Current Food and Drug Administration–approved medications in the United States for prevention or treatment of osteoporosis fall into 1 of 2 categories. The first includes antiresorptive drugs, which inhibit bone resorption, with a subsequent reduction in coupled bone formation. These drugs increase bone mineral density (BMD), but this is due largely to refilling of bone remodeling cavities and an increase in mineralization density. There is no evidence that any of these agents lead to deposition of new bone. Antiresorptive drugs include the bisphosphonates (alendronate, risedronate, ibandronate, and zolendronic acid), a selective estrogen receptor modulator (raloxifene), estrogen, calcitonin, and a monoclonal antibody against receptor activator of nuclear factor-κB ligand (denosumab). The second category includes formation-stimulating drugs, of which teriparatide is the only member.1 Teriparatide stimulates new bone formation and thus has the potential to reverse (rather than just prevent) bone loss. However, with the exceptions of generic alendronate and estrogen, all of these therapies, particularly teriparatide, are relatively expensive.
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