Curtis, E. M, McClung, M. & Compston, JE. (2018). Therapeutic approaches to bone protection in adulthood. N. C. Harvey, C. Cooper. Osteoporosis: A lifecourse epidemiology approach to skeletal health 177-192. United States of America: CRC Press. Retrieved from https://doi.org/10.1201/9781351234627
This chapter describes the existing pharmacological options to reduce fracture risk, documents the emerging considerations regarding their use, and describes novel therapies in development, which will further add to a comprehensive treatment armamentarium. It examines that calcium with concomitant vitamin D supplementation is supported for patients at high risk of calcium and vitamin D deficiency and for those receiving treatment for osteoporosis. Bisphosphonates are synthetic analogues of the naturally occurring compound pyrophosphate and bind strongly to hydroxyapatite, inhibiting bone resorption by inactivating osteoclasts. Denosumab, a fully human antibody to receptor activator of nuclear factor kappa B ligand (RANKL) is a newer antiresorptive agent. RANKL, secreted by osteoblasts, is a major activator of osteoclastic bone resorption. Raloxifene is a selective oestrogen receptor modulator that has antiresorptive oestrogenic effects on the skeleton without the unwanted risks of oestrogen in breast. Sclerostin, an osteocyte-derived glycoprotein that modulates bone formation by osteoblasts, is primarily regulated by mechanical loading; increased load reduces sclerostin secretion.
Mary MacKillop Institute for Health Research
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