OSTEOPOROSIS Future Perspectives

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OSTEOPOROSISFuture Perspectives

• Stephen I. Katz, M.D., Ph.D.
• National Institute of Arthritis and
  Musculoskeletal and Skin Diseases, NIH, DHHS

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ESTROGEN AND BONE

• Estrogen is essential throughout life in males as
  well as females.
• Without estrogen or functional estrogen
  receptors, growth plates fail to close at puberty
  and individuals have very low bone mass.
• Very low estrogen levels in older men and women
  are associated with increased fracture risk.
• Finding a way to achieve the effects of estrogen
  on bone without the effects on reproductive
  tissues is an important target of research not
  only at the NIH but in the private sector

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WHERE DO WE GO FROM HERE?

• The NIH research focus is on-
• how to build and preserve strong bone throughout
  life, and,
• how to reduce fracture risk in those who already
  have deficits in bone mass.
• Several important studies employing novel
  approaches are underway with widespread support
  across the NIH

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NOVEL THERAPIES AND PROMISING DIRECTIONS
CURRENTLY UNDER INVESTIGATION

• Nitric Oxide NIAMS
• Phytoestrogens NIAMS, NCCAM, NIA
• Low-dose doxycycline - NIDCR
• PTHrp - NIDDK
• Hip Protectors to prevent fractures in the
  elderly - NIA
• Biophysical Stimulation NIAMS

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COMBINATION THERAPIES

• Low-dose hormone therapy alendronate NIAMS
• PTH and alendronate - NIAMS
• PTH and hormone therapy - NIDDK

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Key developments over the last several years in
basic bone biology are extremely encouraging and
presage new clinical strategies

• Skeletal genetics is a burgeoning
  field-identification of a gene (LRP5) associated
  with bone mass regulation suggests new strategies
  for therapeutics
• Leptin and the statin effects on bone are being
  studied
• At this years annual meeting of the American
  Society for Bone and Mineral Research,
  investigators supported by the NIA and NIAMS
  reported on a compound that has an estrogen-like
  effect on the bone of both male and female mice
  but has no effect on reproductive tissues

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PROMISING DIRECTIONS

• There are many NIH institutes that have an
  interest in various aspects of bone biology and
  bone diseases.
• We are all committed to working together to
  pursue the promising new directions that have
  arisen from the fundamental sciences that are the
  bedrock of our programs
• We welcome your questions and suggestions as we
  move forward