title: Treatment needs and current options for postmenopausal osteoporosis.
abstract: BACKGROUND
  Osteoporosis is a chronic, skeletal disorder characterized by compromised bone strength and increased risk of fractures, affecting up to 50% of postmenopausal women worldwide. Over the past 2 decades there have been consistent developments in the pharmacotherapy of osteoporosis with the availability of potent inhibitors of bone resorption (bisphosphonates, and denosumab) or stimulators of bone formation (PTH analogs) with substantial improvements over calcitonin or estrogen replacement.
  
  
  METHODS
  In this review we summarize the effects of existing treatment options for postmenopausal osteoporosis along with the unmet clinical needs and we discuss about the potential benefits of new compounds under development.
  
  
  CONCLUSIONS
  Despite the recent progresses, there are still limitations and unmeet needs with all the available drugs, mainly concerning treatment adherence, efficacy on the prevention of nonvertebral fractures and the long-term adverse events of antiresorptive regimens. Moreover, PTH analogs are the only available compounds able to stimulate bone formation, but with a restricted anabolic window of no more than 2 years. Of interest, the more recent advances in bone biology identified new targets for the development of drugs with a more potent and selective activity on either osteoclasts or osteoblasts, thus making possible to uncouple bone formation from bone resorption.
authors.affiliation: a Department of Medicine, Surgery and Neurosciences , University of Siena , Siena , Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Gennari
authors.affiliation: a Department of Medicine, Surgery and Neurosciences , University of Siena , Siena , Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rotatori
authors.affiliation: a Department of Medicine, Surgery and Neurosciences , University of Siena , Siena , Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Bianciardi
authors.affiliation: a Department of Medicine, Surgery and Neurosciences , University of Siena , Siena , Italy.
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
authors.affiliation: a Department of Medicine, Surgery and Neurosciences , University of Siena , Siena , Italy.|b Division of Genetics and Cell Biology, Age Related Diseases , San Raffaele Scientific Institute , Milano , Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Merlotti
mesh_terms: D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*
chemical_list: D004164:Diphosphonates
keywords: Osteoporosis; SERMS; abaloparatide; bisphosphonates; cathepsin K; denosumab; odanacatib; romosozumab; sclerostin; teriparatide