Serum sclerostin levels in Paget's disease and prostate cancer with bone metastases with a wide range of bone turnover

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From disease to treatment: from rare skeletal disorders to treatments for osteoporosis

Bone and mineral researc

Osteoporosis: An overview

This chapter focuses on the clinical aspects and management of osteoporosis in postmenopausal women, men, young women, and various forms of secondary osteoporosis. Dual energy X‐ray absorptiometry is an important tool for clinical research, including clinical trials of bisphosphonates and other drugs. There is strong consensus, based on solid clinical trial evidence, that postmenopausal women, and probably older men, who have experienced fragility fractures of the spine and hip are definite candidates for pharmacological therapy, irrespective of other risk factors. Patients with nonhip, nonspine fractures are also at higher risk for fracture and deserve, at least, to be evaluated for other risk factors and as potential candidates for therapy. Finite element analysis of routine CT scans of the hip and spine provides accurate in vivo measurement of skeletal strength. The anticipated availability of abaloparatide and romosozumab will be the first new treatments for osteoporosis

Bisphosphonates in osteoporosis—beyond 5 years

Bone and mineral researc

Similarities and Differences in the Management of Patients with Osteoporotic Vertebral Fractures and Those with Rebound-Associated Vertebral Fractures Following Discontinuation of Denosumab

Rebound-associated vertebral fractures (RVFx) following denosumab discontinuation are typically multiple, are commonly associated with acute sharp pain, increase the risk of imminent fractures, and are pathogenetically different from common osteoporotic vertebral fractures (VFx). A clinically relevant question is whether patients with RVFx should be managed differently from patients with osteoporotic VFx. To address this question, we performed a systematic search of the PubMed database, and we reviewed current evidence on the optimal management of patients with RVFx. For pain relief of patients with RVFx, potent analgesics, often opioids, are essential. Information on the effectiveness of braces in these patients is scarce. Vertebroplasty and kyphoplasty are strongly contraindicated as they confer a substantial risk for new VFx. Exercise may be helpful, but again evidence is lacking. In contrast to patients with osteoporotic VFx, in whom initial treatment with bone-forming agents is recommended, patients with RVFx should initiate treatment with potent antiresorptives. To summarize, patients who have sustained RVFx following denosumab discontinuation are at a very high risk for new fractures, especially VFx. The management of such patients requires a multidisciplinary approach that should not be restricted to pain relief and administration of antiosteoporotic medication, but should also include back protection, early mobilization, and appropriate exercise

Increased Bone Resorption during Lactation in Pycnodysostosis

Pycnodysostosis, a rare autosomal recessive skeletal dysplasia, is caused by a deficiency of cathepsin K. Patients have impaired bone resorption in the presence of normal or increased numbers of multinucleated, but dysfunctional, osteoclasts. Cathepsin K degrades collagen type I and generates N-telopeptide (NTX) and the C-telopeptide (CTX) that can be quantified. Levels of these telopeptides are increased in lactating women and are associated with increased bone resorption. Nothing is known about the consequences of cathepsin K deficiency in lactating women. Here we present for the first time normalized blood and CTX measurements in a patient with pycnodysostosis, exclusively related to the lactation period. In vitro studies using osteoclasts derived from blood monocytes during lactation and after weaning further show consistent bone resorption before and after lactation. Increased expression of cathepsins L and S in osteoclasts derived from the lactating patient suggests that other proteinases could compensate for the lack of cathepsin K during the lactation period of pycnodysostosis patients