Current outlook on the use of monoclonal antibody therapies for osteoporosis

The availability of monoclonal antibody therapies impacting on the basic pathways of bone formation; (romosozumab) and bone resorption (denosumab) has contributed greatly to our ability to manage patients with osteoporosis and fracture risk. Monoclonal antibodies offer the potential to optimize therapeutic efficacy with minimal adverse effects.

This review discusses aspects of registration clinical trials as well as experience gained from the clinical use of monoclonal antibodies for osteoporosis. The registration clinical trials prove anti-fracture efficacy with subsequent trials investigating bone mineral density, bone turnover markers, and high-resolution bone imaging. Many of these trials indicate superiority of monoclonal antibody therapy for osteoporosis compared with traditional antiresorbers such as bisphosphonates.

There remain significant care gaps in the management of patients at high risk of fragility fracture. Many patients at very high risk remain undiagnosed and therefore untreated. Monoclonal antibody antiresorptive therapy such as denosumab with high specificity and romosozumab with the ability to rapidly stimulate new bone formation are significant advances. Future therapies may direct 'maintenance' therapies to avoid reversal of beneficial effects on monoclonal antibody treatment discontinuation. Other novel therapies being investigated may provide benefits not only to osteoporosis but other diseases associated with aging.