Medical Management of Osteoporosis: Updates and Future Directions

Abstract Osteoporosis, characterized by deterioration of bone microarchitecture, increased bone fragility, and subsequent low-trauma fractures, is the most prevalent bone disease in human beings. Fortunately, preventive treatments are available that can help to maintain or increase bone density and prevent fractures. Oral bisphosphonates remain the first choice of therapy in majority of the people, whereas zoledronic acid and denosumab are the other anti-resorptive drugs to treat osteoporosis. In high-risk patients, teriparatide and the recent addition, romosozumab, are the anabolic agents that improve bone density, increase bone strength, and prevent fractures. However, all of these medications are effective and safe over a finite duration, and most patients with osteoporosis need more than one medication to treat the disease and prevent fractures over their lifetime. Thus, in this review, we focus on the current options for the medical management of osteoporosis, evidence and practicality of sequential and combination treatment, and future therapies in the pipeline. Prevention of recurrent fractures after a primary fragility fracture is a very important but neglected part of medical therapy, and the multidisciplinary Fracture Liaison Services can play a significant role in addressing the gaps in care that often lead to recurrent fractures, and improve the quality of life for individuals at fracture risk.