Anabolic Therapy in Primary Osteoporosis: What Does the Future Hold?

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Antiresorptive therapy for osteoporosis has been a mainstay during the past 50 yr. But an entirely new class of agents known as anabolic drugs has recently been introduced. These drugs “grow new bone,” reconstitute the destroyed skeletal architecture of osteoporosis, and thereby reduce the risk of new fractures. Teriparatide is the first such drug to fulfill these requirements, but other agents look promising such as growth hormone and strontium renalate. On the horizon are native and analogs of parathyroid hormone also. But these are only the beginning of a vast array of possibilities, which will arise from an understanding of the regulatory pathways of osteoblast function. This review focuses on old and new agents, which are prospects for bone growth based on in vivo data from human or other animal studies. It covers drugs that are in use, or nearly so, and discusses a variety of potential target sites for future drug development.