Osteoporosis is a disease in which osteoclasts are much more active than osteoblasts, making bones more fragile and more prone to fracture. In fact, people with osteoporosis have thinner bones and a more porous spongy layer, which increases the likelihood of fractures.
Osteoporosis is a silent disease that gradually reduces bone density and quality. Over the years, they gradually become weaker. Meanwhile, the disease remains undetected since in most cases, no symptoms are identified until the first fracture occurs.
Osteoporosis is a very serious disease; it is more common than stroke heart attacks and breast
cancer combined. Osteoporosis is often related to age and decreases in ovarian activity, which leads to a decrease
in estrogen levels. Other factors are also linked to the onset of osteoporosis, including certain cancers and the
likelihood of being prescribed specific medications. Tragically, some people afflicted with hip fractures caused by osteoporosis succumb within
a year of the fracture.
The seriousness of this problem is underlined by the statistics on hip fractures. A quarter
of those who undergo surgery for a hip fracture face mortality within twelve months. Three out
of four who choose not to undergo surgery face an equally grim fate within the same timeframe.
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Osteoporosis is a serious disease. It affects more than 2 million people in Canada and
200 million worldwide. The disease costs the healthcare system more than $2.3 billion in
Canada and nearly $500 US billion worldwide. A silent disease, osteoporosis is more common
than stroke, heart attack, breast cancer and cancer combined.
Osteoporosis is a prevalent disease, particularly affecting women after menopause, with one
in three women experiencing an osteoporotic fracture after the age of 50. However, men are
not exempt, as one in four men over 55 will also suffer such fractures. The consequences are
severe, with 20-30% of individuals with hip fractures dying within a year. As the population ages,
the risk of fracture will double in the next 20 years, emphasizing the urgency of addressing this issue.
Osteoporosis is characterized by decreased bone mineral density, rendering bones brittle and
highly susceptible to fractures. The classical form of the disease is most common in individuals
over 50 and is influenced by factors like genetics, lack of exercise, smoking, alcoholism, poor diet,
and certain medications. Fractures in the wrist, hip, and spine are common and significantly impact
quality of life, leading to chronic pain, disability, and loss of independence.
Addressing osteoporosis is crucial due to its widespread impact and mortality risks associated
with fractures. Strategies must be implemented to improve prevention, diagnosis, and treatment to
reduce the burden of this debilitating disease.
The situation is even worse for people with osteoporosis related to severe chronic kidney disease. In
these cases, the mortality rate from hip fractures is alarming (as high as 70%), underscoring the need
for rapid intervention and concrete solutions.
Osteoporosis and chronic kidney disease (CKD) are two distinct medical conditions, but there is a close
relationship between them. People with chronic kidney disease (CKD) are at increased risk of osteoporosis.
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Chronic kidney disease can affect bone health in several ways, which can lead to the development of osteoporosis in patients with CKD.
Here are some of the factors that contribute to this association:
- Hormone imbalance: The kidneys play a crucial role in regulating hormone levels in the body. In CKD, the kidneys do not function properly, which can disrupt hormonal balance, including hormones involved in regulating bone metabolism. For example, the production of parathyroid hormone (PTH), which is essential for maintaining calcium balance in the body, can be disrupted. High levels of PTH can lead to increased bone degradation.
- Deregulation of calcium and phosphate metabolism: The kidneys play a key role in eliminating waste and maintaining the balance of minerals, such as calcium and phosphate. In CKD, this regulation can be impaired, leading to increased phosphate levels in the blood and decreased calcium levels. This can contribute to bone demineralization and osteoporosis.
- Metabolic acidosis: In CKD, the kidneys are not able to effectively eliminate acids produced by the body's metabolism. This can lead to metabolic acidosis, a condition where the pH of the blood becomes acidic. Metabolic acidosis can also contribute to bone loss and osteoporosis.
- Medications and treatments: Medications used to treat CKD, such as corticosteroids or some immunosuppressive drugs, can also affect bone health and increase the risk of osteoporosis.
As with patients with classical osteoporosis, it is important to take steps to prevent and treat osteoporosis in patients with CKD. This may include:
- A balanced diet rich in calcium and vitamin D to maintain bone health.
- Regular physical activity, including muscle-strengthening exercises and weight-bearing exercises, to promote bone density.
- The use of specific medications for osteoporosis, such as bisphosphonates, when appropriate and under the supervision of a healthcare professional.
- Regular monitoring of bone density through tests such as bone densitometry.
- Proper management of CKD, including control of hormonal imbalances and blood calcium and phosphate levels.
In some cases, medications used to treat osteoporosis may be contraindicated in people with chronic kidney disease (CKD) because of their impact on kidney function. Some drug classes may require dose adjustments or close monitoring in patients with CKD.
- Bisphosphonates: Bisphosphonates are commonly used to treat osteoporosis, but they can build up in the kidneys and cause kidney toxicity in people with CKD. Oral bisphosphonates, such as alendronate and risedronate, are generally avoided in patients with severe CKD.
- Denosumab: Denosumab is an injectable medication used to treat osteoporosis. It is not metabolised by the kidneys and can lead to hypocalcaemia (low levels of calcium in the blood), which can be problematic in patients with CKD.
- Hormonal therapy: Estrogen-based hormone therapy is often used to treat osteoporosis in postmenopausal women, but it can increase the risk of blood clots in patients with CKD. The decision whether to use hormone therapy should be made with caution, taking into account the potential benefits and individual risks.
- Calcimimetics: Calcimimetics, such as cinacalcet, are used to treat calcium metabolism disorders in patients with CKD. They may help reduce high levels of calcium in the blood, but their use in people with osteoporosis and CKD should be evaluated with caution due to the complex interactions between calcium and bone metabolism.
It is crucial that patients with CKD consult with a nephrologist and rheumatologist to assess their condition, discuss treatment options, and decide on the most appropriate osteoporosis management plan. Treatment recommendations will be personalized based on the severity of CKD, individual medical history, and risk factors specific to each patient.
According to our KOLs (key opinion leaders) and scientific advisors, OSTAAT™ low-intensity electrical stimulation technology may indeed be a promising approach to stimulate bone growth and help reduce the risk of fractures in people with osteoporosis, including those with chronic kidney disease, for whom medication is contraindicated.
The advantages of OSTAAT™ technology include the absence of systemic side effects and the possibility of using it in conjunction with other drug treatments for osteoporosis. OSTAAT™ will address an unmet need in medicine.
Osteoporosis treatment presents significant challenges, particularly for patients with severe chronic kidney
disease (CKD). Due to impaired renal function, traditional medications are contraindicated for this group,
leaving them with few or no viable options. Even for those with primary osteoporosis, available medications
often come with a high risk of side effects and complex administration protocols.
The disease itself carries serious implications beyond bone fragility. Osteoporotic fractures can lead to
life-threatening complications such as infections and blood clots. Moreover, the condition may cause spinal
deformities, potentially compressing internal organs and further compromising overall health.
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Current osteoporosis medications are notoriously difficult to administer correctly. Patients must take them on an empty stomach, remain upright for a specified period, and carefully time their doses in relation to other medications and meals. These stringent requirements contribute to poor adherence rates.
The challenges associated with osteoporosis treatment have led to alarming statistics:
- 25% of diagnosed patients refuse to initiate recommended treatments.
- 52% of those who start treatment discontinue within 24 months.
- Consequently, 64% of the diagnosed population receives no treatment at all.
This significant untreated population represents a substantial market opportunity for innovative solutions. Furthermore, the remaining 36% currently on medication might be open to alternative, more manageable treatment options.
The situation is particularly dire for individuals with osteoporosis secondary to severe CKD, as they currently have no FDA-approved pharmacological options. This unmet medical need is precisely what OSTAAT™ technology aims to address, potentially revolutionizing treatment for this underserved patient population.