Current pharmacotherapy of osteoporosis and its future

Abstract

Osteoporosis is a systemic bone disease characterised by loss of bone mass and abnormal remodelling of the micro-architecture of bone tissue. Worldwide, it is estimated that more than 200 million people suffer from this disease. In Poland, there were 2.1 million patients in 2018. Osteoporosis is not only a burden on the patient's health, but also a significant economic burden on society, which is reflected in the amounts spent annually on the treatment of osteoporosis and its complications. Over the last few decades, many advances have been made in the pharmacological treatment of osteoporosis, and detailed studies of the pathomechanism of this condition have led to a better understanding of it, making it possible to introduce bisphosphonates and biological drugs, among others. A promising research direction is the focus on osteoimmunology. Many new therapies are based on the latest discoveries in this field of science. Pharmacotherapy of osteoporosis is based on two main assumptions: inhibition of bone resorption and anabolic effect on bone metabolism. Bisphosphonates, selective estrogen receptor modulators and denosumab are among the drugs that inhibit resorption. Drugs with positive effect on bone formation include: calcium and vitamin D3 preparations, strontium ranelate, abaloparatide, teriparatide and romosozumab. At present, there are several drugs in clinical and preclinical trials, and there are also reports of positive effects on bone metabolism of drugs used in other diseases, e.g. GLP-2 used in treatment of short bowel syndrome. The new drugs are largely based on the mechanisms of action of osteoclasts and osteoblasts, whose involvement in the pathogenesis of osteoporosis is increasingly well understood. In this work, a brief historical outline of osteoporosis therapy is included, and the most common drug therapies currently in use are described. Additionally, the newest preparations, not yet available on the market, are presented, which may play a significant role in the treatment of osteoporosis in the future. Their mechanisms of action differ significantly from those currently used.

Keywords

• osteoporosis
• bone density
• monoclonal antibodies
• clinical pharmacology