Novel therapies are providing hope in osteoporosis, but questions surrounding optimal treatment regimens remain, according to a presenter at the 2020 Congress of Clinical Rheumatology-East.

“We are making great strides in osteoporosis,” Nancy E. Lane, MD, endowed professor of medicine, rheumatology and aging research, director for the Center for Musculoskeletal Health, director of the K12 NIH Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) and principal investigator of the NIH funded Program on Sex Differences in Musculoskeletal Diseases Across the Lifespan at the University of California at Davis School of Medicine, said in her presentation.

Lane covered topics ranging from what she called the “crisis in treatment” of osteoporosis to specific issues surrounding bisphosphonates or denosumab and what is happening on the research front in glucocorticoids.

But before digging into the pharmacotherapeutic options, Lane reminded CCR-East attendees that prevention is critical. “We should do preventive measures for everyone,” she said, citing exercise, calcium, screening and vitamin D intake as important tools for mitigating the disease.

Nancy E. Lane

While calcium dietary supplements can be useful, natural sources are preferred, Lane said. The maximum daily dose of calcium should be 1,200 mg.

Zeroing in on treatment options, data sets studying denosumab for up to 10 years have shown that patients treated with this drug can reach normal levels of bone mass, according to Lane. “Denosumab keeps on improving the bone mass in our patients,” she said.

However, despite a broader body of data showing this phenomenon, particularly in the hip, why this occurs is “still not understood,” Lane said.

Recent data have shown that denosumab may improve glomerular filtration rate, but whether this effect is related to improved bone mass remains to be seen.

A big change in the field involves the use of denosumab for the treatment of glucocorticoid-induced osteoporosis, but it was not easy to arrive at this conclusion, according to Lane. “These are always very, very difficult studies to do,” she said.

Turning to bisphosphonates, Lane reviewed the mixed bag of outcomes reported for this class of drugs. For example, for patients who have experienced a hip fracture, bisphosphonate therapy can significantly reduce non-spine fractures. However, there can be consequences.

“Bisphosphonates have been associated with osteonecrosis of the jaw,” she said. “This can create challenges for us with our patients.”

If there is one other drug that is showing great promise in osteoporosis, it is abaloparatide, according to Lane, who cited a recent data set comparing the drug with teriparatide. “When you look at total hip and femoral neck, you see that there is a little bit more bone gain with abaloparatide compared with teriparatide, with reduction in new fractures,” she said.

For clinicians looking for guidance in treating the broad spectrum of osteoporosis patients, Lane encouraged attendees to review the 2017 update of the ACR treatment guidelines. “Also, remember to get active to prevent these terrible diseases,” she said.