Osteoporosis can cause the bones to become so weak and brittle that falling down or even just coughing or bending over can cause a fracture. Women who are past menopause are at greatest risk of osteoporosis due to the loss of estrogen. Fractures may lead to hospitalizations and other complications, especially in elderly patients.
The FDA recently approved a new treatment for postmenopausal osteoporosis which appears to be very effective at building bone density. The currently available products fall into two categories, anti-resorptive or anabolic.
Anti-resorptive medications work by decreasing the amount of bone mineral that is absorbed out of the bone through the constant remodeling process that bone cells undergo. This remodeling process helps maintain appropriate levels of calcium in the blood and also to repair damage in the bone matrix. Anti-resorptive medications include bisphosphonates (alendronate, risedronate) calcitonin, estrogens, and raloxifene.
Anabolic agents work by increasing the formation of new bone. These are a better choice for patients with severe osteoporosis, or who developed osteoporosis from taking corticosteroids. Anabolic agents for osteoporosis include teriparatide and abaloparatide. The newest anabolic agent that was just approved is called romosozumab.
Romosozumab is given in 2 consecutive injections once a month. The bone forming effect declines after 12 months, so use beyond 12 doses is not recommended. It works by inhibiting sclerostin, a protein that blocks bone formation. Studies showed that one year of treatment with romosozumab reduced the risk of a spinal fracture by 73%. If treatment is needed beyond one year, the patient should switch to an anti-resorptive treatment.
Studies also indicated that romosozumab may increase the risk of heart attack or stroke, so healthcare professionals should carefully consider the risks and benefits when selecting treatment.