Osteoporosis Treatment Strategies: Current Concepts

Abstract

Osteoporosis is a common condition, affecting 19.6% of women over 50 and 4.4% of men over 50. Fragility fractures are a common complication associated with osteoporosis and carry a significant risk of subsequent morbidity and mortality, particularly hip fractures. Several factors, including estrogen withdrawal during menopause, sedentary lifestyles, poor nutrition, smoking, and genetics, can predispose individuals to osteoporosis. Diagnosis is based on a history of fragility fracture, decreased bone mineral density on dual x-ray absorptiometry (DEXA) scan, and fracture risk factors assessed using the fracture risk assessment tool (FRAX). Treatments can be medical or non-medical. Medical management of osteoporosis falls into two categories: anti-resorptive and anabolic therapies. Anti-resorptive therapies such as bisphosphonates, selective estrogen receptor modulators (SERMS), denosumab, and calcitonin function by decreasing osteoclast function and number. Anabolic therapies include parathyroid hormone (PTH) analogs and sclerostin inhibitors, which upregulate the Wnt transcription factor pathway to stimulate bone formation. Non-medical interventions such as nutrition optimization, weight-bearing exercise, and smoking cessation should be recommended and can benefit osteoporosis patients.