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Treating osteoporosis to prevent fractures: current concepts and future developments.

Mattias Lorentzon1,2

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|January 19, 2019
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Antiresorptive drugs effectively reduce fracture risk in osteoporosis but have limitations. Newer anabolic therapies and sequential treatments show promise for severe cases, aiming for better long-term bone protection.

Keywords:
FRAXanabolic treatmentantiresorptive treatmentbone mineral densityosteoporosisromosozumab

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Area of Science:

  • Endocrinology
  • Gerontology
  • Orthopedics

Background:

  • Osteoporosis is a major health concern, particularly in postmenopausal women.
  • Antiresorptive drugs like bisphosphonates and denosumab are first-line treatments, reducing fracture risk.
  • Limitations exist due to rare side effects and treatment duration caps.

Purpose of the Study:

  • To review current osteoporosis treatments and their efficacy.
  • To explore newer anabolic therapies and their superiority in specific patient groups.
  • To propose optimal future treatment strategies for severe osteoporosis.

Main Methods:

  • Review of current antiresorptive and anabolic osteoporosis therapies.
  • Comparison of fracture risk reduction and bone mineral density (BMD) increase.
  • Analysis of treatment sequencing for severe osteoporosis.

Main Results:

  • Antiresorptives significantly reduce vertebral, nonvertebral, and hip fractures.
  • Anabolic agents like teriparatide and romosozumab demonstrate superior efficacy over bisphosphonates in certain contexts.
  • Sequential therapy (anabolic followed by antiresorptive) shows potential for superior long-term fracture prevention.

Conclusions:

  • While antiresorptives are effective, newer anabolic therapies offer advantages for high-risk patients.
  • Sequential treatment strategies are likely to become the future standard for managing severe osteoporosis.
  • Improved case-finding strategies are crucial to increase treatment initiation rates.