Endocrine Abstracts

A number of new treatments are being developed for the treatment of bone diseases, particularly osteoporosis. We need tools to help identify how these drugs work and which bone compartment they affect. Bone turnover markers are very useful in identifying response to treatment in these allow identification of an early change and information about mechanism. New biochemical tests have become available that allow study of the key regulatory pathways in bone – these include o...

Osteoporosis is characterised by bone fragility with increased susceptibility to fracture. The burden of osteoporosis already costs the NHS over £1.7 billion per annum but its prevalence is increasing. The skeleton is continually remodelled in response to endocrine, paracrine and mechanical signals by the coupled activities of osteoclasts and osteoblasts. Nevertheless, the continuous process of bone turnover results in an inexorable loss of bone because osteoblast-mediate...

Anabolic agents hold the promise of rebuilding the skeleton and thus producing a greater fracture reduction that antiresorptive agents. PTH (either 1–34 or 1–84) suggests improvements in mass and structure, and for 1-34rhPTH significant reductions in vertebral and non-vertebral fractures. Whether the fracture benefits are indeed greater than those seen with bisphosphonates is not clear. The limited duration of clinical trials (and treatment in practice) makes it diff...

Bisphosphonates (BPs) are synthetic analogues of pyrophosphate that inhibit osteoclast-mediated bone resorption and reduce bone turnover. Of proven therapeutic benefit, licensed indications for clinical use of BPs include, 1) prevention of osteoporotc fractures, 2) management of bone pain (Paget’s disease, metastatic breast cancer & myeloma) and 3) treatment of hypercalcaemia of malignancy. The perceived safety of BPs has, however, resulted in growth of ‘off-labe...