title: Bone anabolics in osteoporosis: Actuality and perspectives.
abstract: Vertebral and nonvertebral fractures prevention is the main goal for osteoporosis therapy by inhibiting bone resorption and/or stimulating bone formation. Antiresorptive drugs decrease the activation frequency, thereby determining a secondary decrease in bone formation rate and a low bone turnover. Bisphosphonates are today's mainstay among antiresorptive treatment of osteoporosis. Also, oral selective estrogen receptor modulators and recently denosumab have a negative effect on bone turnover. Agents active on bone formation are considered a better perspective in the treatment of severe osteoporosis. Recombinant-human parathyroid hormone (PTH) has showed to increase bone formation and significantly decrease vertebral fractures in severe patients, but with a modest effect on nonvertebral fractures. The study of Wnt signaling pathway, that induces prevalently an osteoblastic activity, opens large possibilities to antagonists of Wnt-inhibitors, such as sclerostin antibodies and dickkopf-1 antagonists, with potential effects not only on trabecular bone but also on cortical bone.
authors.affiliation: Andrea Montagnani, Metabolic Bone Diseases Area, Department of Internal Medicine, Misericordia Hospital, 58100 Grosseto, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Montagnani
keywords: Anabolic therapy; Bone fracture; Bone mass; Osteoporosis