The Effects of Antifracture Therapies on the Components of Bone Strength: Assessment of Fracture Risk Today and in the Future

K. Shawn Davison, Kerry Siminoski, J. D. Adachi, David A. Hanley, David Goltzman, Anthony B. Hodsman, Robert Josse, Stephanie Kaiser, Wojciech P. Olszynski, Alexandra Papaioannou, Louis George Ste-Marie, David L. Kendler, Alan Tenenhouse, Jacques P. Brown

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

Abstract

Objective: To summarize the current knowledge regarding the impact of the most common antifracture medications on the various determinants of bone strength. Methods: Relevant English-language articles acquired from Medline from 1966 to January 2005 were reviewed. Searches included the keywords bone AND 1 of the following: strength, remodeling, microcrack, structure, mineralization, collagen, organic, crystallinity, osteocyte, porosity, diameter, anisotropy, stress risers, or connectivity AND alendronate, estrogen, etidronate, hormone replacement therapy, parathyroid hormone, risedronate, OR teriparatide. Abstracts from relevant conference proceedings were also reviewed for pertinent information. Results: Antiresorptive therapies increase bone strength through decreasing bone turnover. This lower bone turnover results in a higher mean mineralization and decreases the number of active resorption pits within bone at any given time. These resorption pits are speculated to be areas of focal weakness and a higher number of them would, if all other things were equal, result in greater fragility. Parathyroid hormone therapy increases the rate of bone remodeling, which introduces many resorption pits, but this source of strength loss is thought to be compensated by rapid increases in bone mass. Conclusions: Both the antiresorptives, particularly bisphosphonates, and the parathyroid hormone therapy increase bone strength; however, the changes that are elicited to achieve this differ significantly.

Original languageEnglish
Pages (from-to)10-21
Number of pages12
JournalSeminars in Arthritis and Rheumatism
Volume36
Issue number1
DOIs
Publication statusPublished - Aug 2006

ASJC Scopus Subject Areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

PubMed: MeSH publication types

  • Journal Article
  • Review

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