Current Knowledge, Drug-Based Therapeutic Options and Future Directions in Managing Osteoporosis

Osteoporotic fractures are a worldwide problem that increase mortality of elderly patients leaving a high cost to the world economy. In addition to exercise and supplementary regimens, medications and pharmaceutical agents are used for osteoporosis management. Anti-resorptive drugs particularly bisphosphonates are the classic option. However, anti-resorptive therapy alone may not be a suitable option for all the patients. Osteoporosis may occur as a result of increase in bone resorption, decrease in new bone formation or combination of both. Depending on which mechanism (anabolic vs. catabolic vs. both) is involved, various anti-resorptive and bone-forming drugs or a combination of them may be used for the management of osteoporosis patients. This review focuses on drug-based therapeutic options for the management of osteoporosis patients to find out which of the many available protocols may be the correct solution according to the patient's condition. In this review, we introduce the most recent and important anti-resorptive, bone-forming and dual-mode action drugs, discuss about their accurate mechanism of action, side effects and limitations and review the most recent clinical studies used them for managing osteoporosis. We also compare the available treatment options with each other and discuss about the role of combination therapy for the management of osteoporosis.