Pharmaceutical Treatments of Osteoporosis

Osteoporosis is a common disease and the societal burden of osteoporosis-related fractures is substantial. Progress in the development of new therapies has occurred rapidly over the beginning of the 2000s to include nutritional and pharmacological (both anticatabolic and anabolic). These US Food and Drug Administration-approved agents all significantly reduce fracture risk, albeit through slightly different mechanisms. Anticatabolic agents, bisphosphonates, estrogen, selective estrogen receptor modulators, calcitonin, and anti-RANKL antibody (denosumab) target osteoclast development or activity to reduce remodeling. The only approved anabolic agent, teriparatide, targets osteoblast activity to enhance bone formation. The efficacy of these agents individually has let to interest in assessing various combination treatments in an attempt to maximize fracture risk reduction. Emerging therapies to reduce fracture include both anticatabolic (cathepsin K inhibitors) and anabolic (anti-sclerostin antibody) agents.