Antiresorptive agents in the treatment of osteoporosis

Cilj medikamentoznog liječenja osteoporoze jest uspostaviti ravnotežu između aktivnosti osteoblasta i osteoklasta te time povećati mineralnu gustoću kosti i posljedično smanjiti rizik prijeloma. Antiresorptivni lijekovi suprimiraju djelovanje osteoklasta te na taj način smanjuju razgradnju kosti. Tu pripadaju bisfosfonati, selektivni modulatori estrogenskih receptora (SERM) te denosumab, dok su hormonsko nadomjesno liječenje i kalcitonin danas uglavnom napušteni. Vežući se za kristale hidroksiapatita na površini kosti bisfosfonati inhibiraju resorpciju kosti te posljedično dovode do smanjenja rizika za vertebralne i nevertebralne prijelome. Denosumab je monoklonsko protutijelo koje sprečavanjem interakcije između RANKL-a i RANK-a inhibira osteoklastogenezu i tako smanjuje resorpciju kosti u kortikalnoj i trabekularnoj kosti te posljedično znatno smanjuje rizik za prijelome.The aim of drug treatment of osteoporosis is the balance between activity of osteoblasts and osteoclasts with augmentation of mineral bone density and decrease of fracture risk. Antiresorptive agents depress osteoclasts and diminish resorption of bone. They include bisphosphonates, selective estrogen receptor modulators (SERMs), denosumab, while hormone replacement therapy and calcitonin are mostly abandoned. By binding to hydroxyapatite crystals of bone surface bisphosphonates inhibit the resorption of bone and prevent vertebral and non-vertebral fractures. Denosumab is a monoclonal antibody which by hindering interaction between RANKL and RANK inhibits osteoclastogenesis and diminishes bone resorption in cortical and trabecular bones, thus significantly lessening fracture risk