ADVANCES IN OSTEOPOROSIS MANAGEMENT: PATHOPHYSIOLOGY, THERAPEUTIC STRATEGIES, AND EMERGING MOLECULAR TARGETS

Nikhil Prajapati*, Garima Awasthi

ABSTRACT

Osteoporosis is a common metabolic bone disorder characterized by reduced bone mass and deterioration of bone microarchitecture, resulting in increased fracture risk. It predominantly affects postmenopausal women and the elderly and represents a major global health burden. The condition is classified into primary and secondary forms, depending on etiology. The pathogenesis of osteoporosis is closely associated with an imbalance in bone remodeling, where osteoclast mediated bone resorption exceeds osteoblast driven bone formation. Management of osteoporosis involves both non-pharmacological and pharmacological strategies. Lifestyle modifications, including regular exercise, adequate calcium and vitamin D intake, and avoidance of smoking and alcohol, play a crucial preventive role. Pharmacological treatments are broadly categorized into antiresorptive agents, such as bisphosphonates, selective estrogen receptor modulators, calcitonin, and denosumab, and anabolic agents like parathyroid hormone analogues. Although these therapies effectively reduce fracture risk, their long-term use is associated with limitations, including adverse effects and safety concerns. Recent research has focused on the development of novel therapeutic agents targeting specific molecular pathways, including sclerostin inhibition, Wnt/β-catenin signaling, and inflammatory mediators. These emerging therapies offer promising alternatives; however, further studies are required to establish their long-term efficacy and safety.

Keywords: Osteoporosis, Bone remodeling, Antiresorptive agents, Anabolic therapy, Wnt/?-catenin pathway, Romosozumab, Bone mineral density.