Wednesday, July 3, 2013

What is Next in Osteoporosis Treatment?

Postmenopausal osteoporosis (low bone mass) is a huge global problem. The National Osteoporosis Foundation estimates that about one in two women over the age of 50 will break a bone due to osteoporosis. By 2020, half of all Americans over age 50 are expected to have low bone density.  A recent paper from the Musculoskeletal Research Program at the University of Aberdeen, UK reviewed the present and future drug treatments for osteoporosis.

While exercise is often prescribed for prevention and treatment many women end up taking drugs on a regular basis to prevent further bone loss.  The mainstay of drug treatment since 1995 are a class of drugs called oral bisphosphonates – such as Fosamax, Actonel, or Didronel.  These drugs have been shown to prevent loss of bone (resorption) but they need to be taken frequently and the side effects can include gastrointestinal upset or, more rarely, femoral fracture.  Bisphosphonates can also be administered intravenously.  A bone-building drug (as opposed to a loss-prevention drug) has also been available since 2002 (Forteo). This drug requires sub-cutaneous injection and frequent administration.  The latest addition to treatment is an anti-resorptive called demosumab (Prolia) which has a different mode of action than the bisphosphonates and requires only one subcutaneous injection every 6 months.  All of the above products are FDA approved for the treatment of osteoporosis.

There are number of very promising new products in the pipeline.  Among the most important is a class of drugs called anti-sclerostin antibodies.  These have been shown to be dramatically successful in mice and human trials are under way.

The bottom line of the paper from Aberdeen is that there are now several drug treatment options for osteoporosis that have been shown to be effective.  In the future, drugs with fewer side effects and less frequent administration are likely to be available. This will increase compliance and reduce the risk of fracture.

Read details of the paper here.


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