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Anti-sclerostin antibodies: a new frontier in fragility fractures treatment

Bone fragility is the determinant of the increased risk of minimal trauma fracture and must be treated with a multimodal approach that includes pharmacological therapy, physical exercise, and adequate nutrition. Pharmacological therapy, to date based on the administration of antiresorptive drugs, su...

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Autores principales: Iolascon, Giovanni, Liguori, Sara, Paoletta, Marco, Toro, Giuseppe, Moretti, Antimo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492476/
https://www.ncbi.nlm.nih.gov/pubmed/37694185
http://dx.doi.org/10.1177/1759720X231197094
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author Iolascon, Giovanni
Liguori, Sara
Paoletta, Marco
Toro, Giuseppe
Moretti, Antimo
author_facet Iolascon, Giovanni
Liguori, Sara
Paoletta, Marco
Toro, Giuseppe
Moretti, Antimo
author_sort Iolascon, Giovanni
collection PubMed
description Bone fragility is the determinant of the increased risk of minimal trauma fracture and must be treated with a multimodal approach that includes pharmacological therapy, physical exercise, and adequate nutrition. Pharmacological therapy, to date based on the administration of antiresorptive drugs, such as bisphosphonates and denosumab, or osteoanabolic drugs, such as teriparatide and abaloparatide, has shown to be effective in reducing the risk of fracture in osteoporotic patients. In the context of the cellular and molecular mechanisms that regulate bone metabolism, the discovery of the Wnt signaling pathway and its role in bone tissue homeostasis has allowed the identification of sclerostin as an inhibitor of osteoblastic activity and simultaneously as a stimulator of osteoclastic activity. Therefore, the use of a monoclonal antibody, romosozumab, against this protein has been tested as a potential drug with a dual action, stimulating bone neo-apposition and inhibiting bone resorption. The efficacy of romosozumab has been demonstrated in numerous clinical trials against both placebo and other drugs commonly used in the treatment of patients affected by osteoporosis. The advantages of this drug lie above all in its rapid action which makes it particularly suitable in clinical situations where it is necessary to improve bone strength very quickly due to the imminent risk of fragility fracture. Clinical studies and guidelines suggest romosozumab as an initial drug in an ideal sequential approach from osteoanabolic to antiresorptive drugs. Some aspects of cardiovascular safety remain to be fully investigated, therefore its use in osteoporotic patients at high cardiovascular risk should be avoided until further data become available.
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spelling pubmed-104924762023-09-10 Anti-sclerostin antibodies: a new frontier in fragility fractures treatment Iolascon, Giovanni Liguori, Sara Paoletta, Marco Toro, Giuseppe Moretti, Antimo Ther Adv Musculoskelet Dis Review Bone fragility is the determinant of the increased risk of minimal trauma fracture and must be treated with a multimodal approach that includes pharmacological therapy, physical exercise, and adequate nutrition. Pharmacological therapy, to date based on the administration of antiresorptive drugs, such as bisphosphonates and denosumab, or osteoanabolic drugs, such as teriparatide and abaloparatide, has shown to be effective in reducing the risk of fracture in osteoporotic patients. In the context of the cellular and molecular mechanisms that regulate bone metabolism, the discovery of the Wnt signaling pathway and its role in bone tissue homeostasis has allowed the identification of sclerostin as an inhibitor of osteoblastic activity and simultaneously as a stimulator of osteoclastic activity. Therefore, the use of a monoclonal antibody, romosozumab, against this protein has been tested as a potential drug with a dual action, stimulating bone neo-apposition and inhibiting bone resorption. The efficacy of romosozumab has been demonstrated in numerous clinical trials against both placebo and other drugs commonly used in the treatment of patients affected by osteoporosis. The advantages of this drug lie above all in its rapid action which makes it particularly suitable in clinical situations where it is necessary to improve bone strength very quickly due to the imminent risk of fragility fracture. Clinical studies and guidelines suggest romosozumab as an initial drug in an ideal sequential approach from osteoanabolic to antiresorptive drugs. Some aspects of cardiovascular safety remain to be fully investigated, therefore its use in osteoporotic patients at high cardiovascular risk should be avoided until further data become available. SAGE Publications 2023-09-08 /pmc/articles/PMC10492476/ /pubmed/37694185 http://dx.doi.org/10.1177/1759720X231197094 Text en © The Author(s), 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Review
Iolascon, Giovanni
Liguori, Sara
Paoletta, Marco
Toro, Giuseppe
Moretti, Antimo
Anti-sclerostin antibodies: a new frontier in fragility fractures treatment
title Anti-sclerostin antibodies: a new frontier in fragility fractures treatment
title_full Anti-sclerostin antibodies: a new frontier in fragility fractures treatment
title_fullStr Anti-sclerostin antibodies: a new frontier in fragility fractures treatment
title_full_unstemmed Anti-sclerostin antibodies: a new frontier in fragility fractures treatment
title_short Anti-sclerostin antibodies: a new frontier in fragility fractures treatment
title_sort anti-sclerostin antibodies: a new frontier in fragility fractures treatment
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10492476/
https://www.ncbi.nlm.nih.gov/pubmed/37694185
http://dx.doi.org/10.1177/1759720X231197094
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