Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2011 Aug;469(8):2215-24.
doi: 10.1007/s11999-010-1722-9.

Anabolic agents and bone quality

Tarek Sibai  1 , Elise F Morgan, Thomas A Einhorn
Affiliations
Review

Anabolic agents and bone quality

Tarek Sibai et al. Clin Orthop Relat Res. 2011 Aug.

Abstract

Background: The definition of bone quality is evolving particularly from the perspective of anabolic agents that can enhance not only bone mineral density but also bone microarchitecture, composition, morphology, amount of microdamage, and remodeling dynamics.

Questions/purposes: This review summarizes the molecular pathways and physiologic effects of current and potential anabolic drugs.

Methods: From a MEDLINE search (1996-2010), articles were identified by the search terms "bone quality" (1851 articles), "anabolic agent" (5044 articles), "PTH or parathyroid hormone" (32,229 articles), "strontium" or "strontium ranelate" (283 articles), "prostaglandin" (77,539 articles), and "statin" or "statins" (14,233 articles). The search strategy included combining each with the phrase "bone quality." Another more limited search aimed at finding more novel potential agents.

Results: Parathyroid hormone is the only US Food and Drug Administration-approved bone anabolic agent in the United States and has been the most extensively studied in in vitro animal and human trials. Strontium ranelate is approved in Europe but has not undergone Food and Drug Administration trials in the United States. All the studies on prostaglandin agonists have used in vivo animal models and there are no human trials examining prostaglandin agonist effects. The advantages of statins include the long-established advantages and safety profile, but they are limited by their bioavailability in bone. Other potential pathways include proline-rich tyrosine kinase 2 (PYK2) and sclerostin (SOST) inhibition, among others.

Conclusions: The ongoing research to enhance the anabolic potential of current agents, identify new agents, and develop better delivery systems will greatly enhance the management of bone quality-related injuries and diseases in the future.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Different drugs and conditions can affect multiple components of bone remodeling. BR = bone resorption; BF = bone formation PMO = postmenopausal osteoporosis. Reprinted with permission of John Wiley & Sons, Inc, and copyright (2005, American Society for Bone and Mineral Research) from Riggs BL, Parfitt AM. Drugs used to treat osteoporosis: the critical need for a uniform nomenclature based on their action on bone remodeling. J Bone Miner Res. 2005;20:177–184.
Fig. 2
Fig. 2
Treatment with anabolic drugs can increase bone strength and decrease fracture incidence. Reprinted with permission of John Wiley & Sons, Inc, and copyright (2005, American Society for Bone and Mineral Research) from Riggs BL, Parfitt AM. Drugs used to treat osteoporosis: the critical need for a uniform nomenclature based on their action on bone remodeling. J Bone Miner Res. 2005;20:177–184.
See this image and copyright information in PMC

References

    1. Akhter MP, Cullen DM, Gong G, Recker RR. Bone biomechanical properties in prostaglandin EP1 and EP2 knockout mice. Bone. 2001;29:121–125. doi: 10.1016/S8756-3282(01)00486-0. - DOI - PubMed
    1. Alkhiary YM, Gerstenfeld LC, Krall E, Sato M, Westmore M, Mitlak B, Einhorn TA. Parathyroid hormone (1–24; teriparatide) enhances experimental fracture healing. Trans Orthop Res Soc. 2004;29:328.
    1. Andreassen TT, Ejersted C, Oxlund H. Intermittent parathyroid hormone (1–34) treatment increases callus formation and mechanical strength of healing rat fractures. J Bone Miner Res. 1999;14:960–968. doi: 10.1359/jbmr.1999.14.6.960. - DOI - PubMed
    1. Arlot ME, Jiang Y, Genant HK, Zhao J, Burt-Pichat B, Roux JP, Delmas PD, Meunier PJ. Histomorphometric and μ-CT analysis of bone biopsies from postmenopausal osteoporotic women treated with strontium ranelate. J Bone Miner Res. 2008;23:215–222. doi: 10.1359/jbmr.071012. - DOI - PubMed
    1. Aspenberg P, Genant HK, Johansson T, Nino AJ, See K, Krohn K, García-Hernández PA, Recknor CP, Einhorn TA, Dalsky GP, Mitlak BH, Fierlinger A, Lakshmanan MC. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res. 2010;25:404–414. doi: 10.1359/jbmr.090731. - DOI - PubMed

MeSH terms