Bone Treatments

Several types of bone treatments for osteoporosis exist and will be prescribed to patients based on their bone and clinical evaluation. Each treatment has different action mechanisms (for further information about existing bone treatments, please refer to the short and explanatory article published by Mayo Clinic clinical staff, USA, here). The standard examination to monitor the response of the patient’s bone to a given treatment is DXA, which will be used to verify its impact on areal bone mineral density. However, as each treatment would have different effects on bone (remodelling, anti-resorptive), and each individual may respond differently to the given molecule, it is important to also evaluate and monitor the response of the cortical and trabecular bones.

Indeed, in their clinical trials, pharmaceutical companies evaluate the effect of their drugs on the bone by monitoring not only aBMD but also advanced bone measurements (biomechanical, geometrical, biochemical parameters etc), to evaluate and prove effectiveness and safety of their drugs on bone prior to commercializing them. Until now, they have been mostly using QCT to accurately evaluate cortical and trabecular bone under treatment. However, such clinical trials imply to collect a high number of patients’ data in order to monitor the effects of their drugs on the long-term.

Such practices from pharmacological companies highlight, on the first hand, the need to monitor cortical and trabecular bone to verify the efficacy of a bone treatment. On the other hand, it also highlights the added-value of being able to assess such bone parameters from routinely available examinations such as DXA scans – being available widely as every woman should be scanned regularly from menopause and implying low radiation.

The addition of 3Dimensional measurements, as assessed by 3D-SHAPER®, could help better understand individual response to bone treatment, by analyzing treatment effects at both cortical and trabecular compartments.

This field has already been investigated and some work presented:

  • Analysis of the effects of Denosumab, Alendronate, and Teriparatide at 24 months, “Effects of osteoporosis drug treatments on cortical and trabecular bone in the femur using DXA-based 3D modeling”, R. Winzenrieth et al., Osteoporosis International 2018, publication available here
  • Analysis of the effects of Denosumab and Bisphosphonates, “Hip DXA 3D Modelling shows increased cortical bone density after treatment with Denosumab versus Bisphosphonates”, M. Almohaya et al., WCO-IOF-ESCEO 2018, poster available here
  • Analysis of the effects of Denosumab and Zoledronate, “Cortical and Trabecular Bone Response in Proximal Femur from Women with Osteoporosis Treated with Denosumab or Zolendronic Acid using 3D Modelling Techniques Obtained from DXA”, F. C. Molina et al., AMMOM and PANLAR 2018, Poster available here
  • A summary of the observed effects of treatments using 3D characterization is presented in figure 2.
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