Therapeutic approaches to bone protection in adulthood

This chapter describes the existing pharmacological options to reduce fracture risk, documents the emerging considerations regarding their use, and describes novel therapies in development, which will further add to a comprehensive treatment armamentarium. It examines that calcium with concomitant vitamin D supplementation is supported for patients at high risk of calcium and vitamin D deficiency and for those receiving treatment for osteoporosis. Bisphosphonates are synthetic analogues of the naturally occurring compound pyrophosphate and bind strongly to hydroxyapatite, inhibiting bone resorption by inactivating osteoclasts. Denosumab, a fully human antibody to receptor activator of nuclear factor kappa B ligand (RANKL) is a newer antiresorptive agent. RANKL, secreted by osteoblasts, is a major activator of osteoclastic bone resorption. Raloxifene is a selective oestrogen receptor modulator that has antiresorptive oestrogenic effects on the skeleton without the unwanted risks of oestrogen in breast. Sclerostin, an osteocyte-derived glycoprotein that modulates bone formation by osteoblasts, is primarily regulated by mechanical loading; increased load reduces sclerostin secretion.