The evolving role of anabolic therapy in the treatment of osteoporosis.

PURPOSE OF REVIEW: Many physicians have long considered anabolic osteoporosis medication to be the last resort for patients after multiple fractures have already occurred. Thinking is evolving toward the view that anabolic agents should be used more proactively earlier in patients who are at high risk for fracture.

RECENT FINDINGS: Recent data suggest that the three anabolic agents, teriparatide, abaloparatide and romosozumab, reduce nonvertebral and vertebral fractures faster and to a greater extent than the best antiresorptive treatments.

SUMMARY: This review will summarize the evolving role of anabolic therapy in the management of the postmenopausal woman at high risk for fracture. Pivotal clinical trial data for the three anabolic agents are overviewed and studies comparing anabolic and antiresorptive medications are described. Studies comparing treatment sequences with anabolic and antiresorptive treatments are also summarized. High-risk patients who should be considered for initial treatment with anabolic medication are defined.