Abstract
Osteoporosis and fragility fractures are serious public health problems, which
greatly impact individual health and the economy of other health services.
Pharmacological treatment is still one of the main elements of clinical
intervention, combined with non-pharmacological measures, in preventing the
occurrence of fragility fractures. The emergence of promising new
pharmacological options in the treatment of osteoporosis seems to renew
expectations in the prevention of complications and a subsequent reduction in
morbidity and mortality, including symptomatic treatment, improved physical
function and a better quality of life. This review aims to provide updated
information on the pharmacological treatment of osteoporosis in the adult
population. A comprehensive PubMed search was performed to review the current
evidence on osteoporosis treatment. Of the 378 articles identified from the
initial queries, the final review included 80 articles. Currently, the following
pharmacological options are available: antiresorptive (bisphosphonates,
denosumab, postmenopausal hormone replacement therapy and selective oestrogen
receptor modulators), bone-forming agents (essentially, teriparatide and
abaloparatide) and the new dual-action therapy (romosozumab), recently approved
by the US Food and Drug Administration and the European Medicines Agency, but
which is not yet an option in Portugal. Therapeutic selection is essentially
based on assessment of cost-effectiveness, since current evidence does not
suggest any differences between the distinctive classes in reducing the risk of
fractures, but this analysis is limited by the scarcity of comparative
intraclass studies. Notwithstanding, romosozumab, as a dual effect therapy, is
promising in resolving the physiological limitations resulting from the merely
unilateral action of antiresorptive agents and bone-forming agents in the
inseparable relationship between bone formation and resorption. However, its
cardiovascular safety raises some concerns, and this topic is still being
debated. The underdiagnosis and the undertreatment of osteoporosis remain one of
the greatest challenges of the 21st century. Over the years, new drugs have
appeared that have tried to address these problems with a direct impact on the
health of populations, but a long way remains to be come in optimising their
effectiveness, safety and tolerability.
Key words
osteoporosis - bone density conservation agents - denosumab - romosozumab - abaloparatide
Schlüsselwörter
Osteoporose - Mittel zur Erhaltung der Knochendichte - Denosumab - Romosozumab - Abaloparatid
