[To where and until when handle the osteoporosis?]

Area of Science:

• Endocrinology
• Bone Metabolism
• Pharmacology

Background:

• Osteoporosis management involves antiresorptive therapies (estrogen, SERMs, bisphosphonates, denosumab) and bone-forming agents (teriparatide).
• Current osteoporosis treatments have defined durations or limitations, with teriparatide limited to 24 months.
• A clear target for successful osteoporosis treatment, beyond fracture prevention, is lacking.

Purpose of the Study:

• To review current osteoporosis treatment strategies.
• To discuss criteria for continuing, intensifying, or modifying osteoporosis therapy.
• To explore the concept of a 'therapeutic window' in osteoporosis management.

Main Methods:

• Literature review of osteoporosis pharmacotherapies.
• Analysis of treatment persistence and fracture risk assessment.
• Discussion of drug holidays and sequential therapy.

Main Results:

• Antiresorptive therapies can be used long-term, while teriparatide has a 24-month limit.
• High fracture risk (prevalent fractures, low bone mineral density) warrants continued or intensified treatment.
• Low fracture risk may permit a 'therapeutic window' after bisphosphonates, but denosumab may require subsequent therapy.

Conclusions:

• Treatment decisions in osteoporosis should consider individual fracture risk.
• A 'therapeutic window' concept is relevant after certain antiresorptive therapies.
• Sequential therapy may be necessary following denosumab treatment.