):48-57.
Goldhahn, J., Feron, J., Kanis, J., Papapoulos, S.,
Reginster, J., Rizzoli, R. et al. (2012) Implications for fracture
healing of current and new osteoporosis treatments: an ESCEO consensus
paper. Calcif TissueInt 90: 343–353.
3 comments:
I immediately appreciate this blog more for having a skeleton pirate at the top. That being said, I was also really interested to read about these osteoporosis therapies. I'm glad to hear that new methods are still emerging. Thiago | http://www.whc.com
To: Thiago daLuz,
I'm glad you like the skeleton pirate and my post on osteoporosis therapies. I am also glad to know new therapies are emerging. Some day those with osteoporosis will have more treatment options.
Are you affiliated with the Women's Health Center of Greenville? I rarely allow links to other sites unless they are legitimate and on topic. Although I am not familiar with the center, its website shows it provides OB/GYN and other women's services in Greenville, NC.
Much needed information about osteoporosis therapies.Thnks!
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