title: Assessment of Bone Quality in Osteoporosis Treatment with Bone Anabolic Agents: Really Something New?
abstract: Osteoporosis is a chronic pathologic condition, particularly of the elderly, in which a reduction of bone mineral density (BMD) weakens bone, leading to the so-called fragility fractures, most often of spine and femur. The gold standard exam for the quantitative measurement of BMD is the dual X-ray photon absorptiometry (DXA), a radiological method. However, a relevant number of fragility fractures occurs in the range of normal BMD values, meaning that also qualitative aspects of bone play a role, namely bone architecture and bone geometry. Bone structure is investigated by microCT and histomorphometry, which necessitate an invasive approach with a biopsy, usually taken at the iliac crest, not the typical site of fragility fractures. New tools, trabecular bone score (TBS) and hip structural analysis (HSA), obtained during DXA, can supply informations about bone structure of spine and femur, respectively, in a not invasive way. Therapy of osteoporosis is based on two types of drugs leading to an increase of BMD: antiresorptive and anabolic treatments. The antiresorptive drugs inhibit the osteoclasts, whereas teriparatide and, in part, strontium ranelate ameliorate bone structure. The present review deals with the relation between the anabolic drugs for osteoporosis and the cited new tools which investigate bone architecture and geometry, in order to clarify if they represent a real advantage in monitoring efficacy of osteoporosis' treatment. Data from the studies show that increases of TBS and HSA values after anabolic therapy are small and very close to their least significant change at the end of the usual period of treatment. Therefore, it is questionable if TBS and HSA are really helpful in monitoring bone quality and in defining reduction of individual fragility fracture risk during osteoporosis treatment with bone anabolic agents.
authors.affiliation: Medicina Nucleare, Bone Metabolic Unit, Milano, Italy.
authors.forename: Fabio M
authors.initials: FM
authors.lastname: Ulivieri
authors.affiliation: Maria Cecilia Hospital GVM Care and Research Cotignola, Ravenna, Italy.
authors.forename: Renata
authors.initials: R
authors.lastname: Caudarella
authors.affiliation: Scuola di Specializzazione in Medicina Fisica e Riabilitativa, Milano, Italy.
authors.forename: Marzia
authors.initials: M
authors.lastname: Camisasca
authors.affiliation: Universita degli Studi di Milano - Scuola di Specializzazione in Radiodiagnostica, Milano, Italy.
authors.forename: Daniela M
authors.initials: DM
authors.lastname: Cabrini
authors.affiliation: Universita degli Studi di Milano - Scuola di Specializzazione in Radiodiagnostica, Milano, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Merli
authors.affiliation: Universita degli Studi di Milano - Scuola di Specializzazione in Radiodiagnostica, Milano, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Messina
authors.affiliation: Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - Gastroenterologia ed Endoscopia Digestiva, Milano, Italy.
authors.forename: Luca P
authors.initials: LP
authors.lastname: Piodi
mesh_terms: D045930:Anabolic Agents / Q000627:therapeutic use*; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*
chemical_list: D045930:Anabolic Agents; D050071:Bone Density Conservation Agents
keywords: DXA; HSA; TBS; anabolic Agents; anabolic therapy; antiresorptive drugs; osteoporosis.