Osteoporosis: A Pharmacotherapy Update

Abstract

Hormone replacement therapy (HRT) was the gold standard in prevention and treatment of osteoporosis. However, with new data that demonstrate an increased risk of cardiovascular disease, breast cancer, venous thromboembolic disease, and stroke, HRT is no longer first-line therapy for most postmenopausal women. The bisphosphonates and raloxifene are antiresorptive agents that have been proven to increase bone mineral density and decrease fractures. These agents are considered to be the therapy of choice in prevention and treatment of postmenopausal osteoporosis. New dosing regimens for the bisphosphonates may improve adherence. The other dramatic change to the pharmacotherapy of osteoporosis is the approval of an agent that stimulates bone formation. Parathyroid hormone has the potential to significantly alter the current treatment approach. In addition, this article reviews the role of calcitonin and ipriflavone combination therapy and discusses data on investigational agents including ibandronate, zoledronic acid, vitamin K, and strontium ranelate.