Markers for bone remodeling What markers are available to assess bone remodeling and how are they used? Bone formation Bone resorption Serum alkaline phosphatase Urine or serum N-telopeptides (NTX) Serum Osteocalcin Serum C-telopeptides (CTX) Serum P1NP Elevation of biomarkers predicts future bone loss. A 30% reduction of biomarkers after therapy is initiated verifies compliance and …
How to interpret BMD changes in patients on osteoporosis medications BMD change Interpretation Recommended action Increase > LSC Good response Continue therapy No change or < LSC Adequate response Continue therapy Decrease > LSC Treatment failure Evaluate; consider therapy change
How should BMD testing be used to monitor the response to osteoporosis therapy? BMD testing to monitor osteoporosis therapy responses is most often repeated after 2 years of treatment. To accurately interpret serial changes, the LSC for the specific instrument must be known. The LSC is a precision estimate that informs the user about the …
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Should patients on osteoporosis medications be given a drug holiday? If so, how long should the drug holiday last? Bisphosphonates are the only osteoporosis medication class for which a drug holiday should currently be considered. Osteoporosis medication drug holidays are not recommended with denosumab, teriparatide, or abaloparatide for reasons stated earlier; if and when these …
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optimum duration of treatment with osteoporosis medications? Oral bisphosphonates 5 years (low/moderate-risk patients) 6 to 10 years (high-risk patients aa High-risk patients: old age, prior fracture, very low BMD (T-score <–3), high fall risk, GC use.) Zoledronic acid 3 years (low/moderate-risk patients) 6 years (high-risk patients a ) Denosumab: stopping not recommended without substituting another agent Teriparatide/Abaloparatide: 24 months …
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Should osteoporosis medications be used in combination? No, not yet. Combining antiresorptive medications should be avoided because of concern about excessively suppressing bone remodeling. Combining anabolic and antiresorptive medications is an appealing notion with emerging clinical trial data. The combination of teriparatide and alendronate had no synergy and resulted in inferior bone mass increases compared …
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Are medications to treat osteoporosis prevent fractures? The FDA-approved medications have all been demonstrated in randomized controlled trials to significantly reduce vertebral fractures in women with postmenopausal osteoporosis. Hip fractures have also been reduced by alendronate, risedronate, zoledronic acid, and denosumab. Nonvertebral fracture reduction has been reported with alendronate, risedronate, zoledronic acid, denosumab, teriparatide, and …
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