Ca&Bone

[Antiresorption - same goal, different ways]

HORVÁTH CSABA1

APRIL 15, 2009

Ca&Bone - 2009;12(01)

[Antiresorption - same goal, different ways]

AFFILIATIONS

  1. Semmelweis Egyetem, I. sz. Belgyógyászati Klinika, Budapest

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[RANKL-specific denosumab in the treatment of osteoporosis - Possible adverse effects of long-term use]

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[According to the results of a recent clinical trial, the antiresorptive effect of a single 60-mg injection of denosumab, a monoclonal antibody specific to RANKL (receptor activator of NFκB ligand) substantially exceeds the effect of alendronate (70 mg weekly). Despite these differences, 1-year increases in bone density at the lumbar spine are virtually identical for both agents. The author summarizes experimental and clinical observations illustrating potential consequences of osteoclast deficiency and a constantly low rate of bone resorption for osteoblast function, bone mineralization, bone quality parameters, and mechanical properties, which all may have important implications for bone fragility. These observations also raise the question whether treatment efficiency is truly improved by aggressively pushing the limits of antiresorptive action.]

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[Denosumab - pharmacokinetic and clinical evidences]

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[Denosumab is a fully human monoclonal antibody to RANKL modifying bone resorption in a rapid, sustained and reversible way. In postmenopausal women with low bone mineral density, denosumab 60 mg every 6 months increased mineral density, and reduced bone turnover. In postmenopausal women, it reduced the risk of vertebral, hip, and non-vertebral fractures. Increase in body mass index and reduction in bone turnover was more pronounced with denosumab than with alendronate. In patients who were switched from alendronate to denosumab, positive effects on bone were more pronounced than in those continuing alendronate. Denosumab was safe and well tolerated, and it holds the promise of becoming an efficacious therapy for postmenopausal osteoporosis.]

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[Management of hip fractures: practice, results, and problems in the last decade]

KRICSFALUSY Mihály, FLÓRIS István, CSERHÁTI Péter

[Among fractures attributable to osteoporosis, hip fractures are associated with the most severe consequences and the greatest costs. Surgical therapy for this condition is continuing to improve. Increasingly recent implants and techniques are being developed and introduced to successfully control postoperative adverse events. The authors briefly outline actual practice in Hungary and present some results of the follow-up of their patients in the last decade. These show that, in order to improve outcomes of hip fracture patients, all domains of management need to be addressed.]

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