title: Established and forthcoming drugs for the treatment of osteoporosis.
abstract: OBJECTIVE
  The aim of treatment in patients at high risk for fractures is to reduce the risk of a first or a subsequent fracture. New data are available on the antifracture effects and side-effects of antiresorptive and osteoanabolic drugs, and new emerging therapies with new modes of action are on the horizon.
  
  
  RESULTS
  Calcium and vitamin D intake should be sufficient, but not too high. Vertebral, nonvertebral (including hip fracture) prevention with antiresorptive drugs such as bisphosphonates (alendronate, risedronate and zoledronic acid) and denosumab exceeds the risk of rare side-effects such as atypical femur fracture and osteonecrosis of the jaw. Teriparatide is an osteoanabolic drug that improves quality of life in severe osteoporosis. Strontium ranelate decreases dynamic parameters of bone formation during the first year of treatment, and could increase the risk of cardiovascular events in high-risk patients. Initiation of and adherence to fracture prevention drugs are still low. New potential developments in antiresorptive drugs include odanacatib, a selective inhibitor of cathepsin K, and, in osteoanabolic drugs, monoclonal antibodies against sclerostin.
  
  
  CONCLUSIONS
  These recent data indicate that fracture prevention with antiresorptives and teriparatide is effective with a reasonable safety profile. Odanacatib and antisclerostin are promising new drugs with new mechanisms of action, as they are able to disconnect the normal coupling between bone resorption and bone formation.
authors.affiliation: aVU University Medical Center, Department of Rheumatology, Amsterdam bDepartment of Internal Medicine/Rheumatology, Maastricht University Medical Center and CAPHRI, Maastricht, The Netherlands cBiomedical Research Institute, University Hasselt, Belgium.
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
authors.forename: Piet
authors.initials: P
authors.lastname: Geusens
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002118:Calcium / Q000627:therapeutic use; D056657:Cathepsin K / Q000037:antagonists & inhibitors; D000069448:Denosumab; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control; D010281:Parathyroid Hormone / Q000627:therapeutic use; D013876:Thiophenes / Q000627:therapeutic use; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D010281:Parathyroid Hormone; D013876:Thiophenes; C081587:strontium ranelate; D014807:Vitamin D; D000069448:Denosumab; D056657:Cathepsin K; D002118:Calcium