Bone-forming agents in non-responders to bisphosphonates

Abstract

Osteoporosis is a chronic disease requiring long-term treatment. Oral bisphosphonates, which act by inhibiting bone resorption, are most commonly prescribed but inadequate response, development of intolerance, or fear of long-term side-effects sometimes necessitate change to an alternative therapy. 1 Clark EM Gould VC Tobias JH Horne R Natural history, reasons for, and impact of low/non-adherence to medications for osteoporosis in a cohort of community-dwelling older women already established on medication: a 2-year follow-up study. Osteoporos Int. 2016; 27: 579-590 Crossref PubMed Scopus (13) Google Scholar One option is to switch to teriparatide, a bone-forming agent, but enthusiasm for this strategy is tempered by the blunting of the bone mineral density (BMD) response to teriparatide seen in patients previously treated with antiresorptives. 2 Miller PD Delmas PD Lindsay R et al. Early responsiveness of women with osteoporosis to teriparatide after therapy with alendronate or risedronate. J Clin Endocrinol Metab. 2008; 93: 3785-3793 Crossref PubMed Scopus (177) Google Scholar , 3 Boonen S Marin F Obermayer-Pietsch B et al. Effects of previous antiresorptive therapy on the bone mineral density response to two years of teriparatide treatment in postmenopausal women with osteoporosis. J Clin Endocrinol Metab. 2008; 93: 852-860 Crossref PubMed Scopus (196) Google Scholar , 4 Obermayer-Pietsch BM Marin F McCloskey EV et al. Effects of two years of daily teriparatide treatment on BMD in postmenopausal women with severe osteoporosis with and without prior antiresorptive treatment. J Bone Miner Res. 2008; 23: 1591-1600 Crossref PubMed Scopus (208) Google Scholar Romosozumab (sclerostin monoclonal antibody) versus teriparatide in postmenopausal women with osteoporosis transitioning from oral bisphosphonate therapy: a randomised, open-label, phase 3 trialTransition to a bone-forming agent is common practice in patients treated with bisphosphonates, such as those who fracture while on therapy. In such patients, romosozumab led to gains in hip BMD that were not observed with teriparatide. These data could inform clinical decisions for patients at high risk of fracture. Full-Text PDF