title: Novel advances in the treatment of osteoporosis.
abstract: Osteoporosis is a significant public health issue affecting over half of women aged over 50. With an aging population, its importance is set to increase further over time. Prevention of fragility fractures avoids significant mortality and morbidity as well as saving significant direct and indirect costs to the economy. In this review, we discuss existing treatments to contextualize the treatment landscape, and demonstrate how our understanding of bone pathophysiology has led to novel therapies-in the form of combinations and altered durations of existing treatments, as well as newer drug therapies.
  
  
  
  PubMed and Embase were searched for randomized controlled trials of new therapies for osteoporosis. These searches were supplemented with material presented in abstract form at international meetings.
  
  
  
  New drugs that appear promising in the treatment of osteoporosis include the cathepsin K inhibitor, monoclonal antibodies against sclerostin and parathyroid hormone-related protein analog.
  
  
  
  Separate to the development of novel drug therapies is the issue of how best to use agents that are currently available to us; specifically which agent to choose, alone or in combination; duration of therapy; how best to identify patients at highest risk of fracture, and to ensure the highest possible adherence to medication. Many of these issues have been addressed in other excellent review papers, and will not be considered in detail here.
  
  
  
  As with all new treatments, we await results of long-term use and experience in 'real life' patient populations.
  
  
  
  As alluded to above, data are urgently required regarding the optimal duration of therapy; use of combination therapy; ordering of therapies for best therapeutic effect. As stratified medicine becomes more strongly considered in all areas of therapy, its merits in osteoporosis as in other musculoskeletal conditions, is timely and valuable.
authors: University Hospital Southampton NHS Foundation Trust, Rheumatology Department, Southampton General Hospital, Southampton, SO16 6YD, UK.
authors: Christopher K Y
authors: CK
authors: Chan
authors: University Hospital Southampton NHS Foundation Trust, Rheumatology Department, Southampton General Hospital, Southampton, SO16 6YD, UK.
authors: Alice
authors: A
authors: Mason
authors: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
authors: Cyrus
authors: C
authors: Cooper
authors: Elaine
authors: E
authors: Dennison
mesh_terms: D001713:Biphenyl Compounds / Q000627:therapeutic use; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002136:Calcium, Dietary / Q000627:therapeutic use*; D056657:Cathepsin K / Q000037:antagonists & inhibitors; D019587:Dietary Supplements; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control*; D044162:Parathyroid Hormone-Related Protein / Q000037:antagonists & inhibitors / Q000276:immunology; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use*
chemical_list: D001713:Biphenyl Compounds; D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D004164:Diphosphonates; C470121:PTHLH protein, human; D044162:Parathyroid Hormone-Related Protein; D014807:Vitamin D; D056657:Cathepsin K; C527128:odanacatib
keywords: bone; fracture; osteoporosis; treatment; trial