Before the break: pharmacotherapeutic approachesto osteoporosis

Osteoporosis is a systemic skeletal disease characterised by reduced bone mass and deterioration of bone microarchitecture, leading to increased bone fragility and susceptibility to fractures. Despite the availability of diagnostic tools and pharmacotherapy, osteoporosis remains underdiagnosed and undertreated. Bone remodelling is regulated by the coordinated activity of osteoclasts, osteoblasts, and osteocytes, with hormonal and nutritional factors contributing to bone homeostasis. This review discusses the pathophysiology, classification, and current treatment approaches for osteoporosis, with emphasis on recommendations relevant to South African practice. Osteoporosis management includes lifelong non-pharmacological interventions, including optimising calcium and vitamin D intake, regular weight-bearing exercise, smoking cessation, reducing alcohol intake, and implementing fall prevention strategies. Effective osteoporosis management requires systematic assessment, appropriate pharmacological intervention, and long-term monitoring to reduce fracture risk, maintain therapeutic outcomes, and improve quality of life. Pharmacological treatment aims to reduce osteoporosis through antiresorptive or anabolic means; however, it may contribute to several notable adverse effects that need to be considered during therapy. Approaching management of osteoporosis from a holistic perspective thus allows for promoting a bone-healthy lifestyle, while mitigating pathophysiological changes using medication.