TERAPII CURENTE ŞI DIRECţII DE CERCETARE ÎN TRATAMENTUL OSTEOPOROZEI.

Osteoporosis is a systemic bone disease în which both a reduction în bone mass and an alteration of the normal architecture occur, the combined result being an increased risk of fracture, particularly at the spine, hip and forearm. Primarily affecting postmenopausal women and elderly men, osteoporosis has gained epidemic proportions and with increasing life expectancy în developed countries the incidence of fragility fractures is exceeding that of breast cancer and is coming close to that of cardiovascular diseases. Since the recognition of this disease many treatment options have been found, some of which are currently widely used, with demonstrated effects on reducing the incidence of fractures. Bisphosphonates are currently the most widely used class of drugs worldwide. It has been shown that their antiresorbtive effect is protective against fractures, which exceeds the strict increase în DMO as assessed by DXA. However, the mechanism of action, which involves significant suppression of bone metabolism, given the prolonged duration of treatment, raises concerns about patient safety with such drugs. Increased risk for atypical fractures (subtrochanteric) and dental complications (osteonecrosis of the jaw) are additional arguments that we haven't found yet the ideal drug for the treatment of osteoporosis. Therefore, new therapies for treatment of osteoporosis should bring us closer to this goal. Strontium ranelate's presumtive mechanism of action involves decoupling bone formation from bone resorbtion, with the possibility of net bone accumulation Anabolic therapies, unlike antiresorbtive ones, have the effect of active accumulation of bone mass by stimulating osteoblasts. Teriparatide, the only approved drug în this group, proved to be effective în the prevention of new fractures in high-risk patients. Denosumab, a human monoclonal antibody which inhibits osteoclast activation mediated through RANK-ligand, became first biologic therapy approved for the treatment of osteoporosis. In addition, current research that evaluates the effectiveness of modulators of calcium sensor on stimulation of endogenous pulsatile secretion of PTH, of anti-sclerostin and anti-dikkopf1 antibodies and of integrin antagonists and cathepsin-K inhibitors open up the possibility of new therapeutic approaches. The role of intracellular VEGF in osteoblast differentiation from mesenchymal stem cell to osteoblast is also currently being investigated. [ABSTRACT FROM AUTHOR]