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Drug Insight: existing and emerging therapies for osteoporosis

Nature Clinical Practice Endocrinology & Metabolism volume 2, pages 670–680 (2006)Cite this article

Abstract

Osteoporosis is a major public health problem that is characterized by microarchitectural deterioration, low bone mass, and increased risk of fractures. Currently, many women and men affected with this disease are not diagnosed or treated. As osteoporosis is often clinically silent, risk-factor assessment and measurement of BMD are needed to identify those who may benefit from osteoporosis therapy. Although adequate daily intake of calcium and vitamin D, and regular weight-bearing exercise are important for skeletal health, they are not adequate treatments for individuals with osteoporosis. Therapies approved for treatment and/or prevention of osteoporosis in the United States include oral bisphosphonates (alendronate, ibandronate and risedronate), calcitonin, estrogens, teriparatide (parathyroid hormone fragment [1–34]), and raloxifene. For most patients, oral bisphosphonates are the treatment of choice, given the large-scale randomized-trial data demonstrating efficacy in fracture reduction, although bisphosphonates that reduce spine and nonspine fractures (e.g. alendronate and risedronate) are preferred. For high-risk patients (those with very low bone density, or with fractures), teriparatide therapy for 2 years should be considered. The treatment paradigm for osteoporosis will evolve further as promising new treatments progress through clinical development.

Key Points

  • Osteoporosis is a common disease in aging women and men, and it is a significant contributing factor to more than 1.5 million fractures of the spine, hip, and forearm each year in the United States

  • Initial therapy includes adequate calcium, vitamin D, and weight-bearing exercise; vitamin D insufficiency is common, and many investigators believe that the minimum 25-hydroxyvitamin D level necessary to reduce fracture risk clusters is in the range 70–80 nmol/l (28–32 ng/ml)

  • Although estrogen replacement therapy is effective in preventing fracture, it is no longer recommended for long-term treatment of osteoporosis

  • The oral bisphosphonates are the most widely used antiresorptive therapies for the treatment of osteoporosis: alendronate and risedronate decrease risk of vertebral and nonvertebral fractures, but the ideal duration of bisphosphonate use is uncertain

  • Parathyroid hormone administered intermittently improves skeletal microarchitecture, improves bone mass, and decreases vertebral and nonvertebral fractures

  • Several new and promising osteoporosis therapies are under investigation and the management of osteoporosis will continue to evolve as emerging therapies become available; osteoporosis therapy should be individualized, weighing fracture risk, therapy benefits, and side effects

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Figure 1: Volumetric bone density in postmenopausal women treated with parathyroid hormone (1–84), alendronate, or both

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Authors and Affiliations

  1. Medicine at Harvard Medical School,

    Jean E Mulder, Nikheel S Kolatkar & Meryl S LeBoff

  2. Brigham and Women's Hospital,

    Jean E Mulder, Nikheel S Kolatkar & Meryl S LeBoff

  3. Division of Endocrinology, Brigham and Women's Hospital, and Harvard Medical School,

    Jean E Mulder, Nikheel S Kolatkar & Meryl S LeBoff

  4. Medicine at Harvard Medical School and Director of the Skeletal Health and Osteoporosis Center at Brigham and Women's Hospital, Boston, MA, USA

    Jean E Mulder, Nikheel S Kolatkar & Meryl S LeBoff

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Correspondence to Jean E Mulder.

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MS LeBoff declared associations with the following companies: Amgen (stock ownership), Eli Lilly (research grant), Novartis (consultant, research grant), NPS Allelix (research grant), and Procter & Gamble (advisory board). The other authors declared they have no competing interests.

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Mulder, J., Kolatkar, N. & LeBoff, M. Drug Insight: existing and emerging therapies for osteoporosis. Nat Rev Endocrinol 2, 670–680 (2006). https://doi.org/10.1038/ncpendmet0325

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