In recent years a number of paradigms have changed the way we go about therapy and its monitoring. So, what has changed? Bisphosphonates were until recently the cornerstone of osteoporosis treatment, but in the last few years new drugs and treatment concepts have appeared. Thus, anabolics such as teriparatide are established as the gold standard in patients with high risk of vertebral fractures. In addition, monoclonal antibodies against bone turnover regulators such as denosumab have found their place in the osteoporosis scope. Furthermore, the new drug almost on the market: romosozumab, is another monoclonal antibody, inhibitor of sclerostin, which is proving to be a potent anabolic drug in major trials. New drugs with prolonged anabolic effects are needed. But, from my point of view the main paradigm change is how to figure out all the different kinds of sequential treatment. We know now that after an anabolic agent a potent antiresorptive treatment must be started and in a concise way; a next immediate medication should be planned after denosumab and romosozumab discontinuation. The last paradigm shift is how bone turnover markers are gaining momentum in monitoring, in addition to bone mineral density and bone fracture outcomes. To conclude, with these new concepts we should be open-minded about both new therapies and monitoring strategies.
18 - 21 May 2019
European Society of Endocrinology