Prof John Stevenson
1National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
Biography:
Prof John C Stevenson MB BS, FRCP, FRCOG, FESC, MFSEM is Emeritus Reader in Metabolic Medicine in the National Heart and Lung Institute, Imperial College London, Visiting Professor at the Belgrade School of Medicine, and honorary Consultant Physician at the Royal Brompton Hospital, London, where he jointly ran the UK’s first female heart disease clinic. He graduated from King’s College Hospital, London. His research has included studies of metabolic risk factors for coronary heart disease and the effects of sex hormone deficiency and replacement, and the diagnosis, prevention and treatment of osteoporosis. He has over 460 publications in journals and books, including 12 textbooks. He is Chairman of the charity Women’s Health Concern, Trustee of the British Menopause Society, and Executive Committee Member of the International Society of Gynecological Endocrinology. He was made Fellow Honoris Causa of the RCOG in 2022 for his contribution to women’s healthcare.
Abstract:
Many bone-active agents will help to prevent osteoporotic fractures. These treatments include hormone replacement therapy (HRT) and bisphosphonates, as well as tibolone, raloxifene and parathyroid hormone receptor agonists teriparatide and abaloparatide.
Whilst HRT should remain a first-line therapy for primary prevention of osteoporosis in postmenopausal women, and is a mainly safe therapy, bisphosphonates offer an alternative. However, longer term safety issues with bisphosphonates are now recognised. These include osteonecrosis of the jaw (ONJ) and fragility fractures of the femur. Teriparatide and abaloparatide, PTH receptor agonists, are anabolic agents which reduce vertebral fractures, but effects on hip fractures remain unknown and they are extremely expensive.
New therapeutic agents act on cell signalling systems. Denosumab is very effective in treating osteoporosis. However, side-effect include an increase in infections as well as ONJ and femoral fragility fractures. Romozosumab boosts the Wnt-LRP signal to osteoblasts but has been linked to increases in cardiovascular events as well as ONJ and fragility fractures. These newer agents may prove to have very potent bone effects but are extremely expensive, and are they any better or safer than our older treatments? For most women, the use of HRT or bisphosphonates seems the best economical management.