[Bone and Calcium Research Update 2015. Therapy of osteoporosis--Now and future consideration of long-term therapy]

The target to treat osteoporosis is prevention for future fractures. After the evaluation of cathepsin K inhibitors (CKIs) which was developed as antresorptive agents, there is evidence that these agents also possess anabolic activity, suggesting that CKIs differ from so called antiresorptive agents such as bisphosphonates and denosumab. The classification of agents for treatment of osteoporosis has been changed. Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) and Atypical femoral fractures (AFFs) have been the problems when the therapy continues relatively for a long period. However, there is no clear guidance on when fracture risk has been reduced to an acceptably low level. As a consequence, some patients at low risk for fracture may be treated for longer than necessary, whereas others at high risk for fracture may have treatment stopped when they might benefit from continuation of the same treatment or a change to a more potent therapeutic agent. Therefore, a "treat-to-target" strategy for the management of patients with osteoporosis has been developed to describe the potential clinical utility of evaluating changes bone density and bone turnover markers, and events of fractures.