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Lancet Diabetes Endocrinol. 2017 Nov;5(11):898-907. doi: 10.1016/S2213-8587(17)30188-2. Epub 2017 Jul 7.

Osteoporosis treatment: recent developments and ongoing challenges.

Author information

1
Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA; Endocrine Research Unit, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA. Electronic address: khosla.sundeep@mayo.edu.
2
Division of Endocrinology, Diabetes, and Bone Diseases, Carl Gustav Carus University Hospital, Dresden Technical University, Dresden, Germany; Centre for Healthy Aging, Carl Gustav Carus University Hospital, Dresden Technical University, Dresden, Germany.

Abstract

Osteoporosis is an enormous and growing public health problem. Once considered an inevitable consequence of ageing, it is now eminently preventable and treatable. Ironically, despite tremendous therapeutic advances, there is an increasing treatment gap for patients at high fracture risk. In this Series paper, we trace the evolution of drug therapy for osteoporosis, which began in the 1940s with the demonstration by Fuller Albright that treatment with oestrogen could reverse the negative calcium balance that developed in women after menopause or oophorectomy. We note a watershed in osteoporosis drug discovery around the year 2000, when the approach to developing novel therapeutics shifted from one driven by discoveries in animal studies and clinical observations (eg, oestrogen, calcitonin, and teriparatide) or opportunistic repurposing of existing compounds (eg, bisphosphonates) to one driven by advances in fundamental bone biology (eg, denosumab) coupled with clues from patients with rare bone diseases (eg, romosozumab, odanacatib). Despite these remarkable advances, concerns about rare side-effects of anti-resorptive drugs, particularly bisphosphonates, and the absence of clear evidence in support of their long-term efficacy is leading many patients who could benefit from drug therapy to not take these drugs. As such, there remains an important clinical need to develop ways to enhance patient acceptance and compliance with these effective drugs, and to continue to develop new drugs that do not cause these side-effects and have prolonged anabolic effects on bone. Such changes could lead to a true reversal of this potentially devastating disease of ageing.

PMID:
28689769
PMCID:
PMC5798872
DOI:
10.1016/S2213-8587(17)30188-2
[Indexed for MEDLINE]
Free PMC Article

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