Osteoporotic drug

Although anti-osteoporotic drugs have a good safety profile, some patients can suffer cumbersome adverse effects, such as osteonecrosis of the jaw (ONJ). The pathogenesis of ONJ is unclear, but ischemia and genetic predisposition have been suggested to play a role in the development of this condition. Some SNPs of genes... 

Norzoanthamine has also been isolated from zoanthid Zoanthus sp. which suppresses the decrease in bone weight and strength in ovariecto-mized mice, indicating that it could be a good candidate as an osteoporotic drug (Kuramoto et ah, 1998). 

Kuramoto M, Hayashi K, Fujitani Y, Yamaguchi K, Tsuji T, Yamada K, Ijyuin Y, Ue-mura D (1997) Absolute configuration of norzoanthamine, a promising candidate for an osteoporotic drug. Tetrahedron Lett 38 5683... 

Purple acid phosphatases (PAP) [11-19] Fe(III)-Fe(II), Fe(III)-Mn(II), Fe(III)-Zn(II) Bone metabolism (animals) and phosphate uptake (plants) Target for anti-osteoporotic drugs... 

Treatment decisions regarding initiation of therapy for osteoporosis can be complex. Patients meeting criteria for osteoporosis (T-score below -2.5) or other high-risk patients with a history of osteoporotic fracture gain significant benefit from treatment. Drug therapy should be initiated in these patients. 

Since both raloxifene and the non-hormonal drug alendronate reduce the incidence of osteoporotic fractures in postmenopausal women it is relevant to determine which approach is better tolerated and thus most likely to promote long-term adherence to therapy. Adverse effects and compliance have been studied in a direct randomized comparison over 12 months in 902 women attending 154 treatment centres in Spain (21). They took either raloxifene 60 mg/day or alendronate 10 mg/day. Those who took raloxifene reported significantly better compliance than those who took alendronate more patients discontinued alendronate prematurely than raloxifene (26% versus 16%. The main reason for premature discontinuation was adverse reactions, particularly gastrointestinal reactions (9.9% with alendronate, 3.4% with raloxifene). 

In postmenopausal women with osteoporosis, teriparatide increases bone mineral density and reduces the risk of vertebral and nonvertebral fractures. The precise role of this agent relative to other agents used for osteoporosis, alone or in combination, remains to be determined. Candidates for teriparatide therapy at this time are women with a history of an osteoporotic fracture who have multiple risk factors for fracture and who are intolerant or have failed other therapies. The drug is also approved to increase bone mass in men with idiopathic or hypogonadal osteoporosis who are at high risk for fracture. 

Ensrud KE, Walczak TS, Blackwell TL, Ensrud ER, Barrett-Connor E, Orwoll ES. Osteoporotic Fractures in Men (MrOS) Study Research Group. Antiepileptic drug use and rates of hip bone loss in older men a prospective study. Neurology 2008 71(10) 723-30. 

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