Antiresorptive and anabolic agents in the prevention and reversal of bone fragility.,Nature Reviews Rheumatology

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Antiresorptive and anabolic agents in the prevention and reversal of bone fragility.
Nature Reviews Rheumatology ( IF 29.4 ) Pub Date : 2019-04-01 , DOI: 10.1038/s41584-019-0172-3
Ego Seeman _{1,

2} , T J Martin ₃

Affiliation

Bone volume, microstructure and its material composition are maintained by bone remodelling, a cellular activity carried out by bone multicellular units (BMUs). BMUs are focally transient teams of osteoclasts and osteoblasts that respectively resorb a volume of old bone and then deposit an equal volume of new bone at the same location. Around the time of menopause, bone remodelling becomes unbalanced and rapid, and an increased number of BMUs deposit less bone than they resorb, resulting in bone loss, a reduction in bone volume and microstructural deterioration. Cortices become porous and thin, and trabeculae become thin, perforated and disconnected, causing bone fragility. Antiresorptive agents reduce fracture risk by reducing the rate of bone remodelling so that fewer BMUs are available to remodel bone. Bone fragility is not abolished by these drugs because existing microstructural deterioration is not reversed, unsuppressed remodelling continues producing microstructural deterioration and unremodelled bone that becomes more mineralized can become brittle. Anabolic agents reduce fracture risk by stimulating new bone formation, which partly restores bone volume and microstructure. To guide fracture prevention, this Review provides an overview of the structural basis of bone fragility, the mechanisms of remodelling and how anabolic and antiresorptive agents target remodelling defects.

中文翻译：

抗吸收和合成代谢药物可预防和逆转骨骼脆弱性。

骨骼重塑，骨骼多细胞单位（BMU）进行的细胞活动可保持骨骼的体积，微观结构及其材料组成。BMU是破骨细胞和成骨细胞的局部瞬时团队，它们分别吸收一定量的旧骨，然后在相同位置沉积等量的新骨。在更年期前后，骨重塑变得不平衡和迅速，并且数量增加的BMU沉积的骨量少于其吸收的骨量，从而导致骨质流失，骨量减少和微结构恶化。皮质变得多孔而稀薄，小梁变得稀薄，穿孔且不连贯，从而导致骨骼脆弱。抗吸收剂可通过降低骨重塑率来降低骨折风险，从而减少可用于骨重塑的BMU。这些药物不会消除骨头的脆性，因为现有的微结构恶化不会逆转，未抑制的重塑会继续导致微结构恶化，而变得更矿化的未重塑骨会变脆。合成代谢药物可通过刺激新的骨骼形成来降低骨折风险，从而部分恢复骨骼的体积和微观结构。为了指导骨折预防，本综述概述了骨脆性的结构基础，重塑机制以及合成代谢和抗吸收剂如何针对重塑缺陷。合成代谢药物可通过刺激新的骨骼形成来降低骨折风险，从而部分恢复骨骼的体积和微观结构。为了指导骨折预防，本综述概述了骨脆性的结构基础，重塑机制以及合成代谢和抗吸收剂如何针对重塑缺陷。合成代谢药物可通过刺激新的骨骼形成来降低骨折风险，从而部分恢复骨骼的体积和微观结构。为了指导骨折预防，本综述概述了骨脆性的结构基础，重塑机制以及合成代谢和抗吸收剂如何针对重塑缺陷。

更新日期：2019-02-13

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