Perspectives

Anabolic therapy: a new paradigm for osteoporosis management

Perspectives

Anabolic therapy: a new paradigm for osteoporosis management

Albert S. Kim, Christian M. Girgis

Figures

© gary carlson/spl
© gary carlson/spl

Abstract

Osteoporosis is a chronic condition that requires a whole-of-life approach to prevent fractures. Antiresorptive therapies such as bisphosphonates and denosumab are effective medications to improve bone density and reduce fracture risk. In patients at very high risk of fractures, anabolic agents are effective in promoting bone mass gain and providing more potent and rapid antifracture effects.

Key Points

  • Osteoporotic fractures are associated with significant morbidity and premature mortality.
  • Antiresorptive medications such as bisphosphonates and denosumab are effective treatments for osteoporosis and significantly reduce fracture risk.
  • Patients at very high risk of fracture include those with recent or recurrent fractures, very low T-scores, glucocorticoid use and high risk of falls.
  • Anabolic therapies, such as teriparatide and romosozumab, stimulate bone formation. They result in significantly lower risk of fracture compared with antiresorptive treatments. These treatments are PBS-subsidised for use in people who experience fractures while on antiresorptive therapies.
  • GPs play an integral role in identifying patients at very high risk of fracture who would benefit from specialist referral and initiation of anabolic treatments.
  • Following a course of anabolic treatment, patients require subsequent treatment with an antiresorptive agent to consolidate gains in bone density and further reduce fracture risk.