Pharmacological Management of Osteoporosis in Postmenopausal Women: The Current State of the Art

Abstract

Osteoporosis is a common disease that increases fracture risk. Fragility fractures bring heavy consequences in terms of mortality and disability, with burdensome health and social costs. In subjects with clinical bone fragility, the first goal is to identify the secondary forms of osteoporosis, especially in young subjects, in males and in patients who recently experienced a fragility fracture. In addition, before considering any sort of treatment, it is fundamental to check for adequate calcium and vitamin D intake, since their deficiency is the most common reason for drug failure. In the last decade of the 20th century, several molecules have been developed and proved to be effective in achieving the true goal of any antiosteoporotic drug: fracture prevention. In this article, we considered the most commonly prescribed antiresorptive drugs (hormonal therapy, bisphosphonates, and denosumab), the anabolic agents (teriparatide), the dual-action drugs (romosozumab), and the drugs characterized by an unclear mechanism of action (strontium ranelate) to provide physicians with useful insights for their clinical practice. We discussed the main criteria for the appropriate choice selection and management of each treatment. Finally, we addressed the current controversies related to treatment discontinuation, sequential, and combination therapy.

Strontium ranelate incorporated 3D porous sulfonated PEEK simulating MC3T3-E1 cell differentiation

“…However, long-term OP therapy would increase risk of vascular events, allergies and osteonecrosis [ 16–18 ]. Strontium ranelate (SR) is FDA-approved clinical drug for OP therapy [ 19 , 20 ]. This SR was reported to modulate bone metabolism by facilitating osteoblast proliferation and inhibiting osteoclast differentiation [ 21–23 ].…”

The Role of Endocannabinoid System in Menopause and Its Related-Diseases

“…Osteoporotic fractures cause loss of mobility and several complications, deeply harming the quality of life of these women [49]. Hormone Replacement Therapy (HRT) is considered the first-line choice for the prevention and treatment of OP-related fractures in postmenopausal women at risk of fracture and younger than 60 years [50,51]. Conversely, standard HRT in women older than 60 years is not recommended due to the potential risk of long-term complications, including breast cancer, stroke and thromboembolic events [10,[52][53][54].…”

The Improving Effect and Safety of Probiotic Supplements on Patients with Osteoporosis and Osteopenia: A Systematic Review and Meta-Analysis of 10 Randomized Controlled Trials

“…e onset of primary osteoporosis is related to heredity, aging, hormone levels, immunity, environmental factors, and nutritional status [7,8]. According to the pathogenesis of osteoporosis, the current treatment needs to be combined with lifestyle adjustment, bone health supplement addition, drug intervention, and rehabilitation [9][10][11].…”