There are currently several effective agents available to treat osteoporosis and for the prevention of fractures. Calcium and vitamin D play an important role for fracture prevention and bisphosphonates are the most commonly used antiresorptive agents. Partial oestrogen agonists such as raloxifene have a more limited role in the treatment of osteoporosis. Teriparatide, a recombinant human parathyroid hormone is approved for the treatment of osteoporosis in Australia but is does not attract a Pharmaceutical Benefit Scheme subsidy and its cost is widely regarded as prohibitive.
Denosumab is a novel therapy under investigation for the treatment of osteoporosis in post menopausal women. Receptor activity of nuclear factor kB ligand (RANKL) (a protein expressed by osteoblastic stromal cells) binds to receptor activator of nuclear factor k B (RANK) and is the primary mediator of osteoclast differentiation, activation and survival. RANKL is responsible for osteoclast mediated bone resorption. Osteoprotegerin, a soluble decoy receptor that binds RANKL is the key endogenous regulator of the RANKL-RANK pathway. Denosumab is a fully human monoclonal antibody that binds to RANKL with high affinity and specificity and blocks the interaction of RANKL with RANK mimicking the endogenous effects of osteoprotegerin, leading to decreased osteoclast action and subsequently less bone resorption.
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This newsletter is a joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General
Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
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