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Current and emerging osteoporosis pharmacotherapy for women: state of the art therapies for preventing bone loss |
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| Authors: | Andreas Fontalis Eustathios Kenanidis Rafail Angelos Kotronias Afroditi Papachristou Panagiotis Anagnostis Michael Potoupnis |
| Affiliation: | 1. Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK;2. Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK;3. Academic Orthopaedic Unit, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece;4. Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece;5. Division of Cardiovascular Medicine, Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK;6. Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK;7. Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece;8. Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynaecology, Aristotle University Medical School, Thessaloniki, Greece |
| 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 |