Leveraging Modeling- and Remodeling-Based Bone Formation in Cyclic Administration of Anabolic Agents for Osteoporosis Treatment
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Animal Model
Bone Histomorphometry
Cyclic Treatment
Modeling- and Remodeling- Based Bone Formation
Osteoporosis
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Abstract
Postmenopausal osteoporosis leaves patients at a heightened risk of fracture due to reduced bone mass and quality. To minimize fracture risk, anabolic agents that increase bone formation can be administered, although they are only recommended for 18-24 months and upon discontinuation, there is a withdrawal effect where treatment benefit is lost. Therefore, this thesis sought to optimize the use of anabolic agents for osteoporosis treatment in an ovariectomized rat model. We first compared two anabolic agents, parathyroid hormone (PTH) and PTH-related peptide (PTHrP), during treatment and withdrawal. Both treatments induced more modeling-based bone formation (MBF) than remodeling-based bone formation (RBF), but PTHrP induced more MBF during treatment. PTH and PTHrP had a similar withdrawal response and continued mineral deposition for one week after treatment discontinuation, referred to as the extended anabolic period (EAP), but PTHrP had more bone formation at MBF sites during the EAP. We also compared cyclic treatment regimens of either alternating PTH or PTHrP with Alendronate (ALN, an antiresorptive) or saline and showed that treatment efficacy on trabecular bone microstructure depended on whether ALN was administered. Next, we further assessed a cyclic treatment regimen of PTHrP and ALN to capitalize on the EAP and potentially induce new bone formation sites with a new anabolic period. Surprisingly, no new bone formation sites were formed on quiescent surfaces and ALN blunted the anabolic effect of PTHrP during treatment and the EAP. The cyclic and standard treatments of PTHrP and ALN both induced a greater anabolic response than cyclic PTHrP and saline, with a greater benefit of Cyclic PTHrP-ALN in the vertebrae. We also found that ALN did not affect the EAP formed on MBF and RBF sites after PTH treatment, although this finding warrants further investigation. Altogether, this thesis adds insight regarding the efficacy and underlying mechanisms of cyclic treatment strategies that utilize anabolic agents. We conclude that cyclic treatments are an effective strategy for postmenopausal osteoporosis, but that more investigations are needed to further optimize their anabolic benefit.