Q&A: Anabolic Agents for Osteoporosis

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Three months of treatment with the osteoporosis drug abaloparatide (Tymlos, Radius) has a robust effect on bone formation in postmenopausal women with osteoporosis, according to a study presented on Sept. 12 at the American Society for Bone and Mineral Research (ASBMR) annual meeting which is being held virtually.

In this Q&A with David Dempster, Ph.D., F.R.M.S., professor of clinical pathology and cell biology at the College of Physicians and Surgeons of Columbia University in New York, we discuss the findings from the study and its implications.

Abaloparatide is an analog of human parathyroid hormone-related peptide [PTHrP(1-34)] approved in the United States for the treatment of postmenopausal women with osteoporosis who have a high fracture risk.

Dr. Dempster and colleagues obtained bone biopsies from 19 postmenopausal women with osteoporosis and evaluated the effects of abaloparatide on bone formation. After three months of abaloparatide treatment, bone formation indices of the mineralizing surface increased significantly from baseline in cancellous, endocortical, intracortical and periosteal bone envelopes (p < 0.001). The three types of bone formation: modeling-based formation, remodeling-based formation, and overflow modeling-based formation increased significantly from baseline in the cancellous and endocortical envelopes (p < 0.001), as did modeling-based formation in the periosteal envelopes (p < 0.001).

Why was this study necessary?

“Abaloparatide is a new anabolic agent for the treatment of osteoporosis in postmenopausal women. We have much less information than we do for teriparatide, the first anabolic agent to be approved.”

What is the key take-away from the study?

“This study provides new data on the mechanism of action of abaloparatide by showing that it rapidly stimulates new bone formation on all of the key surfaces on bone.”

an the findings help patients and clinicians?

“This is the first study to demonstrate the rapid anabolic action of abaloparatide at the tissue level. The study also showed that changes in biochemical markers of bone metabolism over one or three months accurately reflect the changes in bone formation. This could be used as a tool by clinicians to provide early reinforcement to the patient that the drug is working.”

What do the findings add to current knowledge?

“Several recent studies have confirmed that anabolic agents are superior to antiresorptive agents in the treatment of severe osteoporosis. We have fairly rapidly gone for having just one approved anabolic agent to having three. It is important for doctors to understand how these drugs differ from antiresorptive agents and how they differ from each other. This study helps in this regard by providing new data on abaloparatide in a study that was very similar in design and execution to a previous study— the AVA trial—on teriparatide.”

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For more news from the annual ASBMR meeting, click here.

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REFERENCE

[1040] Effects of Abaloparatide on Modeling and Remodeling Based Bone Formation. David Dempster. September 12. ASMBR 2020 Annual Meeting Virtual Event.