The phase 3 “STRUCTURE” trial with romosozumab reported a 2.6% improvement in hip bone mass density over 12 months, compared with a 0.6% loss with Forteo. The enhanced bone formation is clinically meaningful, says Taher Mahmud, consultant rheumatologist at the Maidstone and Tunbridge Wells NHS Trust, UK. The estimated hip strength also improved with romosozumab over 12 months, whereas it decreased with Forteo. Although positive, “these results do need to be viewed carefully,” notes Richard Eastell, professor of bone metabolism, head of the academic unit of bone metabolism, director of the Mellanby Centre for bone research, at Northern General Hospital, University of Sheffield in UK, [who attended the meeting in Boston. “We don't know what the relationship is between changes in bone strength in response to anabolic therapy and the risk of hip fracture,” Eastell points out.
Osteoporosis and its associated fracture risk is one of the major health burdens in our aging population. In healthy people, the skeleton is constantly being remodelled, balancing bone building by osteoblasts and bone resorption by osteoclasts. In postmenopausal women bone loss accelerates due to the absence of estrogen. Excessive bone resorption leads to low bone mineral density and the deterioration of bone microarchitecture, resulting in bone loss and an increase in fracture risks. Boosting new bone formation is essential in treating osteoporotic fractures, and sclerostin, an inhibitor of osteoblast activity made by osteoclasts, is an attractive therapeutic target.
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