TY - JOUR
T1 - The Effects of Antifracture Therapies on the Components of Bone Strength
T2 - Assessment of Fracture Risk Today and in the Future
AU - Davison, K. Shawn
AU - Siminoski, Kerry
AU - Adachi, J. D.
AU - Hanley, David A.
AU - Goltzman, David
AU - Hodsman, Anthony B.
AU - Josse, Robert
AU - Kaiser, Stephanie
AU - Olszynski, Wojciech P.
AU - Papaioannou, Alexandra
AU - Ste-Marie, Louis George
AU - Kendler, David L.
AU - Tenenhouse, Alan
AU - Brown, Jacques P.
PY - 2006/8
Y1 - 2006/8
N2 - 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.
AB - 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.
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U2 - 10.1016/j.semarthrit.2006.04.001
DO - 10.1016/j.semarthrit.2006.04.001
M3 - Article
C2 - 16887464
AN - SCOPUS:33746601823
SN - 0049-0172
VL - 36
SP - 10
EP - 21
JO - Seminars in Arthritis and Rheumatism
JF - Seminars in Arthritis and Rheumatism
IS - 1
ER -