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Update Evenity followed by 2 years of alendronate
Osteoporosis & Bone Health | Last Active: Nov 8, 2025 | Replies (33)Comment receiving replies
I reviewed briefly the cited source and it is way beyond my pay grade. However, my takeaway is that there are many sources of the 'cues' given to guide osteoblasts to go where they are needed.
The term 'coupled remodeling' should suggest only that osteoblast receive some sort of guidance on where to go NOT who/what issues that guidance.
Clearly some sort of 'coupling' is required for successful remodeling but how that is accomplished looks to be still at a theoretical stage. So it is not at all clear to me that bisphosphonates, which force into hibernation some part of osteoclastic activity, thereby also reduce osteoblast efforts.
I feel like I am missing something but have no idea what that might be.
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🙂 I also have indigestions from reading that article! The coupling concept has been discussed quite a bit in the literature - I added a citation mainly to prove I’m not making this stuff up, haha. As you pointed out, coupling is a very complex process involving overlapping mechanisms- biochemical (endocrine and paracrine), biomechanical, and cellular - and it’s certainly not one-way.
The TRIO study (Three Oral Bisphosphonate Therapies in Postmenopausal Osteoporosis) demonstrated an early decrease in the bone resorption marker CTX, followed by a subsequent decrease in the bone formation marker P1NP, as shown in the attached figures (alendronate data). That lagging pattern shows, indirectly but clearly, how resorption and formation remain linked, or “coupled", even under antiresorptive therapy.