Developing drugs to treat osteoporosis: lessons learned?

Sialoglycoprotein Isolated from Eggs of Carassius auratus Ameliorates Osteoporosis: An Effect Associated with Regulation of the Wnt/β-Catenin Pathway in Rodents

In the current study, ovariectomized (OVX) rats and the senescence-accelerated mouse strain P6 (SAMP6) were employed to establish models of postmenopausal osteoporosis and senile osteoporosis, respectively. The effects of treatment with sialoglycoprotein isolated from the eggs of Carassius auratus (Ca-SGP) on these two types of osteoporosis were investigated in vivo. Results showed that Ca-SGP significantly increased bone mineral density, ameliorated trabecular bone microstructure, and improved bone biomechanical properties in both OVX rats and SAMP6. The osteogenesis related Wnt/β-catenin pathway was targeted to study the underlying mechanism of Ca-SGP activity. In postmenopausal osteoporosis, Ca-SGP suppressed the activation of Wnt/β-catenin signal via down-regulating the expression of key genes including LRP5, β-catenin, and Runx2, suggesting that overactive osteogenesis was controlled by Ca-SGP. The bone formation was sharply weakened in senile osteoporosis, whereas Ca-SGP treatment promoted osteoblast activity by stimulating the Wnt/β-catenin signal. In conclusion, Ca-SGP ameliorated these two types of osteoporosis by normalizing bone anabolism.

Current and emerging therapies for the treatment of osteoporosis

Osteoporosis represents a weakening of bone tissue due to an imbalance in the dynamic processes of bone formation and bone resorption that are continually ongoing within bone tissue. Most currently available osteoporosis therapies are antiresorptive agents. Over the past decade, bisphosphonates, notably alendronate and risedronate, have become the dominant agents with newer bisphosphonates such as ibandronate and zoledronic acid following a trend of less frequent dosing regimens. Synthetic estrogen receptor modulators (SERMs) continue to be developed as drugs that maintain the bone-protective effects of estrogen while avoiding its associated adverse side effects. Currently available agents of this class include raloxifene, the only SERM available in the United States (US), and lasofoxifene and bazedoxifene, available in Europe. Calcitonin, usually administered as a nasal spray, completes the list of currently approved antiresorptive agents, while parathyroid hormone analogs represent the only anabolic agents currently approved in both the US and Europe. Strontium ranelate is an additional agent available in Europe but not the US that has both anabolic and antiresorptive activity. New agents expected to further expand therapeutic options include denosumab, a monoclonal antibody inhibitor of the resorptive enzyme cathepsin K, which is in the final stages of Food and Drug Administration approval. Other agents in preclinical development include those targeting specific molecules of the Wnt/β-catenin pathway involved in stimulating bone formation by osteoblast cells. This review discusses the use of currently available agents as well as highlighting emerging agents expected to bring significant changes to the approach to osteoporosis therapy in the near future.

Update on estrogens and the skeleton

CONTEXT

The very clinical trial, the Women's Health Initiative, which definitely established the antifracture efficacy of estrogen therapy, led to the demise of estrogen treatment as a viable, long-term option for prevention of bone loss in postmenopausal women due to the well-publicized adverse effects of estrogen plus progestin therapy on a number of nonskeletal endpoints. Given the diminishing clinical use of estrogen, it is logical to question whether estrogen regulation of bone remains a relevant issue at a clinical or basic research level.

EVIDENCE ACQUISITION

Findings of this update are based on a PubMed search and the author's knowledge of the field.

EVIDENCE SYNTHESIS

Basic and clinical studies on the mechanisms of estrogen effects on bone will continue to provide potential novel drug targets for the prevention and treatment of osteoporosis. At a clinical level, it is clear that even the low levels of estrogen present in postmenopausal women have a significant impact on bone turnover, leading to a more aggressive approach to prevent bone loss in patients with breast cancer on aromatase inhibitors. Conversely, increasing these low estrogen levels with small doses of estrogen may have beneficial skeletal effects in postmenopausal women without adverse effects on reproductive tissues. Finally, the search continues for new selective estrogen receptor modulators with beneficial effects on bone and other tissues.

CONCLUSIONS

Even in the post-WHI era, basic and clinical investigation on estrogen and bone will continue to yield important insights that not only expand our knowledge at a basic level but also impact the health of our aging population.