title: Are we taking full advantage of the growing number of pharmacological treatment options for osteoporosis?
abstract: We are becoming increasingly aware that the manner in which our skeleton ages is not uniform within and between populations. Pharmacological treatment options with the potential to combat age-related reductions in skeletal strength continue to become available on the market, notwithstanding our current inability to fully utilize these treatments by accounting for an individual's unique biomechanical needs. Revealing new molecular mechanisms that improve the targeted delivery of pharmaceuticals is important; however, this only addresses one part of the solution for differential age-related bone loss. To improve current treatment regimes, we must also consider specific biomechanical mechanisms that define how these molecular pathways ultimately impact whole bone fracture resistance. By improving our understanding of the relationship between molecular and biomechanical mechanisms, clinicians will be better equipped to take full advantage of the mounting pharmacological treatments available. Ultimately this will enable us to reduce fracture risk among the elderly more strategically, more effectively, and more economically. In this interest, the following review summarizes the biomechanical basis of current treatment strategies while defining how different biomechanical mechanisms lead to reduced fracture resistance. It is hoped that this may serve as a template for the identification of new targets for pharmacological treatments that will enable clinicians to personalize care so that fracture incidence may be globally reduced.
authors.affiliation: Department of Orthopaedic Surgery, The University of Michigan, Biomedical Science Research Building, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA. Electronic address: kjepsen@umich.edu.
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Jepsen
authors.affiliation: Department of Orthopaedic Surgery, The University of Michigan, Biomedical Science Research Building, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Schlecht
authors.affiliation: Department of Orthopaedic Surgery, The University of Michigan, Biomedical Science Research Building, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kozloff
mesh_terms: D000375:Aging; D050723:Fractures, Bone / Q000517:prevention & control; D006801:Humans; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy*
references.citation: J Bone Miner Res. 2009 Dec;24(12):1969-80
references.pmid: 20001599
references.citation: J Osteoporos. 2012;2012:129760
references.pmid: 22496983
references.citation: Osteoporos Int. 2011 May;22(5):1277-88
references.pmid: 21461721
references.citation: Osteoporos Int. 2012 Apr;23(4):1311-6
references.pmid: 21656265
references.citation: Clin Orthop Relat Res. 2011 Aug;469(8):2128-38
references.pmid: 21116752
references.citation: Bone. 2013 Sep;56(1):127-38
references.pmid: 23721816
references.citation: J Biomech. 2010 Jun 18;43(9):1780-6
references.pmid: 20227696
references.citation: Osteoporos Int. 1997;7(4):390-406
references.pmid: 9373575
references.citation: Bone. 2014 Apr;61:191-200
references.pmid: 24468719
references.citation: J Bone Miner Res. 2011 Dec;26(12):2872-85
references.pmid: 21898595
references.citation: J Bone Miner Res. 2008 Feb;23(2):236-46
references.pmid: 17922614
references.citation: Lancet. 2010 May 15;375(9727):1729-36
references.pmid: 20472174
references.citation: J Bone Miner Res. 2011 May;26(5):974-83
references.pmid: 21542000
references.citation: Ann Biomed Eng. 2012 Jul;40(7):1575-85
references.pmid: 22258889
references.citation: Bone. 1997 Aug;21(2):191-9
references.pmid: 9267695
references.citation: Calcif Tissue Int. 2004 Aug;75(2):100-9
references.pmid: 15383923
references.citation: Osteoporos Int. 2007 Feb;18(2):123-8
references.pmid: 17180552
references.citation: J Bone Miner Metab. 2011 Jul;29(4):449-57
references.pmid: 21127922
references.citation: JAMA. 2012 Jun 27;307(24):2591-2
references.pmid: 22735425
references.citation: J Bone Miner Res. 2008 Dec;23(12):1974-82
references.pmid: 18684084
references.citation: N Engl J Med. 2003 Jul 24;349(4):320-3
references.pmid: 12878736
references.citation: Osteoporos Int. 1999;10(6):505-9
references.pmid: 10663352
references.citation: Skeletal Radiol. 2013 Feb;42(2):195-201
references.pmid: 22714125
references.citation: Osteoporos Int. 2013 Apr;24(4):1379-88
references.pmid: 22810918
references.citation: Osteoporos Int. 2013 Jan;24(1):77-85
references.pmid: 23070481
references.citation: Appl Spectrosc. 2012 Jun;66(6):728-30
references.pmid: 22732546
references.citation: Bone. 2001 Aug;29(2):101-4
references.pmid: 11502469
references.citation: J Bone Miner Res. 2012 Sep;27(9):1916-26
references.pmid: 22532507
references.citation: Med Sci Sports Exerc. 1999 Aug;31(8):1088-93
references.pmid: 10449008
references.citation: Rev Sci Instrum. 2012 Apr;83(4):044301
references.pmid: 22559552
references.citation: Calcif Tissue Int. 2012 Jan;90(1):1-13
references.pmid: 22057815
references.citation: BMJ. 1996 May 18;312(7041):1254-9
references.pmid: 8634613
references.citation: J Bone Miner Res. 2012 Jul;27(7):1501-10
references.pmid: 22461103
references.citation: Osteoporos Int. 2011 Feb;22(2):391-420
references.pmid: 21184054
references.citation: Osteoporos Int. 2004 Nov;15(11):847-54
references.pmid: 15322740
references.citation: Clin Biochem. 2009 Jul;42(10-11):929-42
references.pmid: 19362543
references.citation: J Biomech. 1989;22(11-12):1243-8
references.pmid: 2625424
references.citation: J Bone Miner Metab. 2013 Jan;31(1):1-15
references.pmid: 23143508
references.citation: Bone. 2013 Mar;53(1):188-93
references.pmid: 23220597
references.citation: Science. 1964 Jul 10;145(3628):156-7
references.pmid: 14171549
references.citation: J Dent Res. 2010 Dec;89(12):1333-48
references.pmid: 20924069
references.citation: Bone. 2009 May;44(5):734-43
references.pmid: 19195497
references.citation: Lancet. 2002 Jun 1;359(9321):1929-36
references.pmid: 12057569
references.citation: J Bone Miner Res. 2000 Jan;15(1):32-40
references.pmid: 10646112
references.citation: Analyst. 2012 Jan 7;137(1):77-81
references.pmid: 22059232
references.citation: Bone. 2003 Oct;33(4):744-50
references.pmid: 14555280
references.citation: Bone. 2013 Jul;55(1):36-43
references.pmid: 23531785
references.citation: J Biomech. 1998 Feb;31(2):125-33
references.pmid: 9593205
references.citation: Lancet. 1993 Jan 9;341(8837):72-5
references.pmid: 8093403
references.citation: J Clin Endocrinol Metab. 2012 Dec;97(12):4329-40
references.pmid: 23055542
references.citation: J Bone Joint Surg Am. 1970 Apr;52(3):457-67
references.pmid: 5425640
references.citation: J Bone Miner Res. 1993 Oct;8(10):1227-33
references.pmid: 8256660
references.citation: Clin Biochem. 2012 Aug;45(12):887-93
references.pmid: 22579965
references.citation: Curr Osteoporos Rep. 2007 Jun;5(2):62-6
references.pmid: 17521507
references.citation: Bone. 2004 Nov;35(5):1003-12
references.pmid: 15542024
references.citation: Eur Heart J. 2014 Feb;35(5):307-12
references.pmid: 24385374
references.citation: N Engl J Med. 1998 Mar 12;338(11):736-46
references.pmid: 9494151
references.citation: J Bone Miner Res. 2013 Jun;28(6):1290-300
references.pmid: 23362125
references.citation: J Bone Miner Res. 2014 Apr;29(4):787-95
references.pmid: 24123088
references.citation: Bone. 2012 Jan;50(1):165-70
references.pmid: 22015818
references.citation: Calcif Tissue Int. 1984;36 Suppl 1:S123-8
references.pmid: 6430512
references.citation: J Bone Miner Res. 2010 May;25(5):994-1001
references.pmid: 19874201
references.citation: J Bone Miner Res. 2006 Dec;21(12):1856-63
references.pmid: 17002580
references.citation: Lancet. 2011 Apr 9;377(9773):1276-87
references.pmid: 21450337
references.citation: Bone. 2011 Oct;49(4):799-809
references.pmid: 21810492
references.citation: Osteoporos Int. 2000;11 Suppl 6:S2-17
references.pmid: 11193237
references.citation: Anat Rec. 2001 Dec 1;264(4):378-86
references.pmid: 11745093
references.citation: Bone. 2012 Jun;50(6):1416-25
references.pmid: 22430313
references.citation: Bone. 2011 Jun 1;48(6):1221-31
references.pmid: 21320651