Current and emerging osteoporosis pharmacotherapy for women: state of the art therapies for preventing bone loss

ABSTRACT

Introduction: Pharmacological options to address the imbalance between bone resorption and accrual in osteoporosis include anti-resorptive and osteoanabolic agents. Unique biologic pathways such as the Wnt/β-catenin pathway have been targeted in the quest for new emerging therapeutic strategies.

Areas covered: This review provides an overview of existing pharmacotherapy for osteoporosis in women and explore state-of–the-art and emerging therapies to prevent bone loss, with an emphasis on the mechanism of action, indications and side effects.

Expert opinion: Bisphosphonates appear to be a reliable and cost-effective option, whereas denosumab has introduced a simpler dosing regimen and may achieve a linear increase in bone mineral density (BMD) with no plateau being observed, along with continuous anti-fracture efficacy. Abaloparatide, a parathyroid-hormone-related peptide (PTHrP)-analogue, approved by the FDA in April 2017, constitutes the first new anabolic osteoporosis drug in the US for nearly 15 years and has also proven its anti-fracture efficacy. Romosozumab, a sclerostin inhibitor, which induces bone formation and suppresses bone resorption, has also been developed and shown a significant reduction in fracture incidence; however, concerns have arisen with regard to increased cardiovascular risk.

KEYWORDS:

• Osteoporosis
• antiresorptive medications
• osteoanabolic agents
• abaloparatide
• sclerostin
• romosozumab

Article highlights

• Anti-resorptive drugs have spearheaded efforts to address bone loss in osteoporosis, while osteoanabolic agents play a key role in high risk patients and combination therapy.

• Abaloparatide, approved by the FDA in April 2017, has been the first new anabolic anti-osteoporotic medication in the US for nearly 15 years.

• The third generation of bisphosphonates employed to date for the treatment of osteoporosis (alendronate, ibandronate, zoledronate, risedronate) appears to be a reliable and cost-effective option.

• Regarding the third generation of bisphosphonates, concerns have been raised with respect to their link to osteonecrosis of the jaw (ONJ) and atypical femoral bone fractures (AFFs). In addition, poor compliance has been reported owing to complex dosing regimen, while long-term efficacy (> 5 years) is yet to be established

• There is a need for increasing public health awareness and healthcare provider education regarding screening, prevention and treatment of osteoporosis. In addition, the development of new pharmacological approaches that meets the current unmet needs are still required.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.