J Menopausal Med.  2015 Apr;21(1):1-11. 10.6118/jmm.2015.21.1.1.

New Antiresorptive Therapies for Postmenopausal Osteoporosis

Affiliations
  • 1Department of Family Medicine, Eulji University School of Medicine, Daejeon, Korea. ohinia@daum.net

Abstract

Osteoporosis is a systemic skeletal disease whose risk increases with age and it is common among postmenopausal women. Currently, almost all pharmacological agents for osteoporosis target the bone resorption component of bone remodeling activity. Current antiresorptive agents are effective, but the effectiveness of some agents is limited by real or perceived intolerance, longterm adverse events (AEs), coexisting comorbidities, and inadequate long-term adherence. New antiresorptive therapies that may expand options for the prevention and treatment of osteoporosis include denosumab, combination of conjugated estrogen/bazedoxifene and cathepsin K inhibitors. However, the long-term efficacy and AEs of these antiresorptive therapies need to be confirmed in studies with a longer follow-up period.

Keyword

Bone density conservation agents; Fractures bone; Osteoporosis; Postmenopause

MeSH Terms

Bone Density Conservation Agents
Bone Remodeling
Bone Resorption
Cathepsin K
Comorbidity
Female
Humans
Osteoporosis
Osteoporosis, Postmenopausal*
Postmenopause
Denosumab
Bone Density Conservation Agents
Cathepsin K

Reference

1. Food and Drug Administration. FDA approves new injectable osteoporosis treatment for postmenopausal women. Silver Spring, MD: Food and Drug Administration. 2010. cited by 2015 Mar 19. Available from: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm214150.htm.
2. European Medicines Agency. Prolia (denosumab). London, UK: Euopean Medicines Agency;2015. cited by 2015 Mar 19. Available from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/001120/human_med_001324.jsp&mid=WC0b01ac058001d124.
3. Amgen Inc. Prolia® (denosumab). Thousand Oaks, CA: Amgen Inc.;2010. cited by 2015 Feb 16. Available from: http://pi.amgen.com/united_states/prolia/prolia_pi.pdf.
4. Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009; 361:756–765.
5. Kong YY, Yoshida H, Sarosi I, Tan HL, Timms E, Capparelli C, et al. OPGL is a key regulator of osteoclastogenesis, lymphocyte development and lymph-node organogenesis. Nature. 1999; 397:315–323.
6. Bekker PJ, Holloway DL, Rasmussen AS, Murphy R, Martin SW, Leese PT, et al. A single-dose placebo-controlled study of AMG 162, a fully human monoclonal antibody to RANKL, in postmenopausal women. J Bone Miner Res. 2004; 19:1059–1066.
7. Lobo ED, Hansen RJ, Balthasar JP. Antibody pharmacokinetics and pharmacodynamics. J Pharm Sci. 2004; 93:2645–2668.
8. Boonen S, Adachi JD, Man Z, Cummings SR, Lippuner K, Torring O, et al. Treatment with denosumab reduces the incidence of new vertebral and hip fractures in postmenopausal women at high risk. J Clin Endocrinol Metab. 2011; 96:1727–1736.
9. Papapoulos S, Chapurlat R, Libanati C, Brandi ML, Brown JP, Czerwinski E, et al. Five years of denosumab exposure in women with postmenopausal osteoporosis: results from the first two years of the FREEDOM extension. J Bone Miner Res. 2012; 27:694–701.
10. McClung MR, Boonen S, Törring O, Roux C, Rizzoli R, Bone HG, et al. Effect of denosumab treatment on the risk of fractures in subgroups of women with postmenopausal osteoporosis. J Bone Miner Res. 2012; 27:211–218.
11. Brown JP, Prince RL, Deal C, Recker RR, Kiel DP, de Gregorio LH, et al. Comparison of the effect of denosumab and alendronate on BMD and biochemical markers of bone turnover in postmenopausal women with low bone mass: a randomized, blinded, phase 3 trial. J Bone Miner Res. 2009; 24:153–161.
12. Kendler DL, Roux C, Benhamou CL, Brown JP, Lillestol M, Siddhanti S, et al. Effects of denosumab on bone mineral density and bone turnover in postmenopausal women transitioning from alendronate therapy. J Bone Miner Res. 2010; 25:72–81.
13. Block GA, Bone HG, Fang L, Lee E, Padhi D. A single-dose study of denosumab in patients with various degrees of renal impairment. J Bone Miner Res. 2012; 27:1471–1479.
14. Bone HG, Bolognese MA, Yuen CK, Kendler DL, Miller PD, Yang YC, et al. Effects of denosumab treatment and discontinuation on bone mineral density and bone turnover markers in postmenopausal women with low bone mass. J Clin Endocrinol Metab. 2011; 96:972–980.
15. Brown JP, Dempster DW, Ding B, Dent-Acosta R, San Martin J, Grauer A, et al. Bone remodeling in postmenopausal women who discontinued denosumab treatment: off-treatment biopsy study. J Bone Miner Res. 2011; 26:2737–2744.
16. Kendler DL, McClung MR, Freemantle N, Lillestol M, Moffett AH, Borenstein J, et al. Adherence, preference, and satisfaction of postmenopausal women taking denosumab or alendronate. Osteoporos Int. 2011; 22:1725–1735.
17. Watts NB, Roux C, Modlin JF, Brown JP, Daniels A, Jackson S, et al. Infections in postmenopausal women with osteoporosis treated with denosumab or placebo: coincidence or causal association? Osteoporos Int. 2012; 23:327–337.
18. Martín-Baez IM, Blanco-García R, Alonso-Suárez M, Cossio-Aranibar C, Beato-Coo LV, Fernandez-Fleming F. Severe hypocalcaemia post-denosumab. Nefrologia. 2013; 33:614–615.
19. McLachlan JM, Marx GM, Bridgman M. Severe symptomatic hypocalcaemia following a single dose of denosumab. Med J Aust. 2013; 199:242–243.
20. Ungprasert P, Cheungpasitporn W, Srivali N, Kittanamongkolchai W, Bischof EF. Life-threatening hypocalcemia associated with denosumab in a patient with moderate renal insufficiency. Am J Emerg Med. 2013; 31:756 e1–756 e2.
21. Stopeck AT, Lipton A, Body JJ, Steger GG, Tonkin K, de Boer RH, et al. Denosumab compared with zoledronic acid for the treatment of bone metastases in patients with advanced breast cancer: a randomized, double-blind study. J Clin Oncol. 2010; 28:5132–5139.
22. Medicines and Healthcare Products Regulatory Agency. Denosumab 60 mg (prolia▾). London, UK: Medicines and Healthcare Products Regulatory Agency;2013. cited by 2015 Feb 17. Available from: https://www.gov.uk/drug-safety-update/denosumab-60-mg-prolia.
23. Bucay N, Sarosi I, Dunstan CR, Morony S, Tarpley J, Capparelli C, et al. Osteoprotegerin-deficient mice develop early onset osteoporosis and arterial calcification. Genes Dev. 1998; 12:1260–1268.
24. Helas S, Goettsch C, Schoppet M, Zeitz U, Hempel U, Morawietz H, et al. Inhibition of receptor activator of NF-kappaB ligand by denosumab attenuates vascular calcium deposition in mice. Am J Pathol. 2009; 175:473–478.
25. Janda K, Krzanowski M, Chowaniec E, Kuśnierz-Cabala B, Dumnicka P, Krasniak A, et al. Osteoprotegerin as a marker of cardiovascular risk in patients on peritoneal dialysis. Pol Arch Med Wewn. 2013; 123:149–155.
26. Augoulea A, Vrachnis N, Lambrinoudaki I, Dafopoulos K, Iliodromiti Z, Daniilidis A, et al. Osteoprotegerin as a marker of atherosclerosis in diabetic patients. Int J Endocrinol. 2013; 2013:182060.
27. Mogelvang R, Haahr-Pedersen S, Bjerre M, Frystyk J, Iversen A, Galatius S, et al. Osteoprotegerin improves risk detection by traditional cardiovascular risk factors and hsCRP. Heart. 2013; 99:106–110.
28. Kiechl S, Schett G, Wenning G, Redlich K, Oberhollenzer M, Mayr A, et al. Osteoprotegerin is a risk factor for progressive atherosclerosis and cardiovascular disease. Circulation. 2004; 109:2175–2180.
29. Reid IR, Miller PD, Brown JP, Kendler DL, Fahrleitner-Pammer A, Valter I, et al. Effects of denosumab on bone histomorphometry: the FREEDOM and STAND studies. J Bone Miner Res. 2010; 25:2256–2265.
30. Silva I, Branco JC. Denosumab: recent update in postmenopausal osteoporosis. Acta Reumatol Port. 2012; 37:302–313.
31. Chlebowski RT, Anderson GL, Gass M, Lane DS, Aragaki AK, Kuller LH, et al. Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA. 2010; 304:1684–1692.
32. Anderson GL, Chlebowski RT, Aragaki AK, Kuller LH, Manson JE, Gass M, et al. Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women's Health Initiative randomised placebo-controlled trial. Lancet Oncol. 2012; 13:476–486.
33. Komm BS, Kharode YP, Bodine PV, Harris HA, Miller CP, Lyttle CR. Bazedoxifene acetate: a selective estrogen receptor modulator with improved selectivity. Endocrinology. 2005; 146:3999–4008.
34. Crabtree JS, Peano BJ, Zhang X, Komm BS, Winneker RC, Harris HA. Activity of three selective estrogen receptor modulators on hormone-dependent responses in the mouse uterus and mammary gland. Mol Cell Endocrinol. 2008; 287:40–46.
35. Peano BJ, Crabtree JS, Komm BS, Winneker RC, Harris HA. Effects of various selective estrogen receptor modulators with or without conjugated estrogens on mouse mammary gland. Endocrinology. 2009; 150:1897–1903.
36. Van Duren D, Ronkin S, Pickar J, Constantine G. Bazedoxifene combined with conjugated estrogens: A novel alternative to traditional hormone therapies. Fertil Steril. 2006; 86:S88–S89.
37. Harvey JA, Pinkerton JV, Baracat EC, Shi H, Chines AA, Mirkin S. Breast density changes in a randomized controlled trial evaluating bazedoxifene/conjugated estrogens. Menopause. 2013; 20:138–145.
38. Pinkerton JV, Harvey JA, Pan K, Thompson JR, Ryan KA, Chines AA, et al. Breast effects of bazedoxifene-conjugated estrogens: a randomized controlled trial. Obstet Gynecol. 2013; 121:959–968.
39. Lindsay R, Gallagher JC, Kagan R, Pickar JH, Constantine G. Efficacy of tissue-selective estrogen complex of bazedoxifene/conjugated estrogens for osteoporosis prevention in at-risk postmenopausal women. Fertil Steril. 2009; 92:1045–1052.
40. Pinkerton JV, Harvey JA, Lindsay R, Pan K, Chines AA, Mirkin S, et al. Effects of bazedoxifene/conjugated estrogens on the endometrium and bone: a randomized trial. J Clin Endocrinol Metab. 2014; 99:E189–E198.
41. Lobo RA, Pinkerton JV, Gass ML, Dorin MH, Ronkin S, Pickar JH, et al. Evaluation of bazedoxifene/conjugated estrogens for the treatment of menopausal symptoms and effects on metabolic parameters and overall safety profile. Fertil Steril. 2009; 92:1025–1038.
42. Pinkerton JV, Utian WH, Constantine GD, Olivier S, Pickar JH. Relief of vasomotor symptoms with the tissue-selective estrogen complex containing bazedoxifene/conjugated estrogens: a randomized, controlled trial. Menopause. 2009; 16:1116–1124.
43. Kagan R, Williams RS, Pan K, Mirkin S, Pickar JH. A randomized, placebo- and active-controlled trial of bazedoxifene/conjugated estrogens for treatment of moderate to severe vulvar/vaginal atrophy in postmenopausal women. Menopause. 2010; 17:281–289.
44. Bachmann G, Bobula J, Mirkin S. Effects of bazedoxifene/conjugated estrogens on quality of life in postmenopausal women with symptoms of vulvar/vaginal atrophy. Climacteric. 2010; 13:132–140.
45. Skouby SO, Lobo RA, Ryan KA, Thompson JR, Komm BS, Chines AA. Low risk of thrombophilia with bazedoxifene/conjugated estrogens: summary of pooled coagulation data from the selective estrogens, menopause, and response to therapy trialsThe Endocrine Society's 94th Annual Meeting and Expo. Houston, TX: 2012. p. SAT-31.
46. Archer DF, Lewis V, Carr BR, Olivier S, Pickar JH. Bazedoxifene/conjugated estrogens (BZA/CE): incidence of uterine bleeding in postmenopausal women. Fertil Steril. 2009; 92:1039–1044.
47. Pfizer Inc. DUAVEE® (conjugated estrogens/bazedoxifene) tablets for oral use. Philadelphia, PA: Pfizer Inc.;2013. cited by 2015 Feb 17. Available from: http://labeling.pfizer.com/ShowLabeling.aspx?id=1174.
48. Ng KW. Potential role of odanacatib in the treatment of osteoporosis. Clin Interv Aging. 2012; 7:235–247.
49. Vääräniemi J, Halleen JM, Kaarlonen K, Ylipahkala H, Alatalo SL, Andersson G, et al. Intracellular machinery for matrix degradation in bone-resorbing osteoclasts. J Bone Miner Res. 2004; 19:1432–1440.
50. Xia L, Kilb J, Wex H, Li Z, Lipyansky A, Breuil V, et al. Localization of rat cathepsin K in osteoclasts and resorption pits: inhibition of bone resorption and cathepsin K-activity by peptidyl vinyl sulfones. Biol Chem. 1999; 380:679–687.
51. Furuyama N, Fujisawa Y. Regulation of collagenolytic cysteine protease synthesis by estrogen in osteoclasts. Steroids. 2000; 65:371–378.
52. Troen BR. The regulation of cathepsin K gene expression. Ann N Y Acad Sci. 2006; 1068:165–172.
53. Black WC, Percival MD. The consequences of lysosomotropism on the design of selective cathepsin K inhibitors. Chembiochem. 2006; 7:1525–1535.
54. Kim TS, Tasker AS. Non-covalent cathepsin K inhibitors for the treatment of osteoporosis. Curr Top Med Chem. 2006; 6:355–360.
55. Gauthier JY, Chauret N, Cromlish W, Desmarais S, Duong le T, Falgueyret JP, et al. The discovery of odanacatib (MK-0822), a selective inhibitor of cathepsin K. Bioorg Med Chem Lett. 2008; 18:923–928.
56. Bone HG, McClung MR, Roux C, Recker RR, Eisman JA, Verbruggen N, et al. Odanacatib, a cathepsin-K inhibitor for osteoporosis: a two-year study in postmenopausal women with low bone density. J Bone Miner Res. 2010; 25:937–947.
57. Langdahl B, Binkley N, Bone H, Gilchrist N, Resch H, Rodriguez Portales J, et al. Odanacatib in the treatment of postmenopausal women with low bone mineral density: five years of continued therapy in a phase 2 study. J Bone Miner Res. 2012; 27:2251–2258.
58. Merck. Merck announces data from pivotal phase 3 fracture outcomes study for odanacatib, an investigational oral, once-weekly treatment for osteoporosis. Kenilworth, NJ: Merck & Co., Inc.;2014. cited by 2015 Feb 17. Available from: http://www.mercknewsroom.com/news-release/research-and-development-news/merck-announces-data-pivotal-phase-3-fracture-outcomes-st.
59. Khosla S. Odanacatib: location and timing are everything. J Bone Miner Res. 2012; 27:506–508.
60. Masarachia PJ, Pennypacker BL, Pickarski M, Scott KR, Wesolowski GA, Smith SY, et al. Odanacatib reduces bone turnover and increases bone mass in the lumbar spine of skeletally mature ovariectomized rhesus monkeys. J Bone Miner Res. 2012; 27:509–523.
61. Balena R, Shih MS, Parfitt AM. Bone resorption and formation on the periosteal envelope of the ilium: a histomorphometric study in healthy women. J Bone Miner Res. 1992; 7:1475–1482.
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