Anabolic agents: a new chapter in the management of osteoporosis.
Osteoporosis in postmenopausal women has until now been treated with antiresorptive agents, reducing the incidence of fragility fracture by approximately 50%. Clinical research has led to the development of new anabolic therapies capable of increasing the production of bone matrix by osteoblasts and reversing microarchitectural deterioration, resulting in major improvements in both bone quality and bone quantity. Teriparatide, a recombinant human parathyroid hormone consisting of the first 34 of 84 amino acids in human parathyroid hormone, has been shown to reduce significantly the risk of both vertebral and non-vertebral fractures in postmenopausal women. This agent was recently approved for use in Canada. Strontium ranelate is a new oral agent capable of uncoupling bone resorption from bone formation, which results in increases in bone formation with reductions in bone resorption. This agent has also been shown to reduce the risk of both vertebral and non-vertebral fracture while improving bone structure. Anabolic therapies represent a major advance in the management of postmenopausal osteoporosis, and they may provide significant benefit to those patients with severe osteoporosis in whom antiresorptive therapy has proven insufficient. Anabolic therapies should complement the antiresorptive treatments currently available for use in women with postmenopausal osteoporosis.