Facts About New Osteoporosis Treatments

May is Osteoporosis Awareness and Prevention Month.

Ben Swanson is a dentist by profession, but bone health is at his heart.

Swanson, CEO and co-founder of drug development company Skeletalis, and his team are developing bone-targeting technology to protect and rebuild bones in people with musculoskeletal disorders such as osteoporosis.

“The core logic of what we are doing is to broadly expand musculoskeletal health into the era of precision medicine,” Swanson said. “Through a biology-driven approach to understanding how disease develops, we are designing a platform to obtain drugs in a highly targeted manner, with the end result being drugs and treatments that lead to freedom from fractures.”

And this is very important. Most people don’t even know they have a bone disease until a fracture or break occurs. And one in three women over the age of 50 will fracture a bone due to osteoporosis.

“Bone disease is less visible. It doesn’t hurt very often, but it’s a disease. And fractures are something that affects everyone. Everyone has a family member or someone close to them who suffers a fracture, and the consequences are devastating,” Swanson said. “This could be a life-ending event and there really is no treatment that can keep up with the rest of the science.”

We spoke with Swanson about the need to advance osteoporosis treatment options, the benefits of precision therapy, and how biotechnology is changing the way bone diseases are treated.

This interview has been edited for clarity and length.

HealthyWomen: As co-founder of Skeletalis, what inspired you to start a company focused on treating musculoskeletal disorders?

Ben Swanson: I think I was inspired by my fascination with the idea that bone is an organ that is constantly remodeling, that is, constantly changing and adapting. And as someone who studies bone healing, it becomes clear that given that musculoskeletal conditions like osteoporosis affect so many people, there is a tremendous opportunity to create more specific and precise drugs.

The idea is that if we could deliver drugs to the bone where the disease occurs, i.e., on the bone’s physical surface, we could improve both its efficacy and ability to treat disease, and reduce unwanted side effects.

hardware: Advances in osteoporosis treatment options have not shown the same level of innovation as other areas of medicine. Why is progress slow in treating osteoporosis and bone health?

Swanson: Osteoporosis is not a disease that can be confirmed through a simple blood test, such as lowering cholesterol levels. It cannot necessarily measure changes in tumor appearance or survival. We’re trying to demonstrate strength and reduce fractures, but fractures don’t happen every day, and in fact fractures are failures of treatment, and when it comes to failures, we don’t study much of the different drugs.

Research in this area has historically been slow because of the need for long-term clinical trials. One of the things we are very excited about in osteoporosis is the recent changes to the regulatory framework called the SABER Initiative. This made testing much faster and cheaper and actually opened the door to modern developments.

Another thing that’s really important here is that historically, osteoporosis treatments work by closing down the bone. Recent advances in our understanding of why bone degenerative diseases occur and how they switch from a normal maintenance mode to a degenerative or imbalanced mode may allow us to design much more precise treatments. For the first time, we have a combination of exciting new science, a new understanding of why these diseases occur, and a regulatory environment that allows us, as a small company, to make meaningful change.

HW: Please tell us how the company’s Osteoclast Activation Skeletal Intervention System (OASIS) approach differs from existing osteoporosis treatments.

Swanson: If you think about traditional drugs (which could be any drug), they often affect the entire body, so more of the drug is needed and different areas are exposed. The way we think about treatment with OASIS technology is to focus treatment in a precise and thoughtful manner on the areas where osteoclasts, the cells responsible for bone structure and osteoporosis, actually form.

We think of it as a precision skeletal treatment platform technology that covers all diseases, rather than simply a treatment for osteoporosis. With the diversity of skeletal diseases present and all requiring the safety of a precise or targeted approach, we see tremendous opportunity across the women’s lifespan.

HW: What role does screening play in preventing bone loss before a fracture occurs?

Swanson: A fracture is a failure of the skeleton, and for many people it is the beginning of the end. Some people die within a year of a fracture, and many patients never return home. This is a huge cost burden. We are pushing people out of their communities, their families and their jobs. The greatest opportunity we see is to prevent fractures from occurring in the first place.

We, as a clinical community, have an opportunity to shift the treatment of osteoporosis from reactive treatment to prevention and to think about how to stop or reverse the disease before it enters the fracture cascade. Because after a first fracture, the likelihood of a second fracture is much higher.

We also need to make sure women get screened earlier and more often. If you’re only looking at later stages in people who are 10 to 15 years beyond menopause, you can only intervene then, so we need to think about early screening and early detection awareness so that patients can ask for these things. Although this is actually preventable, it can also be a normal part of perimenopause or before menopause.

HW: Some women are hesitant to take existing osteoporosis medications because of potential side effects. How can next-generation treatments improve the safety and reliability of treatments?

Swanson: When thinking about safe and effective medications, the ideal is one that is more precise. The side effects of many currently used drugs are primarily due to their lack of precision in both disease processes and tissues.

The next generation of drugs must be designed for real-world use and the journey patients will face. This is an easier treatment to continue. It fits into your normal lifestyle, is suitable for long-term treatment and prevents complications.

When thinking about a new treatment for patients, it’s not just a matter of making sure it works (of course this is important), but also ensuring that they can live with it for a long period of time and that it will make a meaningful difference to the rest of their healthy lives.

HW: Bone density testing and treatment are underutilized. What do you think about the changes that need to be made to improve women’s access to these services?

Swanson: Unfortunately, osteoporosis is still primarily diagnosed in emergency rooms at a time when people are not thinking about managing their chronic disease. And because emergency medical providers are unable to manage patients long-term, care for patients becomes highly fragmented.

Bone health needs to move much earlier in the treatment conversation as part of team prevention. I liken this to the change in diagnosing breast cancer with early mammography. Bone health needs to be addressed in mainstream health care.

Osteoporosis is not a disease caused by eating or exercising outside. This is a real biological condition, and estrogen decline begins to occur several years before menopause. By age 65, the disease has already started, so I think there’s a real opportunity to start testing earlier.

Screening is not invasive. It’s safe and accurate. Therefore, routine testing should take place in all community health centres, gyms and all primary care practices. One thing that’s really important, like many other diagnostic tools, is that screening tests actually show changes over time, rather than providing a single snapshot. If you start taking baseline measurements on patients in their 40s, you have a real opportunity to detect change, now that the conversation has been had, the data has been established, and you can intervene in a much less reactive way.

HW: How are advances in biotechnology shaping the future of bone disease treatment?

Swanson: We can think about this in two ways. One is how to treat the disease, and the second is how to detect changes in the disease. On both counts for detection, we already have a really good tool called DEXA scanning.

We’re also seeing the use of artificial intelligence in some of these scan analytics to make sense of the data and further personalize it. This is really interesting.

In the drug world, I think we’re seeing the same changes we’ve already seen in diseases like cancer, cardiovascular disease, and neurological diseases like Alzheimer’s disease. The opportunity is to determine how to transition from broad, non-specific therapies to highly targeted, highly precise therapies.

When I think about the future of bone health, I think it will be very similar to other therapeutic areas, with treatments becoming more precise, more personalized, and focused on prevention and preservation of function rather than reactive treatments.

HW: Besides Skeletalis, what are the most exciting current health innovations for musculoskeletal disorders?

Swanson: The larger area of ​​musculoskeletal health, particularly for women who are living longer, healthier, more active lives, is seeing a shift from diagnosis to risk detection. Breast cancer is a prime example. In the case of degenerative diseases caused by aging and diseases with genetic risk factors, these conditions are often diagnosed historically, when the disease has already occurred and the damage has already occurred. What we’re seeing is a huge increase in accessibility and new technologies to diagnose disease early and understand risk. This is enhanced by artificial intelligence/machine learning and the ability to provide more personalized care by actually understanding what a personalized comprehensive data package looks like for each individual.

We are already seeing new models of care delivery. Telehealth is a very interesting example, and virtual primary care pathways specific to menopausal and post-menopausal women mean easier access to specialists for an integrated approach. Making it easier for women to be assessed, monitored, tested, ask questions, and understand their risks makes everything easier and lowers barriers to care.