Antifracture Efficacy of Antiresorptive Agents Are Related to Changes in Bone Density

Richard D. Wasnich, Paul D. Miller
2000 Journal of Clinical Endocrinology and Metabolism  
There is a current debate about the extent to which antifracture efficacy of antiresorptive drugs are related to changes in bone mineral density (BMD). In vitro studies show that most of the variability in bone strength is related to BMD, and prospective studies have shown that low BMD is an important predictor of fracture risk. It seems that higher levels of bone turnover are also associated with increased fracture risk. Over the short term, a reduction in activation frequency or resorption
more » ... cy or resorption depth would lead to fewer (and/or shallower) resorption sites and refilling of existing sites initially. There is also evidence that inhibiting resorption allows bone to respond to mechanical demands, preferentially thickening critical trabeculae, and this may help compensate for reduced connectivity. Each of these mechanisms would increase BMD and would disproportionately improve bone strength. Over the long term, maintaining bone mass and preventing loss of structural elements would result in progressively greater differences in BMD and fracture risk over time, relative to untreated women. The conceptual model predicts that both the short-and long-term anti-
doi:10.1210/jcem.85.1.6267 pmid:10634392 fatcat:63hvvyfhc5bf7i6twrf65ipe6m