A new comprehensive review by Rachner and colleagues  focuses on osteoporosis therapies that have been recently introduced and those with novel mechanisms of action likely to succeed in ongoing clinical trials. The paper is extensively referenced. A discussion of new insights into bone biology precedes the review of clinical trials of new agents. The communication between bone-forming osteoblasts and bone-resorbing osteoclasts has led to novel treatment strategies aimed at inhibiting excessive bone resorption and others aimed at increasing bone formation. The most promising of the new therapies are denosumab, an antiresorptive monoclonal antibody for receptor activator of NF-κB ligand; odanacatib, a specific inhibitor of cathepsin K, the osteoclast protease responsible for the breakdown of bone collagen; and antibodies against osteocyte-expressed sclerostin and dickkopf-1, endogenous inhibitors of bone formation.
University of British Columbia, Vancouver, Canada
Rachner TD, Khosla S, Hofbauer LC. Osteoporosis: now and the future. Lancet 2011;377:127687.