Teriparatide(Chengdu Shengnuo)

Osteoporosis, a systemic skeletal disorder characterized by reduced bone density and increased fracture risk, poses a significant global health challenge. While teriparatide (TRP), a first-line anabolic peptide drug, demonstrates substantial therapeutic benefits in osteoporosis management, its clinical use is restricted by the necessity for daily subcutaneous administration, leading to suboptimal patient compliance. To overcome this limitation, we developed an orally deliverable TRP formulation using biocompatible metal-organic framework nanoparticles (MOF-808 NPs) co-loaded with TRP and functionalized with transferrin targeting ligands (M@P@T NPs). The rationally designed nanoporous architecture coupled with transferrin surface modification synergistically protects TRP from acidic and enzymatic degradation in harsh gastrointestinal environments, while realizing controlled release of TRP in the phosphate-rich bloodstream. Leveraging the overexpression of transferrin receptors (TfR) on intestinal epithelial cells, the nanosystem facilitates receptor-mediated transcellular transport, enabling efficient systemic delivery of TRP with high oral bioavailability. After the one-month oral administration of low-dose M@P@T (200 μg kg^-1·day^-1) to osteoporosis model mice, therapeutic outcomes comparable to those achieved with subcutaneous TRP injections were observed, including increased bone mineral density, improved trabecular structure, and significant alleviation of osteoporosis symptoms. These findings suggest that this MOF-based oral TRP strategy has great potential for simplifying and improving the treatment of osteoporosis.

To summarise recent publications addressing the epidemiology, pathogenesis and management of atypical femur fractures (AFFs).

AFFs have been reported in anti-resorptive treated individuals, bisphosphonate-naïve individuals and individuals with monogenic bone diseases. The likelihood of developing an AFF increases with prolonged exposure to anti-resorptive treatment. AFF risk declines following anti-resorptive discontinuation. Asian ethnicity has emerged as an important risk factor for AFF. Although excluded from the current ASBMR AFF case definition, periprosthetic AFFs and atypical fractures at non-classical sites have been increasingly reported. Following an AFF, anti-resorptive therapy should be discontinued, surgical treatment with intramedullary nailing considered, the contralateral femur imaged, and the underlying osteoporosis addressed. Emerging evidence suggests teriparatide may aid healing in surgically managed AFFs but not in conservatively managed incomplete AFFs.

AFFs remain a rare side effect of anti-resorptive treatment. Emerging areas of interest and further research include genetic and ethnic risk factors and advancements in diagnostic technologies for AFFs.