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Hello, my
name is Felicia Cosman.
I'm an endocrinologist and medical
director of the Clinical Research
Center at Helen Hayes Hospital, and
professor of medicine at Columbia
University College of
Physicians and Surgeons.
Today, I'll be talking about
the role of combination
anabolic and antiresorptive
therapy for the treatment
of severe osteoporosis
Here are my disclosures.
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The majority of pharmacologic
agents for osteoporosis
are antiresorptive medications,
which act primarily by inhibiting
osteoclast number, lifespan,
and/or activity, and thereby
reducing the rate
of bone resorption.
Antiresorptive medications
include all of these listed here.
But the most commonly used for the
treatment of osteoporosis, at least
in adults above age 65, are
the bisphosphonates, including
oral alendronate,
risedronate, and ibandronate,
the intravenous bisphosphonate
zoledronic acid,
and the RANK ligand
inhibitor denosumab.
There is only one class of anabolic
therapy with two agents that are
both parathyroid hormone analogues,
the intact PTH 1-84 molecule
and the amino terminal
PTH peptide teriparatide.
With anabolic agents,
the mechanism of action
is a direct stimulation of
osteoblast number, activation,
and/or function leading to a
rapid increase in bone formation
and a subsequent stimulation
of osteoclast activity
and overall bone remodeling with
a persistent net increment in bone
formation.
