Anti-resorptives in the management of osteoporosis

Bone-active agents that decrease bone turnover (the anti-resorptive agents) have been, to date, the most thoroughly studied pharmacological agents for the management of osteoporosis in a variety of populations - postmenopausal, male, and glucocorticoid-induced osteoporosis - and have received both Food and Drug Administration (FDA) and Committee for Medicinal Products for Human Use (CHMP) as well as other worldwide registrations for the management of these conditions. While the mechanisms of action of 'anti-resorptives' as a class differ, their effect on increasing bone strength and reducing the risk of fragility fractures share common pathways: an increase in bone mineral content, and a reduction in bone turnover. Within the category of anti-resorptives: estrogen, selective estrogen receptor modulators, tibolone, calcitonin, bisphosphonates and denosumab all reduce vertebral fractures risk, but differ in their ability to reduce the risk of non-vertebral fractures in randomized clinical trials. This chapter will discuss the data on these effects for each class of anti-resorptive agent.