Affiliation:
1. University of Novi Sad, Faculty of Medicine Novi Sad + Special Hospital for Rheumatic Diseases, Novi Sad
Abstract
Introduction. Pharmacotherapy and physical therapy in patients with
osteoporosis are aimed at increasing bone density and reducing the risk of
fall in order to prevent fractures. Medications approved for the treatment
of osteoporosis reduce the risk of fracture, either by reducing bone
resorption or by stimulating bone formation. Bisphosphonates are most widely
used antiresorptive agents that lower bone turnover markers to premenopausal
levels and reduce fracture rates. Bisphosphonates bind to bone minerals and
have a long-lasting effect. Long-term, continuous use of oral
bisphosphonates is usually interspersed with drug breaks of 1-2 years to
reduce the risk of atypical femoral fractures. Denosumab is a monoclonal
antibody that also acts as an antiresorptive and it targets receptor
activators of nuclear factor-?B ligand thus inhibiting the formation and
function of osteoclasts. Denosumab is administered as a subcutaneous
injection every 6 months. Anti-fracture effects of denosumab are similar to
those of bisphosphonates, but there is a marked loss of antiresorptive
effect 7 months after the last dose, which may lead to recurrent vertebral
fractures. Anabolic drugs work by stimulating bone formation. Teriparatide
and abaloparatide bind to the parathyroid hormone-1 receptor and are given
as daily subcutaneous injection for up to 2 years. Romosozumab is a
monoclonal antibody that targets sclerostin, stimulates bone formation and
inhibits resorption. The effects of anabolics are transient, so it is
necessary to switch to antiresorptive medications. Conclusion. It is a
matter of great importance to determine the optimal strategy for cycles of
anabolics, antiresorptive drugs and therapy-free periods.
Publisher
National Library of Serbia
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