title: Current and future treatment options in osteoporosis.
abstract: OBJECTIVE
  The incidence of osteoporosis-related fractures will increase substantially over the coming decades as the population ages globally. This has important economic and public health implications, contributing substantially to morbidity and excess mortality in this population.
  
  
  METHODS
  When prescribing for older patients the effectiveness profile of drugs needs to be balanced against their tolerability in individual patients.
  
  
  RESULTS
  Currently we have good anti-fracture data to support the use of many available anti-resorptive and anabolic drugs including bisphosphonates, strontium ranelate and recombinant human parathyroid hormone. We also have evidence to demonstrate the importance of calcium and vitamin D repletion in these patients. However, in recent years our understanding of normal bone physiology and the mechanisms underlying the development of osteoporosis has significantly advanced and this has led to the development of new therapies. Novel agents, particularly denosumab, but also inhibitors of cathepsin K and anabolic agents that act on Wnt signalling, will increase the therapeutic options for clinicians in the coming years.
  
  
  CONCLUSIONS
  This review discusses the evidence supporting the use of currently available treatment options for osteoporosis and potential future advances in drug therapy. Particular consideration should be given when prescribing for certain older patients who have issues with compliance or tolerance and also in those with co-morbidities or levels of frailty that may restrict the choice of therapy. Understanding the evidence for the benefit and possible harm of osteoporosis treatments is critical to appropriate management of this patient population.
authors.affiliation: General and Geriatric Medicine, Beaumont Hospital, Dublin, Ireland. lindabrewer@physicians.ie.
authors.forename: Linda
authors.initials: L
authors.lastname: Brewer
authors.affiliation: General and Geriatric Medicine, Beaumont Hospital, Dublin, Ireland.|Geriatric Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Williams
authors.affiliation: General and Geriatric Medicine, Beaumont Hospital, Dublin, Ireland.
authors.forename: Alan
authors.initials: A
authors.lastname: Moore
mesh_terms: D045930:Anabolic Agents / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D008954:Models, Biological; D058990:Molecular Targeted Therapy; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors
chemical_list: D045930:Anabolic Agents; D050071:Bone Density Conservation Agents