Abstract
Keywords
Although postmenopausal osteoporosis is the most common metabolic bone disease, there are many patient populations who experience alterations in bone health that remain less well studied. This special collection, “Metabolic Bone Disease in Special Populations,” aims to present manuscripts that cover new data in lesser-known areas of metabolic bone disease where there may not be recent guidelines or randomized trials to help guide practitioners.
The paper by Tariq Chukir and colleagues, “Bone health in cancer: perspective on the use of osteoanabolic agents” is a forward-thinking review of the knowns and unknowns surrounding the use of osteoanabolic agents in cancer. Our treatment armamentarium in patients with malignancy has historically been limited to anti-resorptive agents, given the theoretical concerns about the use of osteoanabolic agents in patients with cancer as well as bone metastases. Chukir et al. 1 review the mechanisms of how cancer affects the bone, current data on preventing skeletal-related events, and then provide an up-to-date summary of the pre-clinical and clinical data on both PTH analog therapy and anti-sclerostin antibody therapy. They outline in detail their potential for treatment and areas of concern when considering use in both cancer-related bone loss and bone metastasis, and provide some guidance in a perplexing field.
Patients with cystic fibrosis are living much longer lives today than in prior generations, and with this advance, the concerns for diseases of aging such as osteoporosis and fractures have become more relevant. In “Cystic Fibrosis-Related Bone Disease: An Update on Screening, Diagnosis and Treatment,” Crystal Cobb and colleagues review the risk factors for bone loss in this population as well as pharmacologic and non-pharmacologic therapies for patients living with cystic fibrosis. 2 They discuss the nuances that must be considered regarding nutrition and exercise, as well as what has been specifically studied or yet to be learned about the best pharmacologic treatment choices for fracture prevention. They also review how the highly effective modulator therapy may directly affect bone architecture and outcomes as a window into the future of the field.
Older adults represent a growing proportion of adults with a solid organ transplant. Bone health screening and treatment have become increasingly important. Soumya Kurnool and colleagues provide a detailed description of heart, liver, lung, and renal transplant-related osteoporosis in “Treatment of osteoporosis in the solid organ transplant related recipient: an organ based approach.” 3 They discuss the impact of the various immunosuppressive agents on bone health and the timing of bone loss and advise ways to best target therapy early and appropriately. Their manuscript includes several detailed tables consolidating what is known about treatment options for individual organs and the particularities that must be addressed, that is, consideration of adynamic bone disease in the setting of renal transplant. Pertinent guidelines are addressed, and treatment algorithms are provided that will be of use to clinical providers.
Although fibrous dysplasia is considered a rare bone disease, it accounts for 2.5% of all bone lesions and may be incidentally found in adults undergoing imaging for other reasons. The most recent guidelines for management came out in 2019, and therefore, Kelly Wentworth and colleagues’ article “Update on the Medical Management of Fibrous Dysplasia of the Bone” provides a very timely review on advances in genetic testing as well as the most recent data on managing pain with pharmacologic and nonpharmacologic modalities. They also highlight recent advances targeting phosphate wasting in fibrous dysplasia (FD) and the potential for use of burosumab, a monoclonal antibody targeting FGF-23. 4
This collection provides several state-of-the-art reviews with detailed information on populations with metabolic bone disease that may be understudied. They fill several gaps with additions to the field useful to clinicians and researchers alike.
